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Access to outdoor leisure activities is central to supporting active and healthy ageing. To address the lack of research on services supporting continued engagement, this study examines how public, voluntary and private sectors provide outdoor recreation services for older adults. This study uses a qualitative research design to draw on interviews, a workshop, and field observations conducted in a Swedish municipality. Grounded in the capability approach and theories of active ageing, the study contributes to a better understanding of how opportunities for participation in outdoor recreation are shaped by service provision and structural conditions. This study identifies positive examples of outdoor recreation services but also gaps, characterised by the level of challenge in the activities that stakeholders in different sectors provide. Whereas activities provided by public senior centres were conducted in accessible terrain and inclusive for people with functional limitations, opportunities for slightly more challenging activities were lacking. Activities provided by voluntary organisations offered opportunities for more challenge, with the risk of exclusion for those with mobility limitations. The private sector, despite interest, did not actively provide outdoor recreation for older adults due to demand uncertainties. A structural barrier across all sectors was limited access to transport. This study contributes to the literature by identifying the need for tiered outdoor recreation programs, improved transport solutions, and cross-sector collaboration. While situated in a Swedish context, the findings offer conceptual and practical relevance for broader efforts to provide diversity in outdoor recreation services that support active ageing for different groups. A more coordinated, inclusive approach through policy and resource allocation across sectors is essential to support outdoor engagement in ageing populations.

BACKGROUND: Research is limited on registered healthcare professionals (RHCP) usage of research and evidence-based practice (EBP) in Swedish municipal primary healthcare work.

AIM/OBJECTIVES: The aim of this study was to increase the understanding of experiences, attitudes, and conditions of usage of research and implementation of EBP among RHCPs in a Swedish municipality setting. Further, the study aimed to explore whether those attitudes and conditions were associated with RHCP basing their work on research.

MATERIAL AND METHODS: The study was a mixed- methods study of a convergent design with five dialogue meetings and a web-based survey. Participants were RHCP recruited from one large size municipality.

FINDINGS: Registered healthcare professionals struggled between personal and organisational conditions to use research and work according to EBP. They were torn between personal ambitions and lack of skills to use research, whereas having an advanced level education was significantly associated with basing work on research. Lack of organisational resources and support made usage of research and implementation of EBP difficult.

CONCLUSION: There is a need to strengthen the RHCP competence in using research evidence in clinical practice. Managemental support, education and clinical goals could improve the conditions for usage of research and implementation of EBP.

OBJECTIVE: To highlight experiences from a personal data incident, which occurred during recruitment for a project focused on how housing choices and relocation are related to active and healthy ageing.

RESULTS: Based on established collaboration, the researchers and representatives of housing companies planned for recruitment. Invitations to participate was distributed to persons registered with an interest in relocation. The invitation letter included information according to ethical requirements and a link to an online survey. Within a few days, the housing company was contacted by a person who had received the invitation stating that the company had not secured individual consent to the disclosure of personal data to the researchers. The company and the researchers initiated a range of immediate actions to manage the situation, including a plan for how to respond to persons who wanted their person data to be deleted, how to handle already collected data, and for the continued implementation of the recruitment process. We acknowledge that despite established collaboration based on long term commitment from all parties involved, ethical issues require constant attention. Whereas our case represents a hard-learned lesson on a sensitive ethical issue, the well-established collaboration was of paramount importance for how the situation was handled.

Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.

Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program.

Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively.

Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.

Background: The in‑home work environment is the main work environment for home care workers, but it has only been sparsely studied. Our aim was to investigate the in‑home work environment for home care workers by exploring challenges that arise regardless of a pandemic and by investigating Covid‑19–specific challenges.

Methods: Two cross‑sectional studies were conducted, one before (2017) and one during the pandemic (2021/2022) in three Swedish regions (Jämtland/Härjedalen, Västerbotten and Västernorrland), in which 1,154 (58%) out of 2,000 and 629 (33%) of 1,900 invited home care workers participated, respectively. Participants responded to a question‑naire asking about 10 problems associated with the in‑home work environment as well as Covid‑19–related chal‑lenges. Comparisons were conducted between regions and between study years using univariable analyses.

