Lena Dahlberg
Högskolan Dalarna, School of Education, Health and Social Studies, Department Member
- Karolinska Institutet, Aging Research Center, Department Memberadd
An inclusive neighbourhood is a key facilitator enabling older adults to age in place. Neighbourhoods have been identified as a dimension of social exclusion important to older adults, and it has been argued that older adults are... more
An inclusive neighbourhood is a key facilitator enabling older adults to age in place. Neighbourhoods have been identified as a dimension of social exclusion important to older adults, and it has been argued that older adults are particularly vulnerable to neighbourhood change. The aim of this study was to explore older adults' experiences of neighbourhood exclusion within the context of neighbourhood change. Focus groups were undertaken in the urban and rural areas of a metropolitan borough in England involving a total of 41 older adults, with data analysed via thematic analysis. Urban areas in the borough studied have transformed following the closure of the mining industry, with a high level of deprivation in many areas, while some rural areas have undergone gentrifica-tion. Within the context of structural neighbourhood change, four themes were identified: community cohesion, political agency, feelings of safety and the physical environment. The themes were interlinked, which calls for collaboration across traditional lines of professional responsibility, and for research that encompasses different aspects of neighbourhood exclusion. This study contributes with knowledge on older adults' experiences of exclusion, including novel findings on the importance of political agency and collective memory, and identifies actions to combat exclusion. An active involvement of older adults in the development of initiatives to tackle social exclusion is recommended.
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Background: Today’s older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people’s drinking, but the association is complex. This study investigates... more
Background: Today’s older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people’s drinking, but the association is complex. This study investigates both high and low levels of social integration and their associations with longitudinal patterns of alcohol consumption among older women and men.
Methods: Longitudinal nationally representative data of older Swedish women and men aged over 65 – the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) – from 2010/2011 and 2014 (n=1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses.
Results: Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.
Conclusions: Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.
Methods: Longitudinal nationally representative data of older Swedish women and men aged over 65 – the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) – from 2010/2011 and 2014 (n=1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses.
Results: Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.
Conclusions: Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.
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Background: Social exclusion (SE) is a process that limits participation in society across life domains, and is associated with poor quality of life. Neighbourhood exclusion has been identified as particularly important for older adults.... more
Background: Social exclusion (SE) is a process that limits participation in society across life domains, and is associated with poor quality of life. Neighbourhood exclusion has been identified as particularly important for older adults. This paper examines the association between SE and well-being in older adults from urban and rural areas, focusing on neighbourhood exclusion. Methods: Using a cross-sectional survey design with a stratified sampling frame, participants (aged 65+) from rural (n = 628) and urban (n = 627) areas of Barnsley, United Kingdom, completed a questionnaire containing indicators of five SE domains: civic activity, material resources, social relationships, services and neighbourhood. Sequential multiple regression models were developed for 1) total sample; 2) rural areas; and 3) urban areas, with well-being regressed on SE indicators after controlling for self-reported health. Results: SE indicators explained 13.4% of the variance in well-being in the total sample (of which neighbourhood exclusion explained 1.2%); corresponding figures for the rural model were 13.8% (3.8%) and for the urban model 18.0% (1.7%); the addition of neighbourhood exclusion significantly improved all three models. Five SE indicators were significant in the rural model, compared with seven in the urban model, with four common to both. Discussion: Neighbourhood exclusion explained more variance in well-being in rural than urban areas, whereas exclusion from services explained more variance in urban than rural areas. Area characteristics and the role of neighbourhood should be considered in policy initiatives to reduce SE and promote well-being.
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Background: Age increases the risk of emergency department [ED] visits. Health related quality of life (HRQoL) is often estimated as an outcome of ED visits, but it can be a risk factor of ED visits. This study aims to assess the... more
Background: Age increases the risk of emergency department [ED] visits. Health related quality of life (HRQoL) is often estimated as an outcome of ED visits, but it can be a risk factor of ED visits. This study aims to assess the association of HRQoL with time to first ED visit and/or frequent ED use in older adults during four-year period and if this association differs in 66–80 and 80+ age groups.
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Dahlberg, L., Agahi, N., Schön, P., & Lennartsson, C. (2018). Planned and unplanned hospital admissions and their relationship with social factors: Findings from a national, prospective study of people aged 76 years or older. Health Services Research, 53(6): 4248-4267. DOI: 10.1111/1475-6773.13001.more
Objective. To examine the relationship between social factors and planned and unplanned hospital admissions among older people. Data Sources/Study Setting. 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old... more
Objective. To examine the relationship between social factors and planned and unplanned hospital admissions among older people. Data Sources/Study Setting. 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012. Study Design. The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociode-mographic and ability factors, health factors). Data Collection. Data were collected via interviews with people aged 76+ (n = 931). Principal Findings. Living in institutions was negatively associated with planned admissions (hazard ratio (HR): 0.29; confidence interval (CI): 0.09–0.88), while being in receipt of home help was positively associated with unplanned admissions (HR: 1.57; CI: 1.15–2.14). Low levels of social contacts and social activity predicted unplanned admissions in bivariate analyses only. Higher ability to deal with public authorities was positively associated with planned admissions (HR: 1.77; CI: 1.13–2.78) and negatively associated with unplanned admissions, although the latter association was only significant in the bivariate analysis. Conclusions. Hospital admissions are not only due to health problems but are also influenced by the social care situation and by the ability to deal with public authorities.
