Background: Most patients die in hospital settings either in intensive care unit (ICU), emergency department (ED) or other departments. In Saudi Arabia, approximately 23,000 persons are diagnosed with cancer every year. According to the World Health Organization (WHO), palliative care is a holistic activity that involves physical, psychosocial and spiritual human needs to enhance quality of life for patients and their families. Palliative care is an essential aspect to be applied for patients with chronic diseases to improve their quality of life. Earlier studies have shown that physicians, nurses and nurse assistants who work in long-term care settings lack the knowledge to enforce palliative care principles due to lack of education. According to the WHO, health care professionals should be educated and trained to apply palliative care.Aim: The aim of this study was to explore nurses' knowledge about palliative care in an intensive care unit in Saudi Arabia. Method: Eight individual qualitative semi-structured interviews were conducted. Interviews were audiotaped and transcribed verbatim. Manifest content analysis was used to analyze the data. Results: The palliative care concept was not familiar for most ICU nurses but it was applied in their daily work. Most nurses provided physical care at the end of life to keep the body intact. Some nurses highlighted that dying patients did not feel pain to be treated and did not have emotions to be supported.Conclusions: Nurses had insufficient knowledge of palliative care and how to apply it in ICU setting. The provision of additional education in palliative care is recommended in order to improve the knowledge of palliative care among nurses.

BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge.

AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care.

METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis.

RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality.

CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients.

IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care.

AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care.

DESIGN: A qualitative descriptive study.

METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used.

FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process.

CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine.

RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

AIMS AND OBJECTIVE: To explore registered nurses' perceptions of safe practice in care for patients with an extended length of stay in the emergency department.

BACKGROUND: Extended length of stay and overcrowding in emergency departments are described internationally as one of the most comprehensive challenges of modern emergency care. An emergency department is not designed, equipped or staffed to provide care for prolonged periods of time. This context, combined with a high workload, poses a risk to patient safety, with additional medical errors and an increased number of adverse events. From this perspective, it is important to extend our knowledge and to describe registered nurses' experiences of safe practice.

DESIGN: A qualitative, inductive and descriptive study.

METHODS: Qualitative interview study carried out in five emergency departments. Data were analysed using a qualitative content analysis with a latent approach.

RESULTS: Patient safety meets obstacles in the clinical environment involving experiencing deficiencies regarding patient safety in the clinical setting and the impact of working procedures and routines. Moreover, nurses are challenged in their professional responsibilities involving balancing essential nursing care and actual workload; it is common to experience emotional reactions based on feelings of loss of control.

CONCLUSIONS: From the nurses' perspective, a prolonged stay in the emergency department may lead to negative consequences for both patient safety and care as well as registered nurses' psychosocial experiences. An extended length of stay significantly reduces the level of nursing and caring that registered nurses can perform in the emergency department. This article is protected by copyright. All rights reserved.

AIMS AND OBJECTIVES:

To describe district nurses' perspectives on detecting mental health problems and promoting mental health among homebound older people with multimorbidity.

BACKGROUND:

Mental health problems among older people with multiple chronic conditions, that is, multimorbidity, are challenging issues. These patients' homes often serve as arenas in which district nurses can promote health. Mental health promotion must be studied in greater depth within primary care because older people with multimorbidity are particularly prone to developing poor mental health, which can go undetected and untreated.

DESIGN:

A descriptive, qualitative study using semi-structured interviews and content analysis.

METHODS:

Twenty-five district nurses completed individual or focus group interviews. Data were analysed using qualitative content analysis.

RESULTS:

Most district nurses stated that detecting mental health problems and promoting mental health were important tasks but that they typically focused on more practical home health care tasks. The findings revealed that district nurses focused on assessment, collaboration and social support as means of detecting mental health problems and promoting mental health.

CONCLUSIONS:

The district nurses described various factors and actions that appeared to be important prerequisites for their involvement in primary mental health care. Nevertheless, there were no established goals for mental health promotion, and district nurses often seemed to depend on their collaboration with other actors. Our findings indicated that district nurses cannot bear the primary responsibility for the early detection of mental health problems and early interventions to promote mental health within this population.

