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Relocation patterns and predictors of relocation and mortality in Swedish sheltered housing and aging in place
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0001-5005-5024
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.ORCID iD: 0000-0002-5271-4780
Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0001-8439-2248
Umeå University, Faculty of Medicine, Department of Nursing.
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2023 (English)In: Journal of Aging and Environment, ISSN 2689-2618, E-ISSN 2689-2626, Vol. 37, no 4, p. 386-402Article in journal (Refereed) Published
Abstract [en]

A reported objective of Swedish sheltered housing is to postpone care needs and relocation. The aim of this study was to describe migration patterns and explore predictors of relocation to nursing homes and mortality, in a sample of residents in sheltered housing and aging in place. To explore longitudinal differences between groups, study data were combined with registry data. The results showed that a higher percentage of residents in sheltered housing had relocated to a nursing home and deceased over a three-year time period, compared to aging in place, implying further interventions may be required to promote health in sheltered housing.

Place, publisher, year, edition, pages
Routledge, 2023. Vol. 37, no 4, p. 386-402
Keywords [en]
Cohort study, housing for the elderly, longitudinal study, social participation
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-186894DOI: 10.1080/26892618.2022.2103868ISI: 001095413400002Scopus ID: 2-s2.0-85134750392OAI: oai:DiVA.org:umu-186894DiVA, id: diva2:1587830
Funder
Swedish Research Council, 2014-02715Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-04016
Note

Originally included in thesis in manuscript form. 

Available from: 2021-08-25 Created: 2021-08-25 Last updated: 2024-04-05Bibliographically approved
In thesis
1. Exploring resident health, wellbeing, and thriving in Swedish sheltered housing
Open this publication in new window or tab >>Exploring resident health, wellbeing, and thriving in Swedish sheltered housing
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: As the population of older people is expected to increase in the coming decades, an increase in service demand will likely follow. Aging in place is common in Sweden, but may be associated with loneliness, anxiety, and other negative health effects. Swedish sheltered housing began to emerge around 2008, and was aimed at older people who felt socially isolated, anxious, or unsafe aging in place. Swedish sheltered housing was to be a form of independent housing, providing accommodation with increased opportunities for social participation and accessible spaces, but with no provision of health care services. Despite the emergence of such housing, and policy documents outlining anticipated benefits, the national and international scientific body of knowledge is small.

Aim: The overall aim of this thesis was to explore the health, wellbeing and thriving of residents living in Swedish sheltered housing.

Methods: This thesis is based on data from two data collections and registry data. The first data collection, the U-Age Sheltered Housing Survey Study, took place between October 2016 and January 2017, and consisted of surveys sent to residents living in Swedish sheltered housing, and to a matched control group. The matching criteria was age, sex and municipality of residence. The sample for the U-Age Sheltered Housing Survey Study consisted of 3,805 individuals: 1, 955 individuals living in sheltered housing, and  1,850 aging in place. The second data collection took place between April 2019 and January 2020, and consisted of semi-structured interviews in five sheltered housing accommodations which had participated in the U-age Sheltered Housing Survey Study. This data collection consisted of a total of seven group interviews with a sample of 38 residents. In addition, to enable longitudinal analyses, registry data on social services resource utilization and mortality was obtained from The Department of Health and Welfare in Sweden and Statistics Sweden. Data were analyzed using descriptive statistics, linear regression analyses with interaction variables, logistic regressions, and qualitative content analysis.

Results: Residents living in Swedish sheltered housing generally reported lower self-rated health,  lower health-related quality of life, lower functional status, and higher depressive mood, compared to those aging in place. With increasing level of depressive mood, and decreasing levels of self-rated health and functional status, those residing in sheltered housing generally reported higher levels of thriving, compared to those aging in place. A higher proportion of those living in Swedish sheltered housing received home care services, and received on average more home care service hours, compared to those aging in place. Furthermore, a higher proportion of residents living in sheltered housing had relocated to a nursing home and deceased over a 3-year period, compared to those aging in place. Rates of relocation to a nursing home and mortality were higher among those who lived in Swedish sheltered housing and received home care services, compared to those living in Swedish sheltered housing who did not receive home care services. Interviews with residents living in Swedish sheltered housing revealed four different levels to the experienced facilitators and barriers to thriving in Swedish sheltered housing: individual factors, social context, environmental factors and organizational context.

Conclusions: There seems to be both a want, and a potential need, for health care related support among residents living in Swedish sheltered housing. Although residents in Swedish sheltered housing reported slightly lower self-rated wellbeing than older people aging in place, differences in wellbeing did not seem to be explained by type of accommodation per se. There do however seem to be aspects in Swedish sheltered housing that support thriving specifically among those with lower levels of health, lower functional status, and higher depressive mood, when compared to those aging in place. It seems possible that thriving in Swedish sheltered housing may be influenced by the interplay of various especially influential aspects, such as, but not limited to, levels of health, the services provided, the experience of the social environment, and the perceived support. Thereby, providing residents of Swedish sheltered housing with more health care related support and information could further support resident health and thriving. The findings of this thesis contribute to the currently limited pool of knowledge on health, wellbeing, and thriving in Swedish sheltered housing, and may assist in developing tailored services, support, and interventions for the demographic residing in this type of housing.