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To live with feelings of loneliness has negative implications for quality of life, health and survival. This study aimed to examine changes in loneliness among older people, both with regard to prevalence rates, and socio-demographic,... more
To live with feelings of loneliness has negative implications for quality of life, health and survival. This study aimed to examine changes in loneliness among older people, both with regard to prevalence rates, and socio-demographic, social and health-related correlates of loneliness. This study had a repeated cross-sectional design and was based on the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Analyses of trends in loneliness covered the years 1992, 2002, 2004, 2011 and 2014, and included people aged 77 years or older (n = 2 572). Analyses of correlates of loneliness covered 2004 and 2014, and included people aged 70 years or older (n = 1 962). Logistic regression analyses were conducted with findings presented as average marginal effects. Contrary to what is often assumed, there has been no increase in loneliness among older people over time (1992–2014). Regression analyses for 2004 and 2014 showed that social and health-related correlates were more strongly associated with loneliness than socio-demographic correlates. Psychological distress was most strongly associated with loneliness, followed by widowhood. Most associations between the correlates and loneliness were stable over time.
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Sweden is seen as a typical example of a social-democratic welfare regime, with universal and generous welfare policies. However, in the last decades, there have been substantial reductions in the Swedish provision of care for older... more
Sweden is seen as a typical example of a social-democratic welfare regime, with universal and generous welfare policies. However, in the last decades, there have been substantial reductions in the Swedish provision of care for older people. This study aimed to examine trends in sources of care-receipt in older people (77+) living in their own home and with a perceived need of help with two specific tasks: house cleaning or food shopping. Trends in care-receipt were examined in relation to gender, living alone, having children and socioeconomic position. Data from the 1992, 2002 and 2011 data collection waves of the national study SWEOLD was used. Response rates varied between 86 and 95 per cent, and the sample represents the population well. Trends and differences between groups were explored in bivariate and logistic regression analyses. There was a reduction in formal care-receipt regarding house cleaning and food shopping over the study period. It was more common for women than men to receive formal care, and more common for men than women to receive informal care. Reductions in formal care have affected older women more than older men. Still, living alone was the most influential factor in care-receipt, associated with a greater likelihood of formal care-receipt and a lower likelihood of informal care-receipt. It can be concluded that public responsibility for care is becoming more narrowly defined in Sweden, and that more responsibility for care is placed on persons in need of care and their families.
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Objectives: The understanding of social phenomena is enhanced if individuals can be studied over longer periods. Regarding loneliness in old age, there is a general lack of longitudinal research. The aim of this study was to examine... more
Objectives: The understanding of social phenomena is enhanced if individuals can be studied over longer periods. Regarding loneliness in old age, there is a general lack of longitudinal research. The aim of this study was to examine whether there is an association between loneliness in old age and social engagement 20 years earlier, as stated by life course theory and the convoy model.
Method: Data from the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (2002 and 2011 data collection waves) and the Swedish Level of Living Survey (1981 and 1991 data collection waves) were used. The sample included 823 individuals with an average age of 62.2 years at baseline and 82.4 years at follow-up.
Results: Each form of social engagement in old age was significantly associated with the same form of social engagement 20 years earlier. Close forms of social engagement were associated with loneliness in old age; as were more distant forms of social engagement, but only when they were considered solely in old age.
Conclusion: Patterns of social engagement in old age were established at least 20 years earlier and close forms of social engagement are long-term predictors of loneliness, although current social engagement tended to be more influential on loneliness. The study underlines the importance of interventions targeted at close relationships that can provide social support in old age.
Method: Data from the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (2002 and 2011 data collection waves) and the Swedish Level of Living Survey (1981 and 1991 data collection waves) were used. The sample included 823 individuals with an average age of 62.2 years at baseline and 82.4 years at follow-up.
Results: Each form of social engagement in old age was significantly associated with the same form of social engagement 20 years earlier. Close forms of social engagement were associated with loneliness in old age; as were more distant forms of social engagement, but only when they were considered solely in old age.