RELEVANCE TO CLINICAL PRACTICE:

The findings of this study indicated that workforce training and collaboration between different care providers are important elements in the future development of this field. Early detection and early treatment of mental health-related issues should also be stated as explicit objectives in the provision of care to community-dwelling older people with multimorbidity.

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.

OBJECTIVES: Mental health problems are a major issue worldwide, and there is a need to further explore factors that may increase or decrease people's subjective well-being (SWB). The main aim of the present study was to extend knowledge concerning changes in cohabitation, social support or financial situation and their influence on SWB, after controlling for personality (i.e. neuroticism), in a 3-year follow-up of an adult population-based sample. The change in overall well-being was also studied during the 3- year interval. STUDY DESIGN: Longitudinal design. METHODS: A random sample of Swedish citizens, aged 20-64 years, residing in Stockholm County received a questionnaire by post, comprising items pertaining to demographics, personality, social support and SWB. All the respondents received a second questionnaire 3 years later. In total, 8324 subjects were included in the present study. RESULTS: The overall well-being of the study sample was relatively stable. Separate analyses of the three life circumstances indicated that, after controlling for personality, positive and negative changes in each sphere of life still affected SWB. CONCLUSIONS: Despite personality and the stability of SWB, these results indicate that changes in financial situation, social support and cohabitation influence SWB. It is important for society and the healthcare services to be aware that a negative change in any of these life circumstances may lead to decreased well-being for a period of at least 3 years.

Objectives: The aim of this study was to see if earlier findings about factors associated with well-being could be replicated in a large population-based sample in Sweden. To the best of our knowledge, no research on well-being has been conducted on such a large population in a country, which by most standards is regarded as one of the most fortunate in the world. With its economic wealth and highly developed social welfare and health care system, Sweden is a country where the conditions for a high level of well-being would appear to be met. Methods: 10,441 randomly selected Swedish citizens, aged between 20 and 64 years, living in Stockholm County, completed a questionnaire covering issues such as demographics, social network and psychological well-being. The data were collected during the years 1998-2000. Results: Male gender, greater age, cohabiting, good childhood conditions, support from friends, sound financial situation and absence of negative life events were positively associated with well-being and explained 20% of the variance. Conclusion: The findings replicated earlier studies. Factors associated with well-being seem to remain the same, and are still explaining only a small part of the total variance, despite different measurements, time, sample sizes or country of origin. Therefore, research on well-being needs to take a new turn, by placing less focus on external factors and more focus on the internal factors, such as a person's personality and coping strategies

Objectives: The aim of this study was to describe what kind of self-care strategies people report using to improve or maintain their well-being. Furthermore, we also wanted to investigate whether reports of using self-care strategies were associated with well-being. Methods: A selected sample (n = 871), aged between 20 and 64 years, living in Stockholm County, answered an open-ended question about self-care strategies. Well-being was assessed using the WHO (Ten) well-being index. Results: Ten different categories were found. The most commonly reported self-care strategy was physical exercise, followed by social support and engaging in pleasurable activities. Physical exercise, social support, relaxation, and physical health were associated with a better well-being, social support being strongest correlated. Conclusion: The results suggest that reports of using certain self-care strategies are associated with a better well-being

This thesis examines well-being among the very old and the factors believed to influence the three components of well-being called life satisfaction, positive affect and negative affect. It also examines activity patterns, the factors related to activity and the consequences of different types of activity for well-being. The study is part of the Kungsholmen project which involved all inhabitants aged 75 years and over, living in a specific part of the inner city of Stockholm. This thesis covers 105 subjects who were 90 years and older, scoring 24 points or above on the Mini-Mental State Examination. Well-being was assessed with the Positive and Negative Affect Schedule, the Life Satisfaction Index-B and the Life Satisfaction Index-Z.

Study I examined fife satisfaction among the very old and the factors believed to influence life satisfaction. Life satisfaction was slightly lower than in other studies, which involved samples of younger elderly. In addition, factors such as life events, activities, personality and social contacts were assessed in order to determine their relative influence on life satisfaction. The very elderly tended to have higher life satisfaction if they had an extraverted and emotionally stable personality, excellent subjective health, good social relationships, and if they did pleasurable activities. The factors associated with life satisfaction were also investigated qualitatively. With this approach we found out what the elderly themselves believe gives them life satisfaction, The quantitative and qualitative data came up with some factors in common (e.g., health, family contacts), but there were some differences as well.

Study II examined Positive Affect and Negative Affect among the very old and the factors, which might influence these. Results showed that Positive Affect and Negative Affect were virtually uncorrelated. Comparing the results with studies of younger age groups, Positive Affect appears to decrease with age, while Negative Affect shows no clear age trend. The very elderly tended to have higher Positive Affect during the past year if they had excellent health, an extraverted personality, a definite religious or non religious belief, lived with another person, had good social relationships, read a lot, were well educated and followed radio/TV news. They seemed to have higher Negative Affect during the past year if they scored high on neuroticism, had many adverse life events, did not read, and did not participate in group activities.

Study III examined activity patterns among the very old, the factors related to activity and the consequences for well-being. Activities over the previous day were rated for degree of intellectual, social and physical activity. This age group tended to have variable but relatively low activity levels over the day. Good health and not moving house were associated with greater intellectual activity. Extraversion and negative life events (such as death of close friend or family member) were associated with greater social activity, while younger age and better health were associated with greater physical activity. There was also a positive association between physical activity and well-being.

Study IV examined whether there is an association between objective health, measured as clinical medical diagnoses, and well-being among the very old. Subjects were given a medical examination covering eye diseases, osteoarticular diseases, cancer, cerebrovascular diseases, bronchopulmonary diseases, heart diseases, and endocrine diseases. The data suggested there is no association of physical diagnoses with well-being, despite the fact that a self-rated health measure was found to be associated with life-satisfaction.

Study V focused on the subjective experience of extreme old age for people scoring high and low respectively on well-being measures. The purpose was to illustrate and expand upon the quantitatively derived findings from previous studies using a qualitative approach inspired by Grounded Theory. The results suggested that 'outlook on life', 'social and emotional ties', engagement with the outside world' and 'physical capability' are important contributors to subjectively experienced well-being in this age group.

In these studies, personality emerged as the major determinant of well-being. In addition, the results showed that this age group has a low activity level which is affected by factors such as health, personality and life events.

AIM: to measure activity patterns in very old people, the factors related to this and the association of different types of activity with well-being.

METHODS: a study of 105 people, aged 90 years or older, who were not cognitively impaired, living in Stockholm. The activities carried out during the previous day were recorded and each activity was rated.

RESULTS AND CONCLUSIONS: the degrees of intellectual, social and physical activity are independent of each other. Very elderly people tended to have variable but relatively low activity levels over a day. Good health and not moving home were associated with greater intellectual activity. Extraversion and negative life events (such as death of close friend or family member) were associated with greater social activity, while relatively younger age and better health were associated with greater physical activity. There was positive association between physical activity and well-being.

The purpose of the study was to measure life satisfaction and the factors believed to influence it. The study involved 105 very old people, ninety years and above, who were not cognitively impaired, living in the inner part of Stockholm, Sweden. In order to assess life satisfaction, the Life Satisfaction Index-B (LSI-B) and Life Satisfaction Index-Z (LSI-Z) were used. Information about life events, activities, personality and social contacts were collected in order to determine their relative influence on life satisfaction. Factors associated with life satisfaction were also investigated in a content analysis to find out what the elderly themselves believe gives them life satisfaction. Results showedthat health and an emotionally stable personality were, independently of other factors, the most important factors for life satisfaction among the very old.

The purpose of the study was to measure positive affect (PA) and negative affect (NA), and the factors that might influence these in the very elderly. The study involved 105 people, 90 years and older, who were not cognitively impaired, living in the inner part of Stockholm. The Positive and Negative Affect Schedule was translated and used to measure affect. Results       showed that PA and NA were virtually uncorrelated. Furthermore, it was also demonstrated that the factors that influence affect in the very elderly are similar to those influencing affect in younger ages and that personality traits are the major correlates of affect.

This paper focuses on the subjective experience of extreme old age for 12  people scoring high and low respectively, on wellbeing measures. The purpose  was to illustrate and expand upon the quantitatively derived findings from a  previous study of nonagenarians living in Stockholm, using a qualitative  approach inspired by grounded theory. The results suggest that outlook on  life, social and emotional ties, engagement with the outside world and physical  capability are important contributors to subjectively experienced wellbeing in  this age group.

