Ingalill Hallberg - Academia.edu (original) (raw)

Papers by Ingalill Hallberg

Health and Quality of Life Outcomes, 2018

Background: To assess the quality of life of people with dementia, measures are required for self... more Background: To assess the quality of life of people with dementia, measures are required for self-rating by the person with dementia, and for proxy rating by others. The Quality of Life in Alzheimer's Disease scale (QoL-AD) is available in two versions, QoL-AD-SR (self-rating) and QoL-AD-PR (proxy rating). The aim of our study was to analyse the inter-rater agreement between self-and proxy ratings, in terms of both the total score and the items, including an analysis specific to care setting, and to identify factors associated with this agreement. Methods: Cross-sectional QoL-AD data from the 7th Framework European RightTimePlaceCare study were analysed. A total of 1330 cases were included: n = 854 receiving home care and n = 476 receiving institutional longterm nursing care. The proxy raters were informal carers (home care) and best-informed professional carers (institutional long-term nursing care). Inter-rater agreement was investigated using Bland-Altman plots for the QoL-AD total score and by weighted kappa statistics for single items. Associations were investigated by regression analysis. Results: The overall QoL-AD assessment of those with dementia revealed a mean value of 33.2 points, and the proxy ratings revealed a mean value of 29.8 points. The Bland-Altman plots revealed a poor agreement between self-and proxy ratings for the overall sample and for both care settings. With one exception (item 'Marriage' weighted kappa 0.26), the weighted kappa values for the single QoL-AD items were below 0.20, indicating poor agreement. Home care setting, dementia-related behavioural and psychological symptoms, and the functional status of the person with dementia, along with the caregiver burden, were associated with the level of agreement. Only the home care setting was associated with an increase larger than the predefined acceptable difference between self-and proxy ratings. Conclusions: Proxy quality of life ratings from professional and informal carers appear to be lower than the self-ratings of those with dementia. QoL-AD-SR and QoL-AD-PR are therefore not interchangeable, as the inter-rater agreement differs distinctly. Thus, a proxy rating should be judged as a complementary perspective for a self-assessment of quality of life by those with dementia, rather than as a valid substitute.

Aging & Mental Health, 2020

Objectives: This study aimed to investigate the occurrence of suicidal ideation and associated fa... more Objectives: This study aimed to investigate the occurrence of suicidal ideation and associated factors in older persons with dementia living at home in eight European countries, and its association with quality of life. Furthermore, changes in suicidal ideation over time were investigated. Methods: This cohort study (n ¼ 1,223) was part of the European "RightTimePlaceCare" project conducted in 2010-2013. Participating countries were Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the United Kingdom. Baseline and follow-up data were analysed using bivariate and multivariate logistic regression. Results: The occurrence of suicidal ideation in the participating countries varied between 6% and 24%. Factors significantly (p < 0.0018) associated with suicidal ideation using bivariate analysis were: nationality, depressive symptoms, delusions, hallucinations, agitation, anxiety, apathy, disinhibition, irritability, night-time behaviour disturbances, anxiolytics and anti-dementia medication. In the multivariate regression analysis, country of origin, moderate stage of the dementia, depressive and delusional symptoms, and anti-dementia medication were significantly associated with suicidal ideation (p < 0.05). Over time, suicidal ideation decreased from severe to mild or became absent in 54% of the persons with dementia. Conclusion: It is essential that professionals identify older persons with dementia and suicidal ideation and depressive and other psychological symptoms in order to give them appropriate treatment and provide relief for their informal caregivers. We emphasize the importance of identifying suicidal ideation, irrespective of depressive symptoms, and specifically of paying attention to persons with moderate dementia. Living with the informal caregiver seems to be associated with staying stable without suicidal ideation.

BMC Geriatrics, 2019

Background: Dementia is a syndrome, with a wide range of symptoms. It is important to have a time... more Background: Dementia is a syndrome, with a wide range of symptoms. It is important to have a timely diagnosis during the disease course to reduce the risk of medication errors, enable future care planning for the patient and their relatives thereby optimizing quality of life (QoL). For this reason, it is important to avoid a diagnosis of dementia not otherwise specified (DNOS) and instead obtain a diagnosis that reflects the underlying pathology. The aim of this study was to investigate the prevalence and associated factors of DNOS in persons with dementia living at home or in a nursing home. Methods: This is a cross-sectional cohort study performed in eight European countries. Persons with dementia aged ≥65 years living at home (n = 1223) or in a nursing home (n = 790) were included. Data were collected through personal interviews with questionnaires based on standardised instruments. Specific factors investigated were sociodemographic factors, cognitive function, and mental health, physical health, QoL, resource utilization and medication. Bivariate and backward stepwise multivariate regression analyses were performed. Results: The prevalence of DNOS in the eight participating European countries was 16% (range 1-30%) in persons living at home and 21% (range 1-43%) in persons living in a nursing home. These people are more often older compared to those with a specific dementia diagnosis. In both persons living at home and persons living in a nursing home, DNOS was associated with more severe neuropsychiatric symptoms and less use of anti-dementia medication. In addition, persons with DNOS living at home had more symptoms of depression and less use of antidepressant medication. Conclusions: The prevalence of DNOS diagnosis is common and seems to vary between European countries. People with DNOS are more often older with more severe neuropsychiatric symptoms and receive fewer anti-dementia medication, anxiolytics and antidepressants. This would support the suggestion that a proper and specific diagnosis of dementia could help the management of their disease.

Journal of Nutrition Health & Aging, 2013

Background: To meet the increasing needs for persons with dementia and their relatives a well-fun... more Background: To meet the increasing needs for persons with dementia and their relatives a well-functioning health care system in which resources are used optimally is needed. For this to be achieved requires strategy and planning of synergies between the different cares providers. This study will explore professional caregivers' and stakeholders' views of best practice in terms of information, collaboration and communication in dementia care. Aim: The aim of the study was to explore professional care providers' and stakeholders' views of best practice in concepts of information, collaboration and communication throughout the trajectory of care from diagnosis to end of life care for persons with dementia in Sweden. Method: The study had a qualitative approach based on three focus group interviews with a variation among participants regarding professions and workplaces to represent different types of care for persons with dementia from diagnosis to end of life care. The transcribed verbatim was analyzed with qualitative content analysis. Preliminary results: In early stages primary health care specialized in dementia had close collaboration, training and mentoring, with memory clinic and home care. In the later stages the person with dementia had less frequent contacts with primary health care. Day care played an important role in information delivery of the disease, in collaboration with home and institutional care. In the latest stage the family had an important role as a proxy for the person with dementia about desires in the care. Conclusion: A well-functioning network in professional care seems to have an impact on persons with dementia to remain at home despite loss of mental and physical functions. On the behalf of RightTimePlaceCare consortium.

Objectives: To investigate persons with dementia and their informal caregivers’ views of inter-se... more Objectives: To investigate persons with dementia and their informal caregivers’ views of inter-sectoral information, communication and collaboration throughout the trajectory of dementia care, in e ...

Nordic journal of nursing research, Sep 1, 1994

Studies on aspects of nutrition in patients with congestive heart failure have focused the nutrit... more Studies on aspects of nutrition in patients with congestive heart failure have focused the nutritional status. Problems related to eating have been covered to a much lesser extent. The aim of this pilotstudy was to study the patients' functional eating capacity, the process of eating and the experience of eating. The respondents were at the age of 65 + and suffered from severe congestive hearth failure. Data were collected by means of physical investigation of the oral cavity; experience of food, appetite, hunger, using semantic differentials, observations of two meals per patient and interviews of patients after each meal. The result showed that the patients had detailed opinions about what they could eat and how and experienced a changed taste for food and eating during the progress of the disease. The appetite was reduced, they did not experience hunger any more, they felt very dry in their mouth and extremely tired, physically as well as existentially. None of the patients were able to eat a whole portion of food and they felt physically tired after the meals.

Age and Ageing, Sep 1, 2017

Objectives: to evaluate the frequency of potentially inappropriate medication (PIM) prescription ... more Objectives: to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study 'RightTimePlaceCare', and to evaluate factors and adverse outcomes associated with PIM prescription. Methods: survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries

Nursing Practice Today, 2021

Nursing science has seen a remarkable development in terms of scientific publications in which nu... more Nursing science has seen a remarkable development in terms of scientific publications in which nurses are the lead authors. There has also been an impressive change in nurse education. Nowadays, it is mostly academic, in the form of a bachelor's degree, and the number of nurses gaining a master's degree or a Ph.D. has increased dramatically in many countries. This change is manifested, for instance, in scientific publications showing the participation of nurses in developing the knowledge base for health-care practice (1,2). Further, there are good examples of research that has led to innovations that may change practice. For instance, a group of researchers has, with a new technique, investigated individual blood flow responses to physical pressure in frail older people, for instance, bedridden people. The aim has been to deepen the knowledge about mechanisms in developing pressure ulcers (3). This research line has now contributed to the development of an objective sensor (PUsensor) that identifies pressure-induced blood flow, allowing identification if a local area under pressure is responding to pressure with increased blood flow and thereby a decreased risk of developing pressure ulcer (4). Behind this invention lies years of research attempting to understand the process leading to pressure ulcers in severely ill or bedridden patients (5). I am sure there are many more examples like this with successful, sustainable, and innovative research. Having said this,

Nursing Practice Today, 2018

European Oncology & Haematology, 2016

Cancer in old age means a complex situation that may differ depending on where in the aging proce... more Cancer in old age means a complex situation that may differ depending on where in the aging process the person is. For the older patient it is a reminder of that life is going to its end. Cancer treatment is to be provided in addition to handling other health problems and the overall frailty that goes with old age. Comprehensive geriatric assessment and case management may be a way to handle the frailty and merging oncology and geriatric knowledge.

International psychogeriatrics / IPA, Jan 11, 2015

This study forms part of a larger European programme investigating the transition from home care ... more This study forms part of a larger European programme investigating the transition from home care to long-term care (LTC) facility in people with dementia (PwD) at the margins of LTC. The aim of this study was to explore the factors associated with depressive symptomatology in PwD in different settings. A total of 1,538 PwD, of which 957 received home care and 581 lived in a LTC facility, and their carers were interviewed. The Cornell Scale for Depression in Dementia (CSDD) measured depressive symptomatology. PwD completed measures of cognition and quality of life (QoL), and informal or formal carers completed measures on the PwD' QoL, neuropsychiatric behavior, activities of daily living, comorbidities, pain, and falls. Logistic regression was used to assess which factors contributed to depressive symptomatology in the two settings. Those receiving home care, living in Germany, and with severe dementia, showed the highest prevalence of depressive symptomatology. In the home care...

International Journal of Nursing Studies, 2003

The aim of this study was to illuminate nurses' experiences of the encounter with elderly patient... more The aim of this study was to illuminate nurses' experiences of the encounter with elderly patients who developed acute confusional state (ACS) in orthopaedic care. Forty-eight nurses with professional background as registered (n ¼ 26) or licensed practical nurses (n ¼ 22) who took part in the nursing care of acute confused patients were involved. Open-ended unstructured interviews were conducted with regard to the course of events, experiences and interpretation of what had happened during the ACS as well as the nurses' actions and encounter with the confused patient. The texts were analysed using manifest and latent content analysis, revealing that the nurses had difficulties in reaching the patients and their reality, and thus in understanding their experiences. Interpretation of the nurses' experiences showed that the nurses found it difficult to reach the patients' reality because the patients were in a divided and/or different world. They interpreted the patients as seeking solitude or company, keeping a distance or being suspicious of the nurses. The findings indicated that the interaction in the encounter between the acutely confused patients and the nurses indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and/or being a surrogate. They acted in the encounter based on their view of the patient and their ability to enter into and understand the patients' situation. The strategies were more or less successful, sometimes resulting in contact and calming the patients and in other cases increasing the patients' irritation and anger. The results were more successful when the strategies were derived from the nurses' interpretation of the patients' situation and the nurses paid attention to the patients and confirmed them.

Clinical Effectiveness in Nursing, 2006

ABSTRACT Few Quality of Life (QoL) instruments in use today were originally developed for older p... more ABSTRACT Few Quality of Life (QoL) instruments in use today were originally developed for older populations (75+). Information on their validity and reliability in this age group is sparse. The current study investigated the psychometric properties of the Life Quality Gerontological Centre Scale (LGC), a general QoL instrument designed for use among older people. A further aim was to describe and compare QoL with gender and in people needing help with Activities of Daily Living and those not needing such help. A postal questionnaire surveyed 1093 people (mean age 82.7, SD 5.3). Principal component analysis revealed that LGC was reasonably stable as the construct-and cross validation more or less replicated the suggested QoL factors. The instrument differentiated between needing help and not and between men and women. LGC needs further development with respect to reliability, face and content validity but is potentially useful as a diagnostic or an outcome assessment after interventions among older people. Individuals in need of help and women had lower scores in several QoL areas and in total QoL scores compared to those not needing help and men. Older people’s QoL may be improved by interventions directed to areas beyond health and physical functioning. Men and women might also benefit from different interventions directed towards QoL.

TOGERIMJ, 2008

The aim of the study was to investigate medical health care and informal care consumption among o... more The aim of the study was to investigate medical health care and informal care consumption among older people receiving public long-term care, and factors associated with medical health care consumption. 1958 persons aged 65 years and over were included. Data were collected from two registers, including demography, functional ability and received long-term, informal and medical health care. 35% of those at home were admitted to hospital and 76% had contact with outpatient care by physician compared to 26% and 87% respectively of those in special accommodation. Living in special accommodation was associated with more contacts with primary health care and fewer contacts with specialist care other than psychiatric care. Informal care was associated with more contacts with primary health care, specialist care, admissions to and days in hospital. More elderly people being cared for at home may mean more hospital and outpatient care consumption.

International journal of nursing studies, 2008

Old people's life situation when receiving municipal help and care in their last period of l... more Old people's life situation when receiving municipal help and care in their last period of life is sparsely investigated from their own perspective.

Scandinavian Journal of Caring Sciences, 2008

This is an author produced version of a paper published Scandinavian journal of caring sciences. ... more This is an author produced version of a paper published Scandinavian journal of caring sciences. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.

Scandinavian Journal of Caring Sciences, 2009

Utilization of medical healthcare among people receiving long-term care at home or in special acc... more Utilization of medical healthcare among people receiving long-term care at home or in special accommodation Aim: To investigate the utilization of medical healthcare, hospital care and outpatient care, during a 1-year period in relation to informal care, multimorbidity, functional status and health complaints and to long-term care at home or in special accommodation among people aged 65+, with one or more hospital admissions and receiving long-term care. Method: A total of 694 people receiving long-term care during the year 2001 were studied. Data were collected by means of the administrative registers Patient Administrative Support in Skå ne and PrivaStat and through the study Good Ageing in Skå ne. Those at home and those in special accommodation were compared regarding utilization of medical healthcare, informal care, multimorbidity, functional status and health complaints. Multiple logistic regression analysis was performed using at home vs. in special accommodation as the dependent variable and also two multiple linear regression analyses using the number of hospital stays and the number of contacts with the physician in outpatient care separately as dependent variables. Findings: Those at home were significantly younger (mean age: 81 vs. 84 years) and less dependent in personal and instrumental activities of daily living (PADL/IADL) than those in special accommodation. A larger proportion of those at home was admitted to hospital three times or more (21 vs. 14%) and they had significantly more contacts with physicians in outpatient care (md: 10 vs. md: 7). Informal care was associated with care at home (OR = 0.074) and with utilization of outpatient care (B = 2.045). Dependency in PADL was associated with care in special accommodation (OR = 1.375) and with utilization of hospital care (B =)0.060) and outpatient care (B =)0.581). Conclusion: Medical healthcare seems more accessible to those who live at home are younger, less dependent and who have access to informal caregivers.

Quality of Life Research, 2004

The aim was to investigate the influence of age and gender on quality of life (QoL), complaints, ... more The aim was to investigate the influence of age and gender on quality of life (QoL), complaints, and the presence and nature of self-reported diseases in persons aged 75 and older with cancer (n ¼ 150), compared to a matched group without cancer (n ¼ 138). A second aim was to investigate factors associated with poor QoL in people aged 75 and older. QoL was measured with Short Form (SF-12) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). The study showed that the cancer group had lower (poorer) scores in different domains of QoL, more complaints, and more self-reported diseases than the group without cancer. In both groups, oldest old persons had more complaints than the youngest old. The cancer group had significantly more complaints than the noncancer group. In the youngest old, the cancer group had significantly more complaints than the comparison group. Women with cancer reported the poorest QoL compared to men with cancer and women without cancer. Receiving help for daily living from others and degree of complaints were associated with poor QoL for both the physical and mental component scores (PCS, MCS) of the SF-12. Thus, caregivers should be aware that the most vulnerable cancer patients are women, and that the complaints by cancer patients have implications for QoL especially among the youngest old.