Conclusion: Patterns of social engagement in old age were established at least 20 years earlier and close forms of social engagement are long-term predictors of loneliness, although current social engagement tended to be more influential on loneliness. The study underlines the importance of interventions targeted at close relationships that can provide social support in old age.
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The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with... more
The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services in the north of England: a geriatrician-led hospital outpatient clinic (n=18), a community based nurse-led service (n=22) and a consultant gynaecologist-led service specialising in surgical treatment (n=10). Participants took part in semi-structured interviews, which were transcribed and underwent thematic content analysis. Three main themes emerged: Being brushed aside, in which participants expressed the feeling that general practitioners did not prioritise or recognise their concerns; Putting up with it, in which participants delayed seeking help for their UI due to various reasons including embarrassment, the development of coping mechanisms, perceiving UI as a normal part of the ageing process, or being unaware that help was available; and Something has to be done, in which help-seeking was prompted by the recognition that their UI was a serious problem, whether as a result of experiencing UI in public, the remark of a relative, the belief that they had a serious illness, or the detection of UI during comprehensive geriatric assessment.
Greater awareness that UI is a treatable condition and not a normal part of ageing is needed in the population and amongst health professionals. Comprehensive geriatric assessment appeared an important trigger for referral and treatment in our participants. Screening questions by health care professionals could be a means to identify, assess and treat older people with UI.
Greater awareness that UI is a treatable condition and not a normal part of ageing is needed in the population and amongst health professionals. Comprehensive geriatric assessment appeared an important trigger for referral and treatment in our participants. Screening questions by health care professionals could be a means to identify, assess and treat older people with UI.
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There is a lack of research on the everyday lives of older people ín developing countries. This exploratory study used structured observation and content analysis to examine the presence of older people in public fora and considered the... more
There is a lack of research on the everyday lives of older people ín developing countries. This exploratory study used structured observation and content analysis to examine the presence of older people in public fora and considered the methods’ potential for understanding older people’s social integration and inclusion. Structured observation occurred of public social spaces in six cities each located in a different developing country and in one city in the United Kingdom, together with content analysis of the presence of people in newspaper pictures and on television in the selected countries. Results indicated that across all fieldwork sites and data sources, there was a low presence of older people, with women considerably less present thanmen in developing countries. There was variation across fieldwork sites in older people’s presence by place and time of day and in their accompanied status. The
presence of older people in images drawn from newspapers was associated with the news/non-news nature of the source.The utility of the study’s methodological approach is considered, as is the degree to which the presence of older people in public fora might relate to social integration and inclusion in different cultural contexts.
presence of older people in images drawn from newspapers was associated with the news/non-news nature of the source.The utility of the study’s methodological approach is considered, as is the degree to which the presence of older people in public fora might relate to social integration and inclusion in different cultural contexts.
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Few studies have explored older people’s expected future quality of life (QoL), despite evidence that perceptions of one’s future influence healthy ageing. Research on this topic should embrace a range of potential influences, including... more
Few studies have explored older people’s expected future quality of life (QoL), despite evidence that perceptions of one’s future influence healthy ageing. Research on this topic should embrace a range of potential influences, including perceptions of one’s neighbourhood and region. This study examined expected QoL in a random sample of the population of Dalarna, a Swedish region. A self-completion questionnaire assessed demographic characteristics, current neighbourhood and regional evaluations, self-evaluations, expectations for the future, and current and expected QoL. In total, 786 people aged ≥ 65 years participated. A sequential multiple regression model explained 44% of the variance in older people’s expected QoL, with self-reported health (sr2=.03), Expected Regional Opportunity (sr2=.03), and Perceived Regional Status (sr2=.02) having the strongest associations with expected QoL. Research on the importance of one’s neighbourhood to QoL in older people should encompass people’s perceptions of their region, to better inform social policy for healthy ageing.
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""Objectives: Loneliness is an important influence on quality of life in old age and has been conceptualised as consisting of two dimensions, social and emotional. This article describes analyses that sought to produce models of social... more
""Objectives: Loneliness is an important influence on quality of life in old age and has been conceptualised as consisting of two dimensions, social and emotional. This article describes analyses that sought to produce models of social and emotional loneliness in older people, using demographic, psychological and health, and social variables.
Method: Older people (aged 65þ, n ¼ 1255) from the Barnsley metropolitan area of the United Kingdom were recruited
randomly from within a stratified sampling frame and received a questionnaire-based interview (response rate: 68.1%). The questionnaire contained items and scales on demographic, psychological and health, and social characteristics, and a
validated measure of loneliness that assesses both social and emotional loneliness.