Results: Daily problems with the in‑home work environment were common before the pandemic, and they increased statistically significantly during the pandemic for, among other things, non‑ergonomic beds (29% vs. 37%), impractical bathrooms (40% vs. 50%), indoor smoking (24% vs. 31%), and pets (19% vs. 25%). There were major con‑cerns about the risk of getting infected with Covid‑19 for both staff (42%) and the home care recipients (50%). There were statistically significant differences between regions, e.g. many problems were more common in the Västerbotten region than in the other two regions during the pandemic, while challenges with protective equipment was most common in the Västernorrland region.

Conclusions: In‑home work environment problems are common for home care workers and worsen in a more strained situation. Efforts are needed to strengthen the work environment for home care workers.

Purpose: Dementia refers to a group of neuro-cognitive disorders that affect people worldwide. Reablement may facilitate people to maintain or regain abilities, encourage engagement in activities important to them, promote continued societal participation, and foster a meaningful life experience. However, the adoption of reablement in dementia care has been slow. This study aimed to explore the negative attitudes that hinder the adoption of reablement and to identify strategies to mitigate these factors.

Methods: An exploratory qualitative approach involving semi-structured interviews was adopted. Interviews were conducted with reablement and/or dementia experts in five countries, namely Australia, Denmark, the Netherlands, Sweden, and the United Kingdom. The interviews were recorded and transcribed verbatim. The interviews were analyzed using a thematic analysis approach.

Results: This study explored the views of 10 experts and identified negative attitudes that impede the adoption of reablement. These attitudes were grouped into five themes: 1) lack of understanding of the preserved capabilities in people with dementia, 2) reluctance and fear among family caregivers about disrupting established routines, 3) institutional barriers, 4) misinterpretation of what reablement is, and 5) complexity of the healthcare system. The proposed strategies to address these negative attitudes include enhancing dementia awareness, educating family caregivers, understanding caregiver burden, taking care of community education and destigmatization, improving clinical leadership, raising awareness about reablement evidence and practice, integrating reablement in educational curriculum, developing comprehensive policies, and improving access to services.

Conclusion: This study highlights the importance of addressing and mitigating negative attitudes which obstruct adoption of reablement. By identifying these attitudes and exploring their origin, strategies can be formulated to overcome them. Successful adoption of these strategies is anticipated to enhance the quality of life of people with dementia and their caregivers.

Plain Language Summary: Why did we do this study?: Reablement is a way of supporting people with dementia to stay active, do things that matter to them, and stay involved in daily life. It helps people build on their strengths rather than focusing on their illness. But in many places, reablement is not yet widely used in dementia care. We wanted to understand why that is and what can be done about it.

What did we do?: We talked with 10 experts from five different countries: Australia, Denmark, the Netherlands, Sweden, and the United Kingdom. These experts work with people with dementia or are involved in reablement. We asked them what they think stops reablement from being used more often, and how we could change that.

What did we find?: The experts told us about five main reasons why reablement is not used enough: (1) People often do not understand what someone with dementia can still do. (2) Family members may worry that changing routines will make things worse. (3) Health and care systems do not always support this way of working. (4) People misunderstand what reablement really is. (5) The care system is complicated and hard to navigate. The experts also shared helpful ideas to tackle these problems. These included raising awareness about dementia and what reablement can offer, supporting family caregivers, improving leadership in healthcare, adding reablement to staff training, and making policies and services more supportive.

Why does this matter?: When we better understand and address the reasons why reablement is not used, we can make real changes. These changes can help people with dementia live more meaningful and independent lives, and also support their caregivers.

Background: As populations age in the Western world, interventions aiming for ‘aging in place’, such as reablement, have gained prominence. Reablement programs have focused on enabling older people to maintain independence in their home environment. However, while a growing body of research points to the considerable benefits of engaging in outdoor environments, reablement rarely addresses outdoor activities. People living in rural Arctic areas often tend to have strong cultural, social, and emotional attachments to outdoor places, emphasizing the outdoors as a meaningful arena for engagement. Concurrently, rural Arctic communities face unique obstacles in facilitating outdoor activities, such as geographic isolation, limited access to services, harsh climate conditions, and seasonal variations. Recognizing these challenges, our study sought to tailor an outdoor reablement model that is appropriate and feasible for the context of a rural Arctic setting.

Methods: The study design was inspired by a co-design methodology, incorporating data creation through workshops, focus groups, and individual interviews conducted over an eleven-month period. Three municipalities in rural Arctic Norway were involved, with a total of 35 participants, including older people receiving reablement services and healthcare professionals. A socioecological theory supported the thematic data analysis.

