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BACKGROUND: Femoral neck fractures (FNF) are a severe and common injury that affect older adults physically, psychologically, and socially. Variation in the trajectory of recovery remains underexplored. This study was conducted to investigate older adults' recovery experiences during the first year after FNF.

METHOD: This longitudinal interview-based study was conducted with 13 participants aged ≥75 years with FNF who were admitted to the orthopedics wards of two hospitals in Sweden. Semi-structured interviews were conducted with participants at 1, 4, and 12 months after fracture. Reflexive thematic analysis of the interview transcripts was performed.

RESULTS: Participants described their recovery after FNF as a complex and non-linear journey. Four interrelated themes were identified as key aspects influencing recovery during the first year after FNF: engagement in daily activities, fear of falling, family members' bridging of the support gap, and striving for independence. Recovery was represented as a fluctuating personal experience that evolves over time.

CONCLUSION: Recovery after FNF extends beyond physical healing, encompassing emotional adjustment and social reintegration. The understanding of recovery as an evolving and individualized process highlights the need for follow-up and rehabilitation strategies that address not only functional outcomes, but also patients' confidence, motivation, and support in daily life.

Objective: This study describes patterns of self-management ease and difficulty among older adults with long-term health conditions and the associations with gender, level of education, number of conditions, depression and/or health status.

Materials and methods: Cross-sectional data were collected between 2021–2022 in a municipality in northern Sweden. The survey included demographic and health-related questions. To assess self-management ease or difficulty and symptoms of depression, the Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) and the Geriatric Depression Scale were used. 516 older adults between 72–73 years of age with long-term health conditions were included. Descriptive statistics and logistic regression were used to describe patterns of self-management ease and difficulty and to examine which factors were associated with self-management difficulty.

Results: Most older adults did not experience self-management difficulty. There were, however, differences between the seven PRISM-CC domains. The Internal domain (managing negative emotions and stress) had the highest percentage (25.39%) of older adults with self-management difficulty. In all domains, there was also a subgroup of individuals (n = 26) that had noticeably lower PRISM-CC scores (more difficulty). A strong association between having depressive symptoms or having poor health status and self-management difficulty was found.

Conclusion: This study highlights the need for regular mental health screenings and individualized self-management support for older adults. Future research should explore intervention strategies that integrate mental health support into self-management programs for individuals with long-term health conditions.

Purpose: Developed simultaneously in English and Swedish, the Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) assesses patients’ perceived difficulty managing life with long-term health conditions. This study assessed the comparability of the PRISM-CC across sociodemographic groups, number of health conditions and language (English and Swedish).

Methods: Differential item functioning (DIF) and differential test functioning (DTF) were analysed by age, gender, education level, and number of conditions using independent English and Swedish datasets. Language-based DIF and DTF were examined using pooled data. An iterative hybrid ordinal logistic regression approach was applied to identify potential DIF across the PRISM-CC’s seven domains. The impact of flagged items on total scores (DTF) was evaluated by comparing test characteristic curves.

Results: Few items were flagged for potential DIF in the English, Swedish or pooled data, and only at low cutoff values. The impact of items with potential DIF on DTF was negligible.

Conclusion: The absence of meaningful DIF and DTF in either the English or Swedish version of the PRISM-CC or between English and Swedish versions provides further support for the PRISM-CC as a valuable tool for assessing self-management ease and difficulty. These results also demonstrate the value of simultaneous development of instruments in two languages. Further evaluation of DIF is necessary in populations with greater self-management challenges, such as among people with severe disease burden.

