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1.  Self-care telephone talks as a health-promotion intervention in urban home-living persons 75+ years of age: a randomized controlled study 
Aim
The aim of this study was to evaluate the effects of a telephone-based self-care intervention among urban living individuals 75+ years of age by comparing self-reported perceived health, mental health, sense of coherence, self-care ability, and self-care agency before and after the intervention.
Materials and methods
In a randomized controlled study, 15 persons answered a questionnaire about perceived health, mental health, sense of coherence, self-care ability, and self-care agency. In a sex- and age-matched control group (n=15), the same questions were answered. Data were collected before and after intervention. An open-ended question about experiences of the intervention was included in the last questionnaire. The intervention consisted of a first meeting with health professionals and additional five self-care telephone calls. The control group did not receive any intervention or attention except for the questionnaires. Descriptive statistics were used to describe the study group. To compare the intervention group and control group on nominal and ordinal levels, the McNemar test and the Wilcoxon signed-rank test, respectively, were chosen.
Results
Thirty individuals (14 females and 16 males) participated in the study, ranging in age between 75 and 93 years. A significant difference was obtained in the intervention group regarding mental health. Mental health improved significantly in the intervention group (P=0.037). In the control group, mental health, sense of coherence, self-care ability, and self-care agency showed worse outcome results after the intervention (19 weeks).
Conclusion
Self-care telephone talks improved mental health significantly in our sample, and mental health focus could be understood as a possible condition for health promotion to take place. Structured self-care telephone talks have proved to be successful and a relevant method to use in practice.
doi:10.2147/CIA.S55925
PMCID: PMC3888266  PMID: 24421638
case-control study; changes; mental health; older people
2.  Participation in physical and social activities among home-dwelling persons with dementia – experiences of next of kin 
Introduction
To be next of kin to a home-dwelling person with dementia is known to be a heavy burden, especially early in the process. Studies have revealed a need for information and support during the disease process. Likewise, there is support for the positive impacts of physical and social activities for wellbeing in home-dwelling people with dementia. It is important to obtain experiences from next of kin whose spouses or parents participate in such physical and social activities.
Aim
The aim of this study was to elucidate the experiences of next of kin to home-dwelling persons in an early stage of dementia who had an opportunity to participate in organized physical and social activities.
Method
The study has a qualitative design. Focus group interviews were conducted with ten next of kin to home-dwelling dementia sufferers, who participated in physical and social activities in an activity center. The interview texts were analyzed using qualitative content analysis.
Findings
In the analysis, two categories emerged: “a break in the everyday” and “being attended and cared about.” Two sub-categories identified in each of the two main categories were: “need of relief ” and “meaningful activities;” and “being confirmed” and “sharing experiences and getting advice and help,” respectively. These categories were interpreted in an overall theme: “contentment with adapted activities and group meetings provided with a person-centered approach.”
Conclusion
Adapted physical and social activities led by highly qualified personnel can provide needed relief and support to the next of kin, and meaningful activities to the dementia sufferers. However, it is crucial that the personnel provide person-centered care and are able to meet the needs of the dementia sufferers and their next of kin, to help to give them a new everyday life.
doi:10.2147/PRBM.S46334
PMCID: PMC3704542  PMID: 23847435
activity center; content analysis; parent; qualitative design; spouse
3.  Nutritional self-care in two older Norwegian males: a case study 
Background:
Knowledge about how to support nutritional self-care in the vulnerable elderly living in their own homes is an important area for health care professionals. The aim of this case study was to evaluate the effects of nutritional intervention by comparing perceived health, sense of coherence, self-care ability, and nutritional risk in two older home-dwelling individuals before, during, and after intervention and to describe their experiences of nutritional self-care before and after intervention.
Methods:
A study circle was established to support nutritional self-care in two older home-dwelling individuals (≥65 years of age), who participated in three meetings arranged by health professionals over a period of six months. The effects of this study circle were evaluated using the Nutritional Form For the Elderly, the Self-care Ability Scale for the Elderly (SASE), the Appraisal of Self-care Agency scale, the Sense of Coherence (SOC) scale, and responses to a number of health-related questions. Qualitative interviews were performed before and after intervention to interpret the changes that occurred during intervention.
Results:
A reduced risk of undernutrition was found for both participants. A higher total score on the SASE was obtained for one participant, along with a slightly stronger preference for self-care to maintain sufficient food intake, was evident. For the other participant, total score on the SASE decreased, but the SOC score improved after intervention. Decreased mobility was reported, but this did not influence his food intake. The study circle was an opportunity to express personal views and opinions about food intake and meals.
Conclusion:
An organized meeting place for dialogue between older home-dwelling individuals and health care professionals can stimulate the older person’s engagement, consciousness, and learning about nutritional self-care, and thereby be of importance in reducing the risk of undernutrition.
doi:10.2147/CIA.S45458
PMCID: PMC3686329  PMID: 23807843
elderly; health promotion; intervention; study circle
4.  The meaning of actualization of self-care resources among a group of older home-dwelling people—A hermeneutic study 
Self-care is an activity of mature persons who have developed their abilities to take care of themselves. Individuals can choose to actualize their self-care abilities into self-care activities to maintain, restore, or improve health and well-being. It is of importance to understand the meaning of the actualization of self-care resources among older people. The aim of this study was to investigate the meaning of the actualization of self-care resources, i.e., actions taken to improve, maintain, or restore health and well-being, among a group of older home-dwelling individuals with a high sense of coherence. The design of this study was to reanalyse narratives revealing self-care activities from 11 (five females and six males) Norwegian older home-dwelling people (65 years or older) identified as having a high sense of coherence. In order to reveal the meaning and get an understanding of why these self-care resources were realized or actualized, a Gadamerian-based research method was chosen. The analysis revealed four themes that showed the meaning of actualization of self-care resources in the study group: “Desire to carry on”, “Be of use to others”, “Self-realization”, and “Confidence to manage in the future”. The findings showed what older people found meaningful to strive for, and this information can be used as a guide for health professionals when supporting older people in their self-care. Older people with self-care resources can also be an important resource for others in need of social contact and practical help. These resources have to be asked for in voluntary work among older people in need of help and, thereby, can be a valuable supplement to the community health care system.
doi:10.3402/qhw.v8i0.20592
PMCID: PMC3631604  PMID: 23601788
Activity; coping; health; interpretation; qualitative study; social relationship; salutogenesis; self-realization; sense of coherence; well-being
5.  Lived experiences of self-care among older, home-dwelling individuals identified to be at risk of undernutrition 
Introduction
In a society where most older people live in their own homes, it may be expected of older individuals to exercise their potential to take care of themselves in daily life. Nutrition is a central aspect of self-care, and groups of older, home-dwelling people are at risk of undernutrition.
Aim
The aim of this study was to describe the lived experiences of self-care and features that influence health and self-care among older, home-dwelling individuals identified to be at risk of undernutrition.
Methods
Qualitative interviews were performed with eleven home-dwelling individuals who had been identified as being at risk of undernutrition. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method.
Findings
Self-care as a lived experience among older, home-dwelling individuals identified to be at risk of undernutrition is about being aware of food choices and making decisions about taking healthy steps or not. In the presence of health problems, the appetite often decreases. Being able to take care of oneself in daily life is important, as is receiving help when needing it. Working at being physically and socially active and engaged may stimulate the appetite. Having company at meals is important and missed when living alone. Being present and taking each day by day, as well as considering oneself in the light of past time and previous experiences and looking ahead, is central, even when having fears for the future and the end of life.
Conclusion
Health care professionals should be aware of these findings in order to support self-care in older people, and they should pay attention to the social aspects at meals.
doi:10.2147/JMDH.S38474
PMCID: PMC3526862  PMID: 23271914
aged; health promotion; phenomenology; qualitative interviews
6.  Psychometric properties of the Norwegian version of the General Health Questionnaire (GHQ-30) among older people living at home 
Introduction
The incidence and prevalence of mental problems among older people are difficult to map because the causes are often complex and the symptoms manifest in a range of ways. Therefore, there is a need for robust and useful instruments for screening mental problems in this group. One instrument used in Norway and around the world is the 30-item version of the General Health Questionnaire (GHQ-30). Nevertheless, studies testing reliability and validity of the Norwegian version are scarce.
Aim
The aim of this study was to test the psychometric properties, by means of reliability and construct validity, of the Norwegian version of the GHQ-30 in a sample of older people living at home.
Methods
A cross-sectional design was used. A postal questionnaire including background variables and a range of health related questions, including the GHQ-30, was mailed to 6033 older people (age 65 years or more) who lived in their own homes in southern Norway. A final sample of 2106 persons (34.9%) responded to and returned the questionnaire. Data were analyzed statistically regarding reliability and construct validity of the GHQ-30.