Results: Of the respondents, 7.7% were found to be severely or very severely lonely, while another 38.3% were moderately lonely. Social and emotional loneliness shared 19.36% variance. Being male, being widowed, low well-being, low selfesteem, low-income comfort, low contact with family, low contact with friends, low activity, low perceived community integration, and receipt of community care were significant predictors of social loneliness (R ¼ 0.50, R2 ¼ 0.25, F(18, 979) ¼ 18.17, p < 0.001). Being widowed, low well-being, low self-esteem, high activity restriction, low-income comfort, and non-receipt of informal care were significant predictors of emotional loneliness (R ¼ 0.55, R2 ¼ 0.30, F (18, 973) ¼ 23.00, p < 0.001).
Conclusion: This study provides further empirical support for the conceptual separation of emotional and social loneliness.
Consequently, policy on loneliness in older people should be directed to developing a range of divergent intervention strategies if both emotional and social loneliness are to be reduced.""
Method: Older people (aged 65þ, n ¼ 1255) from the Barnsley metropolitan area of the United Kingdom were recruited
randomly from within a stratified sampling frame and received a questionnaire-based interview (response rate: 68.1%). The questionnaire contained items and scales on demographic, psychological and health, and social characteristics, and a
validated measure of loneliness that assesses both social and emotional loneliness.
Results: Of the respondents, 7.7% were found to be severely or very severely lonely, while another 38.3% were moderately lonely. Social and emotional loneliness shared 19.36% variance. Being male, being widowed, low well-being, low selfesteem, low-income comfort, low contact with family, low contact with friends, low activity, low perceived community integration, and receipt of community care were significant predictors of social loneliness (R ¼ 0.50, R2 ¼ 0.25, F(18, 979) ¼ 18.17, p < 0.001). Being widowed, low well-being, low self-esteem, high activity restriction, low-income comfort, and non-receipt of informal care were significant predictors of emotional loneliness (R ¼ 0.55, R2 ¼ 0.30, F (18, 973) ¼ 23.00, p < 0.001).
Conclusion: This study provides further empirical support for the conceptual separation of emotional and social loneliness.
Consequently, policy on loneliness in older people should be directed to developing a range of divergent intervention strategies if both emotional and social loneliness are to be reduced.""
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"""Objective: To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a... more
"""Objective: To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI).
Design: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services.
Setting: 3 acute and 13 primary care National Health Service Trusts in England.
Participants: 16 continence service leads in England actively treating and managing older people with UI.
Results: In terms of barriers to a good-quality service, participants highlighted a failure on the part of
commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging
the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were
identified as important steps for a good-quality service for older people with UI. More rapid and appropriate
patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high quality continence service. There is a need, however, to
consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work.
Conclusions: Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.
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Design: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services.
Setting: 3 acute and 13 primary care National Health Service Trusts in England.
Participants: 16 continence service leads in England actively treating and managing older people with UI.
Results: In terms of barriers to a good-quality service, participants highlighted a failure on the part of
commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging
the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were
identified as important steps for a good-quality service for older people with UI. More rapid and appropriate
patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high quality continence service. There is a need, however, to
consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work.
Conclusions: Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.
"""
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This paper identifies variations in the age and gender characteristics of informal carers in the UK. The paper is based on the Individual Sample of Anonymous Records, a 3% random sample of the 2001 UK Census. The sample size was 1... more
This paper identifies variations in the age and gender characteristics of informal carers in the UK. The paper is based on the Individual Sample of Anonymous Records, a 3% random sample of the 2001 UK Census. The sample size was 1 825 595. Of this sample, 10% were reported to be carers. The analysis shows that informal caregiving is systematically linked with both age and gender. Caregiving increased with age until reaching a peak in the 45–59 age group, in which almost 20% were carers. Similarly, the amount of time spent caregiving increased with age, with the highest levels of caregiving commitment in people aged 80–89 years. Regarding gender, 11.3% of women were carers compared to 8.6% of men and overall women committed more time to caregiving than men. However, this pattern was reversed in later life (70+), where there was a higher proportion of carers and greater time commitment to caregiving amongst men. While the predominance of women as informal carers has been well reported, the importance of men as informal carers in old age is much less commented upon. This study thus suggests that informal caregiving is most prevalent in groups of the population that, according to previous research, may experience most strain from doing so: elderly people who may be frail and often are in a spousal relationship with the care-recipient, and middle-aged women with multiple roles. Therefore, it is of great importance that their particular needs and circumstances are fully taken into account both in the development of formal support and when information about available support is targeted.