BACKGROUND: Inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD) have great impact on patients' health-related quality of life (HRQOL). The aim of this study was to develop an integrated medical and psychological/ psychosocial group-based intervention program for IBD patients and to evaluate if such a program could influence the patients' HRQOL and coping abilities.

METHODS: IBD patients in remission or with low disease activity were randomized to intervention or control groups. The intervention comprised nine weekly sessions, alternating lectures, and group therapy sessions. The Inflammatory Bowel Disease Questionnaire (IBDQ) and the Sense of Coherence scale (SOC) were used to measure HRQOL and coping ability at 0, 6, and 12 months. The intervention was evaluated by a visual analog scale (VAS) and written comments by a content analysis.

RESULTS: In all, 24 patients were included in the intervention group and 20 in the control group. The mean IBDQ score showed no statistically significant differences before (173.9) or after the intervention at month 6 (175.7) or at month 12 (171.8), or when comparing intervention and controls at month 12. Similarly, there were no statistically significant differences in mean SOC before or after intervention or when comparing groups. The VAS and the content analysis showed that the intervention was well appreciated by the patients.

CONCLUSIONS: The group-based intervention program was feasible and highly appreciated. There were no statistically significant differences in average IBDQ or SOC over time or in comparison with controls, although a significant increase was seen in patients with short disease duration.

AIM: To describe family members' experiences of living with persons with neuropsychiatric symptoms (NPS) related to frontotemporal dementia (FTD).

BACKGROUND: The majority of persons with dementia during the disease trajectory develop NPS. Persons with FTD are likely to develop greater levels of NPS than persons with other types of dementias. Research-based knowledge regarding family members' experiences of living with persons with FTD and NPS is limited.

METHODS: Nine family members of persons with FTD were interviewed. Interviews commenced with completion of the Neuropsychiatric Inventory (NPI). Upon completion of the NPI, questions were posed from an interview guide where study participants provided in-depth information about NPS identified. Interview data were analysed using qualitative content analysis.

RESULTS: Interviewed family members highlighted that persons with FTD had developed between four and eight co-existing NPS. Irritability and disinhibition were the most common NPS, with variations in severity, frequency and distress. From the interview data, two themes emerged: Living with a well-known stranger and Coping and overstepping social norms.

CONCLUSIONS: Living with a well-known stranger depicted a new co-existence with a loved one with changes in personality and behaviour, which were not inherent to the person or predictable any more. The presence of NPS can threaten the safety of the person with FTD and their family in real world and on social media. Support offered should focus on the person's physical and psychological needs, not on a diagnosis.

IMPLICATIONS FOR PRACTICE: From a health care perspective it is important to see the person with FTD and their family as unique individuals with specific needs.

AIM: To describe older persons' experiences of a cognitive assessment and possible neuropsychiatric symptoms [NPS] related to a neurocognitive diagnosis.

BACKGROUND: A cognitive assessment in primary care is offered to persons with suspected dementia with subsequent referral to a specialist clinic if required. The assessment process, with the likelihood of receiving a dementia diagnosis, is surrounded by uncertainty with long waiting times. Although NPS are common among persons with cognitive impairment persons are not routinely asked about these symptoms during a cognitive assessment.

METHOD: Interviews were held with 18 participants who had completed a cognitive assessment. The Neuropsychiatric Inventory [NPI] was incorporated into one of the interview questions enabling participants to self-report NPS, if present. Interview data were analysed using Interpretive Description.

RESULTS: Two main themes were identified: a matter of trust and making sense of a cognitive diagnosis. Experiences of the assessment process ranged from feeling valued to abandoned with variations of trust in the process. A diagnosis of mild cognitive impairment was experienced as an abstract diagnosis devoid of follow-up support. A lack of preparedness for the assessment existed among participants. Some experienced the process as standardised. One half of participants self-reported the presence of one to four NPS, regardless of neurocognitive diagnosis. Irritability and depression were most common NPS identified.