Results
The reliability of the instrument, reflecting its homogeneity, was shown in a Cronbach’s alpha coefficient of 0.93 and in significant item-to-total correlations. Construct validity was supported as the GHQ-30 demonstrated robustness in separating groups with known mental problems. Construct validity was also demonstrated in a logical four factor solution, which accounted for 50.0% of the variance in the study group. The factor structure supported previous testing studies of the instrument.
Conclusion
The GHQ-30 showed satisfactory psychometric properties regarding reliability and construct validity in this study group, which may indicate that the instrument is suitable for use in screening mental problems in older people living at home.
doi:10.2147/PRBM.S37502
PMCID: PMC3496412  PMID: 23152715
factor analysis; mental problems; psychological screening; reliability; validity
7.  Translation and testing of the Risk Assessment Pressure Ulcer Sore scale used among residents in Norwegian nursing homes 
BMJ Open  2012;2(5):e001575.
Objective
The purpose of this study was to translate and test the psychometric properties of the Norwegian-language version of the Risk Assessment Pressure Sore (RAPS) scale.
Background
Risk assessment scales for pressure ulcer (PU) prevention have become an aspect of quality improvement in healthcare, but their effectiveness depends on the reliability and validity of the scale.
Methods
 A convenience sample of 481 residents in 15 nursing homes in rural Norway was included between January and June 2007. The English-language version of the RAPS scale was translated into Norwegian, and this scale was used to collect the data, including a skin examination. The number of PUs and grades were documented. Reliability was assessed in a small group of 26 residents and construct validity in the total study group.
Results
Equivalence between two assessments regarding total scores of the RAPS scale was reflected in an intraclass correlation coefficient (ICC) of 0.95. Construct validity was supported, and the RAPS scale could define groups with expected low and high scores. Further evidence of construct validity was shown in a confirmatory factor analysis.
Conclusion
The Norwegian version of the RAPS scale has shown sufficient psychometric properties to be considered a reliable and valid scale for identifying risk of PUs among nursing home residents. However, further testing is needed.
doi:10.1136/bmjopen-2012-001575
PMCID: PMC3488716  PMID: 23100445
WOUND MANAGEMENT
8.  Nutritional screening of older home-dwelling Norwegians: a comparison between two instruments 
Background
It is important to obtain knowledge about the prevalence of nutritional risk and associated factors among older home-dwelling people in order to be able to meet nutritional challenges in this group in the future and to plan appropriate interventions. The aim of this survey was to investigate the prevalence of home-dwelling older people at nutritional risk and to identify associated factors using two different nutritional screening instruments as self-report instruments.
Methods
This study had a cross-sectional design. A postal questionnaire, including the Norwegian versions of the Nutritional Form for the Elderly (NUFFE-NO) and Mini Nutritional Assessment – Short Form (MNA-SF), background variables, and health-related questions was sent to a randomized sample of 6033 home-dwelling older people in southern Norway. A total of 2106 (34.9%) subjects were included in the study. Data were analyzed using descriptive statistics and logistic regression analyses.
Results
When using the NUFFE-NO and MNA-SF, 426 (22.3%) and 258 (13.5%) older persons, respectively, were identified to be at nutritional risk. The risk of undernutrition increased with age. Several predictors for being at risk of undernutrition, including chronic disease/handicap and receiving family help, as well as protective factors, including sufficient food intake and having social contacts, were identified.
Conclusion
Health professionals must be aware of older people’s vulnerability to risk of undernutrition, perform screening, and have a plan for preventing under-nutrition. For that purpose, MNA-SF and NUFFE-NO can be suggested for screening older people living at home.
doi:10.2147/CIA.S35986
PMCID: PMC3459573  PMID: 23049250
aged; risk factors; undernutrition; screening
9.  Life situation and identity among single older home-living people: A phenomenological–hermeneutic study 
Being able to continue living in their own home as long as possible is the general preference for many older people, and this is also in line with the public policy in the Nordic countries. The aim of this study was to elucidate the meaning of self-care and health for perception of life situation and identity among single-living older individuals in rural areas in southern Norway. Eleven older persons with a mean age of 78 years were interviewed and encouraged to narrate their self-care and health experiences. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological–hermeneutic method inspired by the philosophy of Ricoeur. The findings are presented as a naïve reading, an inductive structural analysis characterized by two main themes; i.e., “being able to do” and “being able to be”, and a comprehensive interpretation. The life situation of the interviewed single-living older individuals in rural areas in southern Norway was interpreted as inevitable, appropriate and meaningful. Their identity was constituted by their freedom and self-chosen actions in their personal contexts. The overall impression was that independence and the ability to control and govern their own life in accordance with needs and preferences were ultimate goals for the study participants.
