Little is known about the types of home care services granted to older clients in Sweden. The objectives of this study were to: (a) identify and describe the range of granted home care services and service hours; (b) compare services granted for clients with and without documented cognitive impairment; and (c) examine associations between the range of granted home care services and factors related to cognitive impairment and demographical characteristics. The study design was descriptive and cross‐sectional. The data, included records of granted home care services for clients age 65+ with (n = 43) and without (n = 88) cognitive impairment documented by the local municipality assessors, collected from one agency in Sweden during a 2‐month period in 2015. Data analyses resulted in an overview of the range of home care services divided into two categories: personal care and service. In the personal care category, the median was 3 for types of services (range 0–12), and shower (n = 69; 52.7%) was the most common service. In the service category, the median was 5 for types of services (range 0–10), and cleaning the household (n = 103; 78.6%) was the most common service. The median for service hours was 27 hr per month (range 2.5–127.5). Logistic regression models revealed that cognitive impairment was associated with a higher number of services in the personal care category and a higher number of hours per month. Living alone was associated with a higher number of services in the service category. In conclusion, a wide range of home care services were provided for clients who have complex needs in daily life. Home care services were granted to clients with cognitive impairment and to a greater extent with clients who were living alone.

There is a need to understand the underlying mechanisms at work within health promotion and occupational therapy interventions. The aim of this article was, therefore, to explore and describe how the participants of a group-based occupational therapy intervention with positive health outcomes created meaning of and around their experiences of the intervention. The studied intervention was part of the evaluation of a single-blinded, exploratory randomised controlled trial of three different interventions. A total of 19 participants between 77 and 82 years of age with experiences from the group-based intervention were interviewed, and the transcribed interviews were analysed from a constructivist approach. The results showed five different perspectives of meaning, including enjoyment, usefulness, togetherness, respect for individuality and self-reflection. Based on our findings, we argue that the possibility of getting information, sharing with others and having fun, and the ability to adjust the activities in the intervention so that they met the individual's needs, created meaning for the participants. Moreover, meeting with others supported the participants’ perspectives of themselves. The results are discussed in relation to the pervasive discourse of successful ageing, including how it was present but also challenged within the participants’ accounts of the intervention.

Social isolation and loneliness among older people is a growing problem with negative effects on physical and mental health. In co-creation with older adults individualized social activities were designed where older adults through computer mediated communication were able to participate in social activities without leaving their homes. Four types of activities were designed; outdoor activity, music event, visiting a friend and leisure activity. A participatory action research design was applied, where end users together with scientists from two research fields developed, tested and evaluated online participation in the activities. Usability and safety of the systems were major concerns among older adults. The evaluation pointed out that level of simplicity, usability and audio-video quality determined the level of satisfaction with the human interaction during the activity, thereby affecting the meaningfulness of the activity. The research presented in this paper constitutes the first step in a long-term research process aiming at developing a digital coaching system that gives older adults personalized support for increasing participation in meaningful social activities.

Background: Older persons with cognitive impairment (CI) risk social isolation. Strong evidence shows that perceived loneliness, or inadequate social networks, triggers and increases health problems. How homecare systems address social participation remains unknown; anecdotal data suggests there are significant gaps. This study's objective was to identify and describe how the assessors of homecare needs document social participation among persons with CI and how their documentation corresponds with the services actually provided to meet social needs. The research questions were: How and what kinds of social participation needs are documented on need assessment forms? What types of homecare services (with a social focus) are documented and approved? How are specified needs in social participation profiles addressed by a homecare service?

Methods: Descriptive data from need assessment forms and their attached care plans for all applicants aged 65+ were collected during a 2 month period from a large homecare agency serving a municipality in Sweden. Persons with documented CI (n = 43) in the group were identified. Qualitative data analysis was conducted to examine the research questions.