CONCLUSIONS: Experiences of a cognitive assessment varied from feeling valued by society to abandoned in the absence of follow-up support. The assessment was viewed as a standardised procedure failing to see the person behind the testing. Diagnosis disclosure conversations were experienced as diffuse with participants unprepared for a dementia diagnosis. The NPI enabled participants to identify and report the presence of NPS which otherwise could go undetected during the cognitive assessment, impacting on the person's well-being and daily life.

Background: Persons with dementia, whdo reside in their own homes, are often cared for by family members or friends. The presence of a family career is said to have a protective effect, postponing admissions to residential care. The majority of persons with dementia develop behavioural and personality changes during the disease trajectory. The quality of life for both the person with behavioural and psychological symptoms and their careers are affected, increasing both suffering and risk for hospitalisation. Family careers to persons with dementia have identified behavioural changes as more distressing than cognitive impairment leading to increased burden of care and admissions to residential care. Knowledge gaps exist regarding how family careers living with persons with dementia experience behavioural and psychological symptoms in a community setting.

AIM: To describe spouses’ experiences of living with partners who have behavioural and psychological symptoms related to dementia. Methods:Semi-structured interviews were carried out with 14 spouses of partners with dementia. The interviews included the completion of the NPI (Neuropsychiatric Inventory, Cummings, 1994). Interview data was analysed using content analysis. Results:(Preliminary) Spouses identified that partners with dementia had on average five to eight co-existing NPI symptoms. Frequency, severity and distress varied. The behavioural and psychological symptoms highlighted were within three of four possible symptom domains; Behaviour, Psychosis and Mood. From the narrative data four main categories emerged; Support, Coping, Vulnerability and domestic violence AND Social isolation. Conclusions: A large proportion of persons with dementia reside in the  community. Support offered to persons with dementia and their families should have a person-centered approach meeting individual needs. A greater awareness is required regarding welfare and safety of persons with dementia and their partners in a community setting.

Persons with dementia, who reside in their own homes, are often cared for by family members. The presence of a family career is said to have a protective effect, postponing admissions to residential care. The majority of persons with dementia develop behavioural and personality changes during the disease trajectory also known as neuropsychiatric symptoms. Quality of life for both the person with neuropsychiatric symptoms and their careers are affected, increasing suffering and risk for hospitalisation and admission to long-term residential care. Family careers to persons with dementia have identified behavioural changes as more distressing than cognitive impairment leading to increased burden of care and admissions to residential care. Knowledge gaps exist regarding how family careers living with persons with dementia experience neuropsychiatric symptoms in a community setting. The aim was to describe spouses' experiences of living with partners who have developed neuropsychiatric symptoms related to dementia in a community setting. Semi-structured interviews were carried out with 14 spouses of partners with dementia. The interviews included completion of the neuropsychiatric inventory. Interview data were analysed using a content analysis approach. The results showed that spouses identified in the neuropsychiatric inventory that partners with dementia had on average five to eight co-existing symptoms. Frequency, severity and distress varied. From the narrative data, the theme living on the edge lacking support and time for self, emerged. The findings of this study suggest that support offered to persons with dementia and their spouses should have a person-centred approach meeting individual needs. Safety and welfare of persons with dementia and their spouses residing in their own homes may be jeopardised in the presence of neuropsychiatric symptoms. A greater awareness is required in the community regarding the well-being of these persons.

Cardiovascular diseases constitute the most common health problems in very old people. Consequently, cardiovascular drugs are the medicines that are most frequently used by elderly subjects. Although many studies have examined the physiological effect and adverse reactions of these drugs, knowledge on their effect on emotional well-being is missing. The present study aims to examine the association between cardiovascular diseases and their medical treatment on the emotional well-being of very old people. We investigated a representative group of elderly subjects gathered from a population-based study (n=235). Participants were 84 years or older and cognitively intact (mini-mental state examination (MMSE) > or =24 points). Well-being was assessed with the positive and negative affect schedule (PANAS), measuring different mood categories. Cardiovascular diseases were diagnosed following the International Classification of Diseases. In this population the prevalence of cardiovascular diseases was high (62%). Multivariate regression analysis showed that while being affected by a cardiovascular disease did not affect the emotional well-being of the subjects (PANAS-PA, p=0.171; PANAS-NA, p=0.209), the use of some cardiovascular drugs showed an association. Cardiac glycosides (p=0.006) and nitrates (p=0.008) were associated with increased negative feelings. Due to high prevalence of cardiovascular diseases and use of cardiovascular medicines, this finding has relevance on the quality of life of elderly people. However, due to the nature of this study we cannot assess cause-effect relationship of this positive association. Therefore, the present findings suggest that there is a need for clinical studies in this increasing and limited studied age group.