Results: The study yielded experiences that generated a comprehensive model for implementing outdoor reablement that meet the specific needs that the participants experienced in the rural Arctic setting. The model includes the individual level, accounting for physical and mental functioning; the organizational level, necessitating access to aids and equipment and cross-sectorial collaboration; and the environmental level, adapting to climatic, seasonal, and geographic challenges.

Conclusion: This study contributes with knowledge that broadens the scope of reablement as an initiative to support aging in place to include outdoor environments. The tailored outdoor reablement model developed in this study addresses the complexity of aging in place in rural Arctic settings. The study underscores the importance of context-specific strategies that support older people in maintaining a healthy and meaningful life through active engagement with the outdoors.

Falls are the most common cause of injury in older people, with consequences for the individual and society. With an increasing population of older people, falls and related costs are expected to increase. It is crucial to identify scalable and cost-effective interventions and subsequently reduce fall-related costs. The aim was to evaluate the cost-effectiveness of the Safe Step digital fall preventive exercise intervention over a period of 12 years and, in addition, to evaluate the impact of increased recruitment cost and decreased intervention effect. The intervention was evaluated in an observational study in a municipality context targeting community-dwelling older people of age 70 +. A Markov model with five states was used to model the cost-effectiveness of the Safe Step intervention and evaluate quality-adjusted life years (QALYs) and fall-related costs from a societal perspective. By using data from a meta-analysis as basis for the estimated intervention effect, the Safe Step intervention was compared with a no-intervention alternative. The results showed that the Safe Step intervention dominated no intervention. In the sensitivity analysis with the most conservative estimate of intervention effect, the ICER was €7 616 per QALY gained. Hence, Safe Step showed to be a cost-saving fall preventive intervention in older people at risk of falling and potentially cost-effective even with a low estimated intervention effect. Future studies on efficacy of fall preventive digital interventions will contribute in precising effect estimates and enhance the validity of these cost-effectiveness results.

The World Health Organization (WHO) recognizes the right of individuals with dementia and their family caregivers to access interventions that enhance their participation in society. Reablement is an approach that enables older people to participate in meaningful daily and social activities. Over the past decade, a growing body of evidence has underscored reablement as a promising approach within dementia care, including positive outcomes for people with dementia and their family caregivers, and cost-effectiveness. However, the dissemination of knowledge about and practical implementation of reablement remain slow. This position paper, authored by the ReableDEM research network, aims to address key issues related to implementing reablement in dementia care. To expedite the adoption of reablement within dementia care, we propose five critical areas of focus: 1) Changing the attitudes and expectations of stakeholders (eg health and social care staff, policy makers, funders) – encouraging people to think about dementia as a disability from a biopsychosocial perspective; 2) Disrupting health and social care-A radical change is needed in the way services are organized so that they are more holistic, personalized and resource-oriented; 3) Investing in capacity-building and creating a supportive environment – the workforce needs to be trained and supported to implement reablement in dementia care; 4) Involving, educating and supporting family caregivers-services and staff that are equipped to provide reablement will be better able to involve family caregivers and the person’s social network; 5) Providing robust evidence about reablement in dementia care by conducting high-quality research with long-term follow-up.

Background and aims: Active aging is the process through which people strive to maintain wellbeing when growing old. Addressing the lack of research on active aging in the context of housing, the aim was to describe active aging among people aged 55 and older considering relocation and investigate whether perceived housing moderates the relationship between functional limitations and active aging.

Methods: We utilized cross-sectional data from a sub-sample (N = 820; mean age = 69.7; 54% women) of the Prospective RELOC-AGE. Functional limitations were reported using 10 dichotomous questions. Active aging was assessed with the University of Jyvaskyla Active Aging Scale (UJACAS; 17 items, self-rated for four perspectives). Perceived housing was self-rated with four usability questions and meaning of home (MOH; 28 items). Cross-sectional associations and interactions were analysed using linear regression models, adjusting for gender and educational level.

Results: Each functional limitation decreased the active aging score by almost five points (p < 0.001). Usability did not moderate that relationship while MOH significantly attenuated the association between functional limitations and active aging (p = 0.039). Those with high MOH had two points less decrease in active aging score compared to those with low MOH.

Discussion and conclusions: Having a home with more personal meaning attached to it seems to provide more ability and opportunity for meaningful activities, thus supporting active aging despite functional limitations. This sheds new light on the known association between MOH and different aspects of wellbeing in old age and has relevance for theory development, housing policies and housing counselling targeting younger older adults.