This study explored experiences with time-restricted eating (TRE) and weight loss in the RESET trial, including 3 months of intervention and 3 months of follow-up. Participants were living with overweight and at risk for type 2 diabetes (T2D). Data included semi-structured interviews and body weight measurements at baseline, post-intervention and follow-up. Participants were grouped based on relative weight loss: (1) High weight loss (median −5.1% (range: −2.4% to −7.1%)) (n = 6), (2) moderate weight loss (median −1.1% (−1.4% to −0.7%)) (n = 7) and (3) low/no weight loss (median +0.8% (range: −0.2% to +3.4%)) (n = 7). Second, interviews were analysed longitudinally, applying content analysis. The concept of career was used to analyse TRE preparation, initiation, continuation and maintenance. Participants who achieved high weight loss when practicing TRE had structured daily routines, consistent meal patterns and strong social support from partners. They adapted quickly to TRE and maintained/furthered their weight loss during follow-up. Although weight loss was an initial motivator for all, participants motivated by health benefits found TRE easier and achieved better weight loss results than those overly focused on losing weight. Participants who achieved moderate weight loss faced TRE challenges due to inconsistent routines and motivations, often switching to ‘traditional dieting’ during follow-up. Participants who achieved low or no weight loss struggled with irregular routines, low social support, guilt when exceeding the eating window and viewing weight loss as an all-or-nothing goal of TRE, making it unmaintainable. In conclusion, successful TRE practice for weight loss requires greater flexibility in the concept, tailored guidance to adapt daily routines and strengthening social support.

Cross-sector interventions are increasingly suggested in care for trauma-affected refugees, but knowledge about how they influence mental health over time remains sparse. Using a qualitative longitudinal design, we explored patterns of mental health change and aspects contributing to change among refugees participating in a cross-sector intervention addressing post-migration stressors alongside treatment for post-traumatic stress disorder. Interviews were conducted with participants at four time points during the intervention and the year after. A pattern-oriented analysis helped identify three patterns of mental health change, in which participants experienced either consistent improvements, decline without the support of the intervention, or persistently poor mental health despite changes to post-migration stressors. The patterns differed in how refugees (a) perceived benefiting from the intervention, (b) desired or benefited from social interactions and support, (c) encountered challenging life events, and (d) explained their expectations and agency. The intervention supported improved mental health in two patterns; however, lasting improvement beyond the intervention period was identified in only one pattern. We discuss adaptations and alternative interventions. Findings support a personalized and cross-sectoral approach to mental health treatment to better support the individual needs of refugee patients.

Many refugees suffer from post-traumatic stress disorder (PTSD), influenced by traumatic experiences and post-migration stressors, including unemployment. This complexity calls for person-centered care (PCC) and interprofessional collaboration across sectors. In this qualitative study we aimed to understand what refugees and professionals from two sectors value about participating in cross-sector network meetings to coordinate and agree on shared plans for PTSD treatment and assessing employability. We conducted interviews with 24 unemployed refugees, 10 physicians, and 20 municipal employment case workers. Results from our thematic analysis demonstrated that all participants appreciated the value of coordinating care and agreeing on next steps. However, the meetings were not void of power dynamics. The refugees valued the physicians being health advocates and preferred the physicians to explain mental health challenges. Equally, the employment case workers looked to the physicians to validate the experiences of the refugees. The physicians thus played a central role in helping refugee patients and employment case workers come to a mutual understanding and way forward. Our results suggest that interprofessional collaboration across sectors supports PCC by fostering trust-building and holistic understanding. However, PCC is also challenged by interprofessional collaboration due to the validated information and documentation required by organizational practices.

Nursing approaches to self-care, self-management, and adaptation to illness encompass diverse strategies aimed at enhancing patient well-being and empowering chronic condition management. The BMC Nursing collection “Nursing Approaches to Self-Care, Self-Management, and Adaptation to Illness” invites research advancing knowledge and care quality in these areas.

Background: Falls among community-dwelling older adults can be significantly reduced through exercises for balance and strength. Digital solutions show promise in increasing the reach and promote adherence to fall prevention exercises among older adults. However, research on long-term engagement in self-managed fall prevention programs is lacking. The Safe Step application is designed, in collaboration with older adults, to motivate and support them in independently engaging in balance and strength exercises. The aim of this study was to explore longitudinal patterns of older adults’ engagement in self-managed fall prevention exercise supported by the Safe Step digital application.

Methods: A qualitative longitudinal study was nested within a randomized controlled trial that evaluated the effectiveness of the Safe Step application in reducing falls among community-living older adults. A selection of participants who maintained an exercise dose of ≥ 60 min each week was invited to the study. Fifteen participants were included. Each participant was interviewed twice, first at the end of a twelve-month trial period and then after an additional six months. The analysis followed the Pattern-Oriented Longitudinal Analysis approach, analyzing patterns of change over time.