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Previous research has shown that different providers of social welfare tend to provide complementary services at a local level, but that there is no complete task specialisation. This means that elements of complementarity theory are... more
Previous research has shown that different providers of social welfare tend to provide complementary services at a local level, but that there is no complete task specialisation. This means that elements of complementarity theory are challenged, especially the so-called ‘principle of matching’, i.e. that actors only undertake tasks which match their characteristics. The aim of the present study was to explore complementarity between Swedish local authorities and voluntary organisations in their support for relatives of older people. Interviews were carried out with 55 politicians, civil servants and representatives of voluntary organisations drawn from four municipalities. These municipalities were selected from a sampling frame that ensured representation of different combinations of high and low levels of voluntary and statutory services. Qualitative analysis of interview transcripts showed that, while local authorities are seen as responsible for the support for relatives, voluntary organisations are expected to be complementary, offering ‘the icing on the cake’, i.e. social support and activities which are regarded as less demanding. Overall, substantial support for a norm of complementarity was found. It is argued that, if those who are active in social policy and voluntary work at a local level agree with the ideal of complementarity, this will influence their wish to arrange activities and services. Therefore, the complementarity norm – rather than the principle of matching – influences the outcome in terms of service provision.
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Many welfare states have met with criticism and it has been argued that they are in crisis. Simultaneously, there has been a greater openness to voluntary work as an alternative to statutory services, for example in Sweden. Sometimes the... more
Many welfare states have met with criticism and it has been argued that they are in crisis. Simultaneously, there has been a greater openness to voluntary work as an alternative to statutory services, for example in Sweden. Sometimes the activities of voluntary organizations have been seen as complementary to those of local authorities; at other times this issue has been addressed in terms of welfare pluralism. However, countries with strong welfare states have often been assumed to have insignificant voluntary work—as claimed in substitution theory. The purpose of this article is to examine variation in welfare service provision in the light of welfare pluralism, substitution theory and complementarity theory. The study was carried out in the area of support for relatives of older people in Sweden. It was conducted by means of national questionnaire surveys of voluntary organizations and local authorities in 1999 and 2002. In this period, there was an increase in statutory service provision and more voluntary organizations were involved in service provision. However, it is yet too early to describe this in terms of welfare pluralism. Neither was any evidence found for substitution theory. Furthermore, overlaps in service provision from voluntary organizations and local authorities question complementarity theory, which assumes that different actors specialize in different tasks. Nevertheless, the actors tended to be complementary at a local level. It is suggested that this complementarity might be explained by ideological support for a norm of complementarity.
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This study investigates the relationship between statutory and voluntary activity in the field of support to family carers of older people in Sweden. The relationship is considered in regard to substitution theory. A survey was conducted... more
This study investigates the relationship between statutory and voluntary activity in the field of support to family carers of older people in Sweden. The relationship is considered in regard to substitution theory. A survey was conducted compris-ing 80 local authorities and 358 ...
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We examined determinants of carer strain in a random sample of 170 relative of dependent elderly persons in Sweden aged 80 years or more. These persons were interviewed at home by means of the Sickness Impact Profile (SIP). Carer strain... more
We examined determinants of carer strain in a random sample of 170 relative of dependent elderly persons in Sweden aged 80 years or more. These persons were interviewed at home by means of the Sickness Impact Profile (SIP). Carer strain was assessed in interviews with carers who bore the main responsibility for care of an elderly relative. The response rate was 92%. Multiple logistic regression showed that cohabitation of carer and recipient was the sociodemographic variable most significantly associated with various stress factors and consequences or manifestations of stress; strain connected with ADL assistance given to the elderly person, strain arising from the elderly person&#39;s uncooperative or recalcitrant attitude or behaviour, worsening of the elderly-carer relationship, and encroachment on the carer&#39;s social life. Correlations between strain and various categories of physical and mental impairment were much lower, and in some respects were even negative. We conclude that support programs for relatives caring for dependent elderly persons should aim primarily at creating continuous relief for the carers and improving their opportunities for contact with other people generally.
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This book is a starter 'DIY' text for practitioners who are looking to conduct evaluation studies and research as part of their own professional practice. The growing emphasis on evidence-based practice means that there is an... more
This book is a starter 'DIY' text for practitioners who are looking to conduct evaluation studies and research as part of their own professional practice.
The growing emphasis on evidence-based practice means that there is an increasing need for practitioners to have at least a basic understanding of research, be aware of methodological pitfalls and to be updated on new methods. This book provides a practical, user-friendly guide to social science research methods for professionals who have benefited from little, if any, formal research methods training but find themselves in a role that requires them to read and understand complex research findings and carry out their own research as part of their professional practice.
Practical Research and Evaluation is aimed at practitioners working in education, health, social care and community work. Many in this market are non-graduates or are those whose study did not contain a research element, but are required to know how research works. This book has three main aims which will benefit this audience - to enable readers to carry out small-scale research projects of their own, provide them with the basic understanding necessary to commission research, and enable them to better understand and evaluate critically research reports.
This book is designed specifically for 'Do-it-Yourself' researchers working in the public or voluntary sectors. It is accessible and relevant to practitioners, uses non-technical language wherever possible and employs grounded examples, practical tips, checklists and readings lists throughout.