Abstract [sv]

Bakgrund: Antalet äldre förväntas öka under de kommande decennierna, vilket troligtvis kommer medföra ett ökat behov av service för äldre. Att bo kvar hemma i eget boende är den vanligaste boendeformen bland äldre i Sverige. Detta är en boendeform som har förknippats med ensamhet, oro och andra negativa hälsoeffekter. Trygghetsboende etablerades omkring 2008, och riktade sig till äldre som kände sig socialt isolerade, oroliga eller otrygga hemma. Trygghetsboende skulle vara en form av eget boende, som skulle erbjuda boende med ökade möjligheter till social samvaro och tillgängliga utrymmen, men utan hälso- eller sjukvårdstjänster. Trots framväxten av sådana boenden, samt policydokument som beskriver förväntade fördelar med denna boendeform, så finns ett begränsat nationellt och internationellt vetenskapligt kunskapsunderlag kring hälsa, välbefinnande och trivsel hos äldre personer som lever i trygghetsboenden.

Syfte: Det övergripande syftet var att utforska de boendes hälsa, välbefinnande och trivsel i trygghetsboende.

Metod: Denna avhandling bygger på data från två datainsamlingar samt registerdata. Den första datainsamlingen, en enkätstudie kallad Tygghetsboendestudien, ägde rum mellan oktober 2016 och januari 2017 och bestod av enkäter som skickades till boende i trygghetsboende samt en matchad kontrollgrupp. Matchningskriterierna var ålder, kön och boendekommun. Urvalet för enkätstudien bestod av 3,805 individer: 1,955 individer i trygghetsboende och 1,850 individer i eget boende. Den andra datainsamlingen ägde rum mellan april 2019 och januari 2020, och bestod av semistrukturerade intervjuer på fem trygghetsboenden som hade deltagit i enkätstudien. Denna datainsamling bestod av totalt sju gruppintervjuer, med ett urval av 38 personer som lever i trygghetsboende. För att möjliggöra longitudinella analyser erhölls dessutom registerdata om socialtjänstresursutnyttjande och dödlighet från Socialstyrelsen och Statistiska centralbyrån. Data analyserades med hjälp av beskrivande statistik, linjära regressionsanalyser med interaktionsvariabler och logistiska regressioner samt med kvalitativ innehållsanalys. Resultat

De äldre som bodde i trygghetsboende rapporterade i allmänhet lägre självskattad hälsa, lägre hälsorelaterad livskvalitet, lägre funktionell status, och högre nivå av nedstämdhet jämfört med de i eget boende. Trots högre nivå av nedstämdhet och lägre nivå av självskattad hälsa och funktionell status, rapporterade de som bodde i trygghetsboende i allmänhet högre nivå av trivsel jämfört med de i eget boende. En högre andel av de äldre i trygghetsboende fick hemtjänst, de fick även i genomsnitt fler hemtjänsttimmar jämfört med de i eget boende. Dessutom hade en högre andel äldre i trygghetsboende flyttat till ett särskilt boende och avlidit under en treårsperiod jämfört med de i eget boende. Frekvensen av flytt till annan boendeform och dödligheten var högre bland de som bodde i trygghetsboende och fick hemtjänst jämfört med de som bodde i trygghetsboende och inte fick hemtjänst. I intervjuer med äldre i trygghetsboende framkom fyra olika faktorer som påverkarade trivsel positivt respektive negativt inom trygghetsboende: individuella faktorer, socialt sammanhang, miljöfaktorer och organisatoriskt sammanhang.

Konklusion: Det verkar finnas både en önskan och ett potentiellt behov av vårdrelaterat stöd bland de som bor i trygghetsboende. Även om de äldre i trygghetsboende rapporterade något lägre självskattat välbefinnande än de i eget boende, verkar skillnader i välbefinnande inte förklaras av typen av boende. Det verkar dock finnas aspekter i trygghetsboende som positivt inverkar på trivsel specifikt bland de äldre med lägre nivåer av hälsa, funktionell status och högre nivåer av nedstämdhet jämfört med de som lever i eget boende. Trivsel i trygghetsboende verkar kunna influeras av samspelet mellan olika särskilt inflytelserika aspekter, såsom, men inte begränsat till, nivåer av hälsa, de tjänster som erbjuds, upplevelserna från den sociala miljön och det upplevda stödet. Genom att erbjuda de som bor i trygghetsboende mer hälso- och sjukvårdsrelaterat stöd och information skulle man eventuellt kunna stödja de boendes hälsa och trivsel ytterligare. Resultaten av denna avhandling bidrar till den begränsade vetenskapliga kunskapen om hälsa, välbefinnande och trivsel i trygghetsboende och kan hjälpa till att utveckla bättre skräddarsydda tjänster, stöd och insatser för de som bor i trygghetsboende.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2021. p. 79
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2148
Keywords
sheltered housing, older people, health status, wellbeing, thriving, cross-sectional, longitudinal, nursing, trygghetsboende, äldre, hälsostatus, välbefinnande, trivsel, tvärsnittstudie, longitudinell studie, omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-186898 (URN)978-91-7855-615-1 (ISBN)978-91-7855-614-4 (ISBN)
Public defence
2021-09-24, Aula Biologica, Biologihuset, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2021-09-03 Created: 2021-08-25 Last updated: 2021-09-02Bibliographically approved

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Corneliusson, LauraLövheim, HugoSköldunger, AndersSjögren, KarinEdvardsson, David

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