Recommendations for healthy aging as documented by health professionals: a summative content analysis of health records

AIM

To identify what type of recommendations were recorded in older adults' health records by health professionals during preventive home visits.

BACKGROUND

To promote health and prevent ill health, health professionals can give support and recommendations to older adults. The preventive home visit for older adults is one example of an intervention where health professionals such as nurses, social workers, and assistant nurses can give recommendations. By exploring what recommendations are recorded and within what areas, we can also gain knowledge about areas where provision of recommendations seems lacking. This knowledge would provide health professionals with guidance in their counseling with the older adult.

METHODS

Records from preventive home visits (n = 596; mean age 78.71) were qualitatively and quantitatively analyzed.

FINDINGS

The most frequently recorded recommendations were related to physical or mental illness, falls, and then nutrition. The results showed that recommendations could be sorted into ten sub-categories related to physical or mental illness, falls, nutrition, physical activity, preparation for the future, social participation, finances, getting help from others, municipal services, and security at home. These ten sub-categories were classified into the International Classification of Functioning, Disability, and Health categories body functions & structure (including one sub-category), activity (including four sub-categories), participation (including three sub-categories), and environmental factors (including two sub-categories). From the results, we could conclude that the major focus was on risk prevention and less focus was on health promotion. Thus, the visitor's recommendations most likely mirror the older adult's explicit needs 'here and now' to a great extent. However, health visitors also need to focus on intrinsic capacities to promote health. Besides recommendations relating to the person's intrinsic capacities, environmental aspects should be focused upon, to improve healthy aging.

What makes older adults feel good?

BACKGROUND AND AIM

To inform health promotion interventions, there is a need for large studies focusing specifically on what makes older adults feel good, from their own perspective. The aim was to explore older adults' views of what makes them feel good in relation to their different characteristics.

METHODS

A qualitative and quantitative study design was used. Independently living people (n = 1212, mean age 78.85) answered the open-ended question, 'What makes you feel good?' during preventive home visits. Following inductive and summative content analysis, data was deductively sorted, based on The Canadian model of occupational performance and engagement, into the categories leisure, productivity, and self-care. Group comparisons were made between: men/women; having a partner/being single; and those with bad/good subjective health.

RESULTS

In total, 3117 notes were reported about what makes older adults feel good. Leisure activities were the most frequently reported (2501 times), for example social participation, physical activities, and cultural activities. Thereafter, productivity activities (565 times) such as gardening activities and activities in relation to one's home were most frequently reported. Activities relating to self-care (51 times) were seldom reported. There were significant differences between men and women, having a partner and being single, and those in bad and good health, as regards the activities they reported as making them feel good.

DISCUSSION AND CONCLUSIONS

To enable older adults to feel good, health promotion interventions can create opportunities for social participation and physical activities which suit older adults' needs. Such interventions should be adapted to different groups.

Give Older Persons a Voice in the Society-By Using Information Compiled during Preventive Home Visits on a Societal Level

Preventive home visits (PHVs) are offered to older persons with the purpose of promoting health and preventing risks on an individual level. However, aspects of health need to be considered on a societal level as well. This study aims to get a deeper understanding of perceptions of the usability of the information compiled during the PHVs to promote health, among older persons, on a societal level. Three online focus groups were conducted with heads of unit of PHVs, heads of department, and politicians responsible for health and welfare in seven municipalities in Sweden (n = 12). The findings were visualised in the core category Enable an inclusive society and the interrelated categories Monitoring determinants of health and Enabling exchange of information. The information from the PHVs could be used to monitor determinants of health by identifying assets, challenges, shifts, trends, and future needs in the society. Moreover, exchange of information from the PHVs could occur within and outside the health and welfare organisation. However, the potential use was affected by hindrances illustrated in the category Obstacles to interpreting and communicating the information. To conclude, using the information from the PHVs could possibly contribute to an inclusive society, where persons not usually represented in decision making are given a voice.

Promote social participation among older persons by identifying physical challenges - An important aspect of preventive home visits

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 = 1245, ≥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 analyze 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 recognize 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.

Older person’s experiences of benefits gained from the support and advice given during preventive home visits

Background

Life expectancy is increasing all over the world. To be able to support this positive development, health interventions focusing on promotion and prevention are crucial. Preventive home visits represent one example of a health intervention which addresses both promotion through a supportive dialogue and prevention by giving advice. However, to give support and advice that older persons experience as beneficial, there is a need for more research.

Aim

The aim of this study was to explore older person’s experiences of the benefits gained from the support and advice given during the preventive home visit.

Method

Individual semi‐structured interviews were conducted with 13 older persons, median age 77 years old, living at home, who had received a preventive home visit. The interviews were analysed with content analysis.

Findings

The overarching theme Becoming empowered and recognised as a person was experienced as the major benefit of the support and advice given during the preventive home visit. The support and advice generated conditions for the person to become empowered, by contributing to a feeling of control and preparedness for the future. Furthermore, the support and advice given contributed to a feeling of becoming recognised as a person, as an outcome of the supportive dialogue and the assessment of their health, behaviour and their surrounding environment.

Conclusion

The support and advice given during the preventive home visit were experienced as person‐centred, and conditions for becoming empowered were created. In order to create a positive outcome from the support and advice given during the preventive home visit, it seems important to focus on providing both a supportive dialogue and a structured assessment.

Factors associated with good health among older persons who received a preventive home visit: a cross-sectional study

Background

The ageing population is increasing worldwide, and this trend is bringing challenges both for the older person and for society. In order to meet the challenges a comprehensive approach is needed involving both health promotion and risk prevention. The preventive home visit is a public health intervention used around the world with the purpose of promoting health and preventing risk among older persons. However, most preventive home visits are focused on questions asking about risks. In order to strengthen the health promotion perspective during the preventive home visits, factors associated with good health need to be identified. The aim of this study was therefore to determine which factors were associated with good self-rated health among older persons who received preventive home visit.

Methods

This was a register study with a cross-sectional design, including older persons (≥75 years old), living in their own homes, and that had received preventive home visit. Data were collected during a period of 9 months, in two municipalities in the south of Sweden. A questionnaire covered mental, physical and lifestyle factors were used at home visit. Binary logistic regression was used to analyse the data.

Results

In total, 619 older persons were included in the study; 55.4% were women, and the mean age was 80.6 years (standard deviation 2.2 years). The following items were significantly associated with good health (after adjustment for age and gender): being able to do things that make one feel valuable, having no physical problems affecting participation in social activities, not feeling sad, not having reduced energy, and not having impaired endurance.

Conclusions

The main conclusion of this study is that questions focusing on risks could be seen from a health promotion perspective and could thus be turned into assets with a positive impact on older persons’ health. Furthermore, the mental and physical factors identified in the results as associated with good health have implications for the person’s ability to feel valuable and participate in social activities. The results suggest that issues regarding both health promotion as well as risk prevention must be brought up during the preventive home visit.