doi:10.3402/qhw.v7i0.18456
PMCID: PMC3406221  PMID: 22848230
Activity; adaptedness; freedom; health; independence; self-care actions
10.  Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people 
Background
Nutritional screening instruments need to be evaluated in terms of reliability and validity and being able to demonstrate sensitivity and specificity for use in clinical practice and research. The aims of this study were to test the reliability and validity of the Norwegian version of the Nutritional Form For the Elderly (NUFFE-NO) in a sample of older home-dwelling people, and to use the short form of the Mini Nutritional Assessment (MNA-SF) as a standard.
Methods
A postal questionnaire, including the two instruments, background variables, and health-related questions, was sent to 6033 home-dwelling older people (65+ years) in southern Norway. In total, 2106 persons responded and were included. Data were analyzed statistically regarding homogeneity, concurrent and construct validity, sensitivity, and specificity of NUFFE-NO.
Results
A Cronbach’s alpha coefficient of 0.71 and significant item-to-total correlations were obtained as measures of homogeneity. Concurrent validity was assessed by a correlation coefficient of −0.37 (P < 0.001) between NUFFE-NO and MNA-SF. NUFFE-NO could separate known nutritional at-risk groups as a measure of construct validity. A cut-off point of ≥4 for identification of older people at nutritional risk was found for NUFFE-NO with MNA-SF as a standard.
Conclusion
NUFFE-NO shows adequate psychometric properties regarding homogeneity and construct validity. MNA-SF was not found to be the most suitable standard to use, because a low correlation coefficient was obtained as a measure of concurrent validity and a lower cut-off point was found compared with another study using the Mini Nutritional Assessment (MNA®) as a standard for NUFFE-NO. The obtained cut-off point of ≥4 is not recommended for use in practice or research, because many false positive nutritional at-risk persons would then be identified. Further studies with suitable design have to be performed among older home-dwelling people using the MNA as a standard.
doi:10.2147/JMDH.S32502
PMCID: PMC3392698  PMID: 22791993
nutritional screening instrument; reliability; sensitivity; specificity; validity
11.  Ability for self-care in urban living older people in southern Norway 
Background
The number of older people living in urban environments throughout the world will increase in the coming years. There is a trend in most European countries towards improved health among older people, and increased life expectancy for both women and men. Norway has experienced less increase in life expectancy than some other European countries, and it is therefore important to investigate older urban Norwegian people’s health and ways of living in a self-care environment, with special regard to health promotion.
Aim
The aim of this study was to describe self-care ability among home-dwelling older (65+ years) individuals living in urban areas in southern Norway in relation to general living conditions, sense of coherence (SOC), screened nutritional state, physical activity, perceived self-reported health, mental health, and perceived life situation.
Methods
In 2010, a randomized sample of 1044 men and women aged 65+ years who were living in urban areas in southern Norway answered a postal questionnaire consisting of five instruments, some background variables, and 17 health-related questions. Univariate and multivariate statistical methods were used in the analyses of the data.
Results
The mean age of the participants was 74.8 years (SD = 7.1). Eighty-three percent of the participants had higher abilities to care for themselves. Self-care agency, perceived good health, being active, being frequently active, good mental health, not being at risk of undernutrition, and satisfaction with life were all positively related to self-care ability. Negative factors were perceived helplessness, receiving home nursing, being anxious, and being at a more advanced age. People aged 85+ years had worse mental health, were less physically active, and more at risk of undernutrition.
Conclusion
Health professionals should focus on the health-promoting factors that reinforce older people’s ability to care for themselves, and be aware of important symptoms and signs associated with a reduction in a person’s self-care ability. Politicians should assume responsibility for health care with a special regard to senior citizens.
doi:10.2147/JMDH.S29388
PMCID: PMC3333801  PMID: 22536079
activity; aged; health promotion; mental health; perceived health; undernutrition
12.  Living alone, receiving help, helplessness, and inactivity are strongly related to risk of undernutrition among older home-dwelling people 
Background
Being at risk of undernutrition is a global problem among older people. Undernutrition can be considered inadequate nutritional status, characterized by insufficient food intake and weight loss. There is a lack of Norwegian studies focusing on being at risk of undernutrition and self-care ability, sense of coherence, and health-related issues among older home-dwelling people.
