Social Assistance Beneficiaries’ Access to Social Services in a Digitalized Social Assistance System

Access to social work has become a matter of even higher significance as remote services and the digitalization of public services has increased extensively during the COVID-19 pandemic . Using statistical data on notifications on need for social services in the Finnish social assistance system in 2017 – 2019 and survey data on social work professionals from 2021, we assess how well a “red flag” system identifies social assistance clients in need of municipal social work and how social clients access social services in a system where cash and care are separated . Our findings show that the red flag system primarily identified need for social work in case of financial problems while social and health problems were less often recognized . Thus, the system emphasizes clients’ own knowledge and skills to receive the necessary services . According to our results, social workers are critical about benefit handlers’ ability to recognize need for social work counselling and one fourth of them do no trust that clients in need of support are guided to social work . We argue that the digitalization has affected not only the way clients apply for benefits, but it has also created pressure for new kinds of social work such as outreaching social work, and direct contact with clients who are in danger of falling out of services . © 2022 Duncker und Humblot GmbH. All rights reserved.

Social workers' perceptions on clients' service needs and social work practices during the COVID-19 pandemic

Ever since the start of the COVID-19 pandemic, the specialized health-care resources have been the main focus of political attention in any country. However, the pandemic and subsequent lockdowns have also had a major impact on social services. The pandemic increased service needs among those who were already adult social work clients before the pandemic;it also created needs among new groups of clients, while the operating environment for service provision changed dramatically. In our study, we examine social workers' perceptions on: 1) how well social services were able to respond to clients' needs during the pandemic;and 2) examine practices in adult social work that were used and developed during the outbreak of the pandemic. For the analysis, we use national survey data obtained from social workers in the Social Barometer survey collected in May 2020 (n=496) and in January 2021 (n=412). The findings show that according to social workers, during the first year of the pandemic social work in Finland succeeded in responding to clients' rather clear and concrete problems, such as difficulties in applying for social benefits and a lack of housing, while more complicated problems, such as unmanageable debts, loneliness and mental health problems, were not adequately responded to. At the same time, social workers assessed that people suffering from these problems were the most affected by the COVID-19 pandemic. © 2021. All Rights Reserved.

How can dementia and disability be prevented in older adults: