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Home care assistants' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity
Sophiahemmet University.ORCID iD: 0000-0002-5923-8764
Sophiahemmet University.ORCID iD: 0000-0002-6109-1992
Sophiahemmet University.ORCID iD: 0000-0003-0971-5283
2016 (English)In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 9, 83-95 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Elderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs). Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients’ mental health status.

Aim: To describe HCAs’ perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity.

Methods: We applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs.

Results: Most HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors’ own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health. Conclusion: The HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of loneliness, and increasing physical activity. The results indicate that the HCAs seemed dependent on supervision by district nurses and on care managers’ decisions to support the needed care, to schedule assignments related to the detection of mental health problems, and to promote mental health.

Place, publisher, year, edition, pages
2016. Vol. 9, 83-95 p.
Keyword [en]
Home care assistants, Mental health promotion, Municipal care, Older people, Sweden
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:shh:diva-2001OAI: oai:DiVA.org:shh-2001DiVA: diva2:876053
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-06-10Bibliographically approved
In thesis
1. Mental health promotion among community-dwelling seniors with multimorbidity: perspectives of seniors, district nurses and home care assistants
Open this publication in new window or tab >>Mental health promotion among community-dwelling seniors with multimorbidity: perspectives of seniors, district nurses and home care assistants
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The prevalence of mental illness is increasing among the older population in Sweden. One of the most vulnerable groups for mental health problems is older persons with multimorbidity, i.e. seniors with multiple chronic conditions. Many of them remain in their own homes with a comprehensive and complex need of support and healthcare, mainly provided by home care assistants (HCAs) and district nurses (DNs). However, the detection of mental health problems for adequate treatment or to promote mental health among community-dwelling seniors with multimorbidity, calls for skills and competences in this area.This thesis aimed to gain a deeper understanding of how mental health may be promoted among community-dwelling seniors with multiple chronic conditions. Four studies have been included in this thesis (I-IV). All studies had a qualitative descriptive design with either a phenomenographic approach or latent and manifest qualitative content analysis technique. The aim of study I was to describe the variations in how community-dwelling seniors with multimorbidity perceived the concept of mental health and what may influence it. The findings showed the participants conceptualised mental health as having both positive and negative facets. The participants further conceived that social contact, physical activity and optimism may improve mental health, while social isolation, ageing, and chronic pain may worsen it. Study II aimed to describe the experience of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity, and what these seniors believed to be important for achieving a dialogue that may promote their mental health. The main finding was the necessity of being seen as a unique individual by an accessible and competent person. Further, the participants missed having friends and relatives to talk to and they especially lacked healthcare or social service providers for health-promoting dialogues that may promote mental health. The aim of study III was to describe DNs’ perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity. Findings revealed that the DNs’ focus was on assessment, collaboration and social support as a way of detecting mental health problems and promoting mental health. Study IV described HCAs’ perspectives on detecting mental health problems and promoting mental health among the seniors in focus. The findings revealed that continuity of care and the seniors’ own thoughts and perceptions were regarded as essential for the detection of mental health problems. Further, observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health.Conclusions: The results of this thesis are based on interviews and show that: 1) Seniors with multimorbidity should have an opportunity to describe how multiple chronic conditions may affect their life situation; 2) An optimal level of care can be achieved through continuity, involvement, and by providing a health-promoting dialogue based on the person’s wishes and needs; 3) Even if DNs seemed engaged in primary mental healthcare, there were no expressed goals set in the improvement of mental health, and it seemed that these DNs could not bear the primary responsibility for early detection of mental health problems and early interventions to improve mental health; 4) HCAs had knowledge about risk factors for mental health problems and it appears that they were dependent on care managers’ decision-making in granted support, as well as supervision from DNs in the detection of mental health problems and to promote mental health.In summary, the finding in the present thesis demonstrates that managing mental health problems is still an ongoing challenge for those organisations providing continuity in home care and home healthcare for homebound elderly persons with complex chronic conditions. The finding in the thesis also shows that DNs and HCAs seem to be dependent on each other in this area. Mental health promotion was expressed as an important assignment among DNs and HCAs, even though they describe different prerequisites and factors which could be seen as barriers in the detection of common mental health problems such as depression, anxiety and sleep problems. These personnel further described difficulties in collaboration and transmission of information between care- and healthcare providers from the community and primary care context. Social and physical interventions - as well as social contacts and social support to break social isolation - seemed important according to all the informants, with their different perspectives of how mental health may be promoted.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2015. 95 p.
Keyword
Ageing, Care of older people, District nurse, Home care assistants, Mental health, Mental health promotion, Municipal care, Nursing, Older people, Primary healthcare, Sweden
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:shh:diva-2002 (URN)978-91-7676-076-5 (ISBN)
Public defence
2015-12-11, Erforssalen, Sophiahemmet Högskola, Valhallavägen 91, Ingång R, Stockholm, 13:00
Opponent
Supervisors
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-06-09Bibliographically approved

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