AIM: The aim of this study was to describe how older people living at home in Stockholm, Sweden, experienced the management of their own medication regimen from their own perspective. BACKGROUND: Very old people tend to use more medicines, and without proper medication, many of them would not function well and would not be able to remain in their own homes. METHODS: This qualitative study involved audiotaped interviews with 25 very old persons. Inclusion criteria: aged >or=85 years, mini-mental state examination >or=24, living at home, taking medicines regularly. Data collected May-June 2005, analysed using content analysis. DESIGN: Descriptive study. RESULTS: Findings revealed that most participants managed their medicines by themselves and were very content with this. Older people who received some help with their medicines were also very pleased with that help. The most important components for older people were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back up. CONCLUSION: Our results indicate that most of the participants were very pleased with their medicine management, either on their own or they were able to get some help. There was, however, a need for assistance in delivering the medicines to their homes. RELEVANCE TO CLINICAL PRACTICE: Understanding how older people experience their management of medicines and to reveal the components which may affect them in this situation is important to improve nursing care. To observe the life of an older person as a whole is important in nursing care, so that the person's behaviour can be understood, as how older people manage to handle their medicines may have an impact on their autonomy and on health-care resource use.

BACKGROUND AND AIMS: Elderly people in Sweden live longer in their own homes, some of them with good health, and others with chronic conditions that require medical treatment. Thus, the aim of this study was to investigate factors influencing elderly people's handling of their medicines. METHODS: Cross-sectional population-based study. Participants were 333, aged 84+ years, living in their own homes. Information on regular drug use was obtained from interviews. Descriptive statistics were used to describe the population, and logistic regression models were used to investigate the factors associated with receiving help in handling medicines. The Mini-Mental State Examination (MMSE) measured cognitive status, and the basic Activities of Daily Living (ADL) assessed functional status. RESULTS: Most participants were women living alone. 88% of this population took medicines on a regular basis and 23% of them received help with medicine handling. Using logistic regression models controlling for sociodemographic variables, cognitive and functional status, female (OR=2.8, 95% CI=1.2-6.5) was the only variable associated with regular use of medicines. Older age and functional disability in ADL increased the risk of receiving help with medicines, while higher cognitive status decreased the odds of receiving help. The only factor related to receiving help from a family member was living alone (OR=0.05; 95% CI=0.01-0.40). CONCLUSIONS: This study indicates that cognitive and functional problems require increased help with handling medicines. These results stress the need for ongoing vigilance of, and support for, people with this high-risk profile.

BACKGROUND AND AIMS: Pain is a common and unpleasant problem among elderly people and affects the possibility for them to remain living in their own homes. The aims of this study were therefore to report the prevalence of pain reporting and pain treatment, and their association with functional and cognitive status in a very old population. METHODS: Cross-sectional population-based study. Participants were 333, aged 84 years or older, living at home alone or with someone in Kungsholmen, in central Stockholm, Sweden. Information on pain was obtained from interviews. The Mini- Mental State Examination (MMSE) measured cognitive status and the index of basic Activities of Daily Living (ADL) functional status. Descriptive statistics were used to describe the population and logistic regression models to investigate factors associated with pain reporting and pain treatment. RESULTS: The prevalence of pain was 46%, and the prevalence of pain treatment 71%. Results from logistic regression analysis including all variables in the model showed that pain reporting was not associated with age, gender or living conditions. However, pain reporting was correlated with cognitive and functional status. There was no association between pain treatment and age, gender, living conditions, cognitive or functional status. CONCLUSIONS: Pain is common among the oldest old. Our results indicate that cognitive and functional status affect pain reporting. Poor cognitive status was associated with less pain reporting, whereas poor functional status was associated with more pain reporting.