The growing emphasis on evidence-based practice means that there is an increasing need for practitioners to have at least a basic understanding of research, be aware of methodological pitfalls and to be updated on new methods. This book provides a practical, user-friendly guide to social science research methods for professionals who have benefited from little, if any, formal research methods training but find themselves in a role that requires them to read and understand complex research findings and carry out their own research as part of their professional practice.
Practical Research and Evaluation is aimed at practitioners working in education, health, social care and community work. Many in this market are non-graduates or are those whose study did not contain a research element, but are required to know how research works. This book has three main aims which will benefit this audience - to enable readers to carry out small-scale research projects of their own, provide them with the basic understanding necessary to commission research, and enable them to better understand and evaluate critically research reports.
This book is designed specifically for 'Do-it-Yourself' researchers working in the public or voluntary sectors. It is accessible and relevant to practitioners, uses non-technical language wherever possible and employs grounded examples, practical tips, checklists and readings lists throughout.
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Research Interests: Gerontology and Community
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The association between social exclusion and well-being in older adults from rural and urban areas
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Sweden’s changing welfare mix over two decades : Trends in care for community-based older people with perceived need
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Few studies have explored older people’s expected future quality of life (QoL), despite evidence that perceptions of one’s future influence healthy aging. Research on this topic should embrace a range of potential influences, including... more
Few studies have explored older people’s expected future quality of life (QoL), despite evidence that perceptions of one’s future influence healthy aging. Research on this topic should embrace a range of potential influences, including perceptions of one’s neighborhood and region. This study examined expected QoL in a random sample of the population of Dalarna, a Swedish region. A self-completion questionnaire assessed demographic characteristics, current neighborhood and regional evaluations, self-evaluations, expectations for the future, and current and expected QoL. In total, 786 people aged ≥65 years participated. A sequential multiple regression model explained 44% of the variance in older people’s expected QoL, with self-reported health ( sr2 = .03), Expected Regional Opportunity ( sr2 = .03), and Perceived Regional Status ( sr2 = .02) having the strongest associations with expected QoL. Research on the importance of one’s neighborhood to QoL in older people should encompass people’s perceptions of their region, to better inform social policy for healthy aging.
Research Interests: Psychology, Cognitive Science, Perception, Gerontology, Aging, and 15 moreQuality of life, Medicine, Humans, Older people, Female, Male, Regression Analysis, Health Status, Clinical Sciences, Aged, Geriatric Assessment, Self report, attitude to health, Rural Population, and Residence Characteristics
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Intergenerational family care provided to older parents by adult children is growing and differs based on gender and socioeconomic status. Few studies consider these elements in relation to both the parent and their adult child, and... more
Intergenerational family care provided to older parents by adult children is growing and differs based on gender and socioeconomic status. Few studies consider these elements in relation to both the parent and their adult child, and little is known about the number of care tasks received even though those providing intensive levels of care are at risk of experiencing adverse consequences in their lives. This study uses data from the nationally representative 2011 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and includes child-specific information from parents aged 76 years and above. Analyses used ordinal logistic regression and are presented as average marginal effects and predictive margins. Results show that parents in need of care report that one-third of all adult children in the sample provide care to three out of five of them. The care is most often non-intensive, yet nearly one in ten of all children provide more intensive care of two or more tasks. Wh...
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ObjectivesTo examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors.DesignA register-based prospective cohort study.SettingSwedish region... more
ObjectivesTo examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors.DesignA register-based prospective cohort study.SettingSwedish region of Dalarna.ParticipantsParticipants were 16 543 community-living adults aged 80 or older who were residents of the Dalarna region of Sweden, excluding older adults who moved out of Dalarna or into residential care during the study period.Outcome measuresDependent variables were initial ED visit, and at least one ED revisit within 30 days of an initial ED visit.ResultsApproximately 36% of the participants visited the ED during the study period with 18.9% returning to the ED within 30 days. For both initial ED visits and ED revisits, the addition of contextual factors to models containing individual factors significantly improved model fit (p<0.001; p<0.022) and the amount of variance explained in the outcome. In the final models, initial ED vi...
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The care of older people and the underpinning values of care of older people in a recent government report on dignity in care. Care of older people should be based on six aspects of dignity which i ...
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Rapporten presenterar oversikter av tidigare forskning och analyser av kanslan av ensamhet bland aldre personer. Overlag finns det kunskap om ensamhetens konsekvenser for ohalsa, men det behovs ytt ...
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Background Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT... more
Background Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life. Method Semi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis. Results A main category “Support by significant others is always part of daily time management”, and three categories “Facing new challenges”, “Using strategies to han...
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IntroductionPersons with dementia experience time‐related problems, but there is a lack of instruments evaluating their time processing ability and daily time management. This study aimed to evaluate the psychometric properties of the... more
IntroductionPersons with dementia experience time‐related problems, but there is a lack of instruments evaluating their time processing ability and daily time management. This study aimed to evaluate the psychometric properties of the instruments KaTid®‐Senior measuring time processing ability, and Time‐S© Senior and Time‐Proxy© measuring daily time management for persons with dementia.MethodsPersons with dementia (n = 53) and their significant others (n = 49) participated in the study. Rasch analyses were used to evaluate the instruments' rating scale functioning; internal scale validity; person‐response validity; unidimensionality; person‐separation reliability; and internal consistency. Versions excluding items with poor fit to the Rasch model were also evaluated.ResultsOverall, the Rasch analyses showed acceptable psychometric properties. All instruments met the criteria for unidimensionality and the reliability was good. More challenging items should be added in KaTid‐Senio...
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Research Interests: Sociology, Psychology, Gerontology, Medicine, Home Care, and 13 moreSoc, Elderly, Loneliness, Psychological Intervention, Social distance, Social Isolation, Sociologi, Pandemic, Psychology and Cognitive Sciences, CoVid, coronavirus outbreak, Coronavirus Disease 2019 (COVID-19), and Medical and Health Sciences
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Background: Social exclusion is a framework for understanding the complexity of disadvantage across various domains of life such as material resources, social relations, civic activities and servic ...
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Background: Social exclusion (SE) is a framework for understanding how social factors - often neglected in health psychology research - influence individual well-being and health. This paper describes a study on the association between SE... more
Background: Social exclusion (SE) is a framework for understanding how social factors - often neglected in health psychology research - influence individual well-being and health. This paper describes a study on the association between SE and well-being in urban and rural communities. Methods: The study had a cross-sectional survey design with a stratified sampling frame. Participants (≥65 years old, N=1255) were recruited from rural (n=628) and urban (n=627) metropolitan areas of Barnsley, U.K. and completed a questionnaire measuring indicators of four SE domains: civic activity, material resources, social relationships and services; plus an additional domain, neighbourhood, regarded as of particular importance for older adults. Hierarchical linear regression models were developed for 1) total sample; 2) rural areas; and 3) urban areas, in which well-being was regressed on SE indicators after controlling for self-reported health. Findings: SE indicators accounted for 12.1% of the variance in well-being in the total sample (neighbourhood 2.3%); the corresponding figures for the rural model were 13.3% (4.3%) and for the urban model 17% (2.1%); all models and model increments p<.05. Four SE indicators were significant in the rural model, compared with six in the urban model, with only two common to both. Discussion: After controlling for self-reported health, SE indicators explained significant variance in well-being. Of the SE domains, neighbourhood exclusion explained more variance in well-being in rural areas compared to urban, whereas exclusion from services explained more variance in urban than rural areas. This suggests that SE processes operate differently in urban and rural communities.
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It is important to identify factors associated with loneliness in older people if effective policies and strategies to prevent and reduce loneliness are to be developed. In this presentation two studies that identify factors associated... more
It is important to identify factors associated with loneliness in older people if effective policies and strategies to prevent and reduce loneliness are to be developed. In this presentation two studies that identify factors associated with loneliness in old age are reported. Strengths and weaknesses of the studies, which differ in design and focus, shed light on issues of importance for future studies on loneliness.The first study was based on data from two waves of SWEOLD, a Swedish longitudinal national survey study (N=613). It aimed to examine the extent to which older people (70+) report feelings of loneliness with a focus on changes in loneliness over time, and on factors predicting loneliness in women and men, respectively. This study showed that older people moved in and out of loneliness over time, but there was a general increase in loneliness as they aged. It also identified gender differences in both incidence and risk factors.The second study was based on data from the Barnsley Social Exclusion in Old Age Study, an English cross-sectional community survey (N=1255), and aimed to identify risk factors for social and emotional loneliness in older people (65+). This study identified different, as well as shared, risk factors for social and emotional loneliness, thereby providing further empirical support for the conceptual separation of emotional and social loneliness.Taken together, these studies demonstrate the importance of: 1) longitudinal research in order to determine risk factors for loneliness; 2) considering women and men separately; and 3) looking at social and emotional loneliness separately. These approaches in combination will aid the development of effective interventions to reduce loneliness in the older population and to ensure those interventions are targeted at the appropriate groups.
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Several factors associated with loneliness are also considered indicators of social exclusion. While loneliness has been proposed as an outcome of social exclusion, there is limited empirical evidence of a link. This study examines the... more
Several factors associated with loneliness are also considered indicators of social exclusion. While loneliness has been proposed as an outcome of social exclusion, there is limited empirical evidence of a link. This study examines the associations between social exclusion indicators and loneliness in older adults (60+ years) in four Nordic countries. Data from four waves of the European Social Survey were pooled, providing a total of 7755 respondents (Denmark n = 1647; Finland n = 2501, Norway n = 1540; Sweden n = 2067). Measures of loneliness, demographic characteristics, health, and eight indicators of social exclusion were selected from the survey for analysis. Country-specific and total sample hierarchical logistic regression models of loneliness were developed. Significant model improvement occurred for all models after social exclusion indicators were added to models containing only demographic and health variables. Country models explained between 15.1 (Finland) and 21.5% (S...
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This study investigated associations between time processing ability (TPA), daily time management (DTM), and dementia severity. Persons with dementia (PwDs) (n = 53) and their significant others (n = 49) participated in this... more
This study investigated associations between time processing ability (TPA), daily time management (DTM), and dementia severity. Persons with dementia (PwDs) (n = 53) and their significant others (n = 49) participated in this cross-sectional study. Bivariate analyses were used to investigate associations between TPA and DTM and the dementia severity. Linear regression models were used to further predict the contribution of the subtests in the Mini Mental State Examination (MMSE) for TPA results. The results showed significant correlations between TPA and dementia severity, where visuospatial functions were the most highly correlated. TPA also showed a significant correlation to proxy-rated DTM. In addition, proxy-rated DTM was significantly correlated with dementia severity and PwDs’ own self-ratings of their DTM. Knowledge of the association between TPA, dementia severity, and visuospatial functions can enable early detection of TPA impairments. For a comprehensive assessment of TPA...
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As welfare providers struggle to meet the care needs of persons with dementia (PwDs), most of their needs are being met by a family carers, most often a spouse. The situation for spouse carers is unique, e.g., with grief, loneliness and... more
As welfare providers struggle to meet the care needs of persons with dementia (PwDs), most of their needs are being met by a family carers, most often a spouse. The situation for spouse carers is unique, e.g., with grief, loneliness and loss of intimacy combining with stress and poor health. Research is needed to develop adequate support for spouse carers based on evidence of what influences negative and positive outcomes of care. The present study investigated psychosocial correlates of spouse carers’ (i) negative impact and (ii) positive value of caring. Data from a cross-sectional survey of 165 spouse carers community-resident in Sweden was analysed in two hierarchical regression models to predict negative impact and positive value of caring. Results found that negative impact and positive value were explained by different variables, significant predictors for negative impact included carer stress, health, and emotional loneliness, and change in intimacy with the care-recipient, ...
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The core concepts of CAIn the theoretical framework of CA, well-being is constituted by a person’s unique way of functioning and capabilities. This means that a person's well-being is personal and ...
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Little is known about the values that older people consider important in receipt of home help. Therefore, this study aimed to explore which values older people hold in relation to home help service ...
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Background: Social exclusion (SE) is a framework for understanding how social factors - often neglected in health psychology research - influence individual well-being and health. This paper describes a study on the association between SE... more
Background: Social exclusion (SE) is a framework for understanding how social factors - often neglected in health psychology research - influence individual well-being and health. This paper describes a study on the association between SE and well-being in urban and rural communities. Methods: The study had a cross-sectional survey design with a stratified sampling frame. Participants (≥65 years old, N=1255) were recruited from rural (n=628) and urban (n=627) metropolitan areas of Barnsley, U.K. and completed a questionnaire measuring indicators of four SE domains: civic activity, material resources, social relationships and services; plus an additional domain, neighbourhood, regarded as of particular importance for older adults. Hierarchical linear regression models were developed for 1) total sample; 2) rural areas; and 3) urban areas, in which well-being was regressed on SE indicators after controlling for self-reported health. Findings: SE indicators accounted for 12.1% of the v...
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Research Interests: Medicine and Risk Factor
IntroductionInformal (unpaid) caregivers play an essential role in caring for older people, whose care needs are often not fully met by formal services. While providing informal care may be a positive experience, it can also exert a... more
IntroductionInformal (unpaid) caregivers play an essential role in caring for older people, whose care needs are often not fully met by formal services. While providing informal care may be a positive experience, it can also exert a considerable strain on caregivers’ physical and mental health. How to best support the needs of informal caregivers remains largely debated. This umbrella review (review of systematic reviews) aims to evaluate (1) whether effective interventions can mitigate the negative health outcomes of informal caregiving, (2) whether certain types of interventions are more effective than others, (3) whether effectiveness of interventions depends on caregiver/receiver, context or implementation characteristics and (4) how these interventions are perceived in terms of acceptability, feasibility and added value.Methods and analysisWe will include systematic reviews of primary studies focusing on the effectiveness of interventions (public or private, unifaceted or multi...