Results: Four engagement patterns were identified that began to emerge during the first year and were consolidated over time: (i) Coherent and sustained pattern, (ii) Coherent and episodic pattern, (iii) Integrated and sustained pattern, and (iv) Integrated and episodic pattern. The long-term engagement in self-managed digital fall prevention was characterized by the degree of cohesion and regularity in training. Initially, all participants followed the exercise recommendations provided by the application. With time they developed different strategies to maintain the exercises that resonated with their own preferences and daily activities. Conclusions: The digital program played a meaningful role in initiating and establishing exercise routines, while other determinants also influenced long-term engagement strategies. Support for self-management of fall preventive exercise needs to evolve over time to meet the changing needs of individuals and their different patterns of exercise engagement. Further research is needed to inform digital interventions aimed at supporting long-term engagement in fall prevention programs.

Hard-to-heal arterial leg ulcers in older adults are a challenging and complex condition. In this quasi-experimental study, three treatment approaches were compared. The purpose was to investigate (1) the healing time of arterial leg ulcers in older adults (≥ 70 years) who underwent photobiomodulation, revascularisation, or conservative treatment; (2) the importance of factors associated with impaired healing; and (3) ulcer recurrence after healing with photobiomodulation. Participants who received photobiomodulation (n = 51) were frail older adults recruited from municipal home healthcare and matched with participants who received revascularisation (n = 71) or conservative treatment (n = 153). The latter two groups were retrieved from the Swedish Quality Registry RiksSår for ulcer treatment. Photobiomodulation was performed at wavelengths of 635 and 904 nm twice weekly. The results showed that the photobiomodulation group had a significantly shorter healing time (p < 0.001) and a higher proportion of healed ulcers; photobiomodulation 66.7%, revascularized 50.7% and conservatively treated group 41.2%. The median healing times for the photobiomodulation group were 135 days (confidence interval 95–175), compared to 252 (confidence interval 181–323) and 316 (confidence interval 192–440) in revascularized and conservatively treated groups, respectively. Neither ulcer duration nor other pretreatment factors exerted clinically relevant effects on healing time. In this study, recurrence within 24 months of healing with photobiomodulation was < 12%. In conclusion, photobiomodulation has the potential to heal hard-to-heal arterial ulcers markedly faster than revascularisation or conservative treatment. It could be a suitable treatment alternative for frail older adults, including those with previous substantial ulcer duration.

Background: Self-management is internationally recognized as important to maintain independence, quality of life and to minimize the risk of poor health outcomes, especially among persons with multi-morbidity. Self-management can be especially challenging for older adults, who have higher rates of multi-morbidity and experience diverse impacts of long-term health conditions on everyday life. Good measures of self-management are currently lacking. The Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) is a new, generic, multidimensional measure of self-perceived ease or difficulty with self-management, that overcomes many of the limitations of existing measures.

Objectives: To test the structural validity and test-retest reliability of the Swedish version of the PRISM-CC among seventy-year-olds with long-term health conditions.

Methods: Translation of PRISM-CC items into Swedish followed the Patient-Reported Outcome (PRO) Consortium process. Survey data (n = 516 Swedish seventy-year-olds with ≥1 long-term health condition) was used to assess structural validity of the 36-item PRISM-CC using multidimensional item response theory (IRT) models. Test-retest reliability was assessed on a subsample of 58 individuals using intra-class correlation coefficient (ICC) and Bland-Altman Plots.

Results: The Swedish PRISM-CC demonstrated good internal consistency with Cronbach’s alpha >0.8 for all domains, and good fit to a graded response IRT model (RMSEA 0.034, SRMSR 0.050, CFI 0.952 and TLI 0.945). All 36 items had standardized loadings >0.7. ICC showed moderate to good test-retest reliability for all seven domains. The Bland-Altman plots showed minimal bias and good test-retest agreement for all domains.

Conclusion: The Swedish PRISM-CC showed good structural validity and test-retest reliability in this sample of relatively healthy seventy-year-olds with long-term health condition(s). Further validation in a population with more severe health issues is needed.