Aim
To describe the prevalence of being at risk of undernutrition among a group of older home-dwelling individuals in Norway, and to relate the results to reported self-care ability, sense of coherence, perceived health and other health-related issues.
Methods
A cross-sectional design was applied. A questionnaire with instruments for nutritional screening, self-care ability, and sense of coherence, and health-related questions was sent to a randomized sample of 450 persons (aged 65+ years) in southern Norway. The study group included 158 (35.1%) participants. Data were analysed using statistical methods.
Results
The results showed that 19% of the participants were at medium risk of undernutrition and 1.3% at high risk. Due to the low response rate it can be expected that the nonparticipants can be at risk of undernutrition. The nutritional at-risk group had lower self-care ability and weaker sense of coherence. Living alone, receiving help regularly to manage daily life, not being active and perceived helplessness emerged as predictors for being at risk of undernutrition. The results indicate difficulties in identifying people at nutritional risk and supporting self-care activities to maintain a good nutritional status.
Conclusion
Health care professionals have to be able to identify older home-dwelling people at risk of undernutrition, support self-care activities to enable people at risk to maintain a sufficient nutritional status, and be aware that older people living alone, who receive help, feel helpless, and are inactive are especially vulnerable.
doi:10.2147/IJGM.S28507
PMCID: PMC3302765  PMID: 22419884
health; nutrition; self-care; sense of coherence
13.  Volunteering in dementia care – a Norwegian phenomenological study 
Introduction
The number of people suffering from dementia will increase dramatically in the future, and this will be a great challenge and concern for health care services. It is assumed that volunteers will strengthen community health care services more in the future than they do today.
Aim
The aim of this study was to elucidate lived experiences of working as a volunteer in an activity center with adapted activities for home-dwelling people with early stage dementia.
Methods
Qualitative interviews were implemented in a group of nine female volunteers from an activity center in southern Norway. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method.
Results
Volunteering in an activity center for home-dwelling people with early stage dementia was reported to provide experiences of being useful and feeling satisfied with performing a good job. It was an advantage for the volunteers to have had experiences from life in general, but also as a health professional or as being the next of kin of a dementia sufferer. It was important for the volunteers to focus on the dementia sufferer and show caring behavior, and interaction with and the appreciation of the health care professionals were also important. The volunteers were motivated by being able to have influence and participate in the planning of the work, to be a part of the social setting, and to learn. However, for some volunteers it was difficult to adjust to an appropriate role.
Conclusion
In order to promote volunteering in a caring context, mutual trust and freedom should be emphasized. Being conscious of important volunteer characteristics like their experiences, knowledge, and caring behavior, as well as a focus on the staff showing appreciation and providing feedback, may be the difference between success and failure.
doi:10.2147/JMDH.S28240
PMCID: PMC3292403  PMID: 22396627
activity; early stage dementia; phenomenology; voluntary work
14.  Narrated lived experiences of self-care and health among rural-living older persons with a strong sense of coherence 
Sense of coherence (SOC), with its components comprehensibility, manageability, and meaningfulness, is a major factor in the ability to cope successfully with stressors and is closely related to health. Qualitative studies related to SOC are scarce, and in this phenomenological interview study, self-care is investigated in relation to SOC. The aim of this study was to describe the lived experiences of self-care and features that may influence health and self-care among older home-dwelling individuals living in rural areas and who have a strong SOC. Eleven persons with a mean age of 73.5 years and a SOC value in the range of 153–188, measured by Antonovsky’s 29-item SOC scale, were interviewed. The interviews were recorded, transcribed verbatim, and analyzed with a phenomenological descriptive method. The findings showed that successful self-care involves having, when needed, contact with the health care system, being conscious of a sound lifestyle, being physically and mentally active, being engaged, having social contacts with family and/or others, and being satisfied and positive and looking forward. Formal and informal caregivers should be conscious of the importance of motivating and supporting older individuals with respect to these dimensions of self-care.
doi:10.2147/PRBM.S27228
PMCID: PMC3255462  PMID: 22241954
aged; activity; contacts; phenomenology; well-being

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