Results: Social participation factors were not documented consistently. The relationship between recognition of limitations to social participation and approval of service eligibility was not consistent. Social participation was designated by references to social status, sometimes by social network size, and occasionally by limitations to social participation. The range of approved homecare services (with social focus) covered services such as day care center visits or companionship. Three profiles of social participation were identified: clients with, (a) no participation limitations; (b) potential limitations; and (c) marked limitations.

Conclusion: Given the known health harms from social isolation and the high risk of isolation among older persons with CI, this novel study's documentation of inadequate and inconsistent information in homecare social need assessments and services is sobering. The findings suggest a pressing need for initiatives to formulate best practices and standards to ensure alignment of care service systems to the health needs of the growing group of aging individuals with CI.

The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals’ quality of life and societal costs. The aim of this study was to evaluate longterm cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.

The focus of this ECCE 2017 panel is on digital technology in healthcare and elderly care. The discussion concerns the design of technology and the use of technology for health. 

Facets of participation have changed with the growing pervasiveness of digital technology in daily life. To enable older adults as active participants in an evolving digital society, it is relevant to examine how they engage in and situate digital technology-mediated occupations in daily life. Narrative inquiry was used to elucidate features in older adults’ engagement in occupations involving digital technology situated in everyday life. Analysis was based on data gathered through concurrent think aloud protocol and observations from 10 older adults in Northern Sweden. In line with narrative analysis, findings were presented as three stories about negotiating needs and values while interacting with the technological and social environments, entitled playing by the rules, being on the same wavelength, and calling the shots. Looking at these stories with an occupational lens resulted in an understanding that older adults’ participation involving digital technology likewise deals with negotiating and refining identities, as well as finding and experiencing meaning in daily life. There is potential for older adults to become active participants through digital technology, and new challenges in research and practice emerge.

The aim of this study was to examine leisure engagement among people in later life and the potential relationship between leisure engagement and self-rated health. A population-representative sample of 5,435 persons between 65 and 80 years of age, living in northern Sweden and Finland were included. Data were collected by a posted questionnaire survey. Results revealed that levels of leisure engagement decreased progressively between the youngest and the oldest age groups. A significant relationship was found between leisure engagement and self-rated health. The relationship between leisure engagement and health as well as implications for developing health promotion programs are discussed.

The main purpose of assistive technology is to support an individual's daily activities, in order to increase ability, autonomy, relatedness and quality of life. The aim for the work presented in this article is to develop automated methods to tailor the behavior of the assistive technology for the purpose to provide just-in-time, adaptive interventions targeting multiple domains. This requires methods for representing and updating the user model, including goals, preferences, abilities, activity and its situation. We focus the assessment and intervention tasks typically performed by therapists and provide knowledge-based technology for supporting the process. A formative evaluation study was conducted as a part of a participatory action research process, involving two rehabilitation experts, two young individuals and one senior individual as end-user participants, in addition to knowledge engineers. The main contribution of this work is a theory-based method for assessing the individual's goals, preferences, abilities and motives, which is used for building a holistic user model. The user model is continuously updated and functions as the base for tailoring the system's assistive behavior during intervention and follow-up.

Introduction: Restraints and changes in social activities might contribute to loneliness and health decline for older adults. To reduce loneliness and support activities, social internet-based interventions are indicated to be effective. The aim of this study was to evaluate the effects of a social internet-based intervention for older adults who are vulnerable to loneliness. Method: An explorative, randomised, crossover study with an AB/BA sequence was completed. The intervention was conducted over a period of three months. Thirty participants were included (24 women and six men, 61–89 years old) and allocated to two groups. Data were collected at three time points. The primary outcome was the UCLA loneliness scale, and the secondary outcomes were satisfaction with social contacts and social interaction skills. Statistical analyses were conducted with the paired t-test, Wilcoxon’s signed-rank test and repeated-measures analysis of variance. Results: Loneliness was significantly decreased in both groups post intervention, and satisfaction with social contacts online significantly increased in one group. Significant treatment effects were detected for all outcomes. Conclusion: The results of the social internet-based intervention programme are promising, but further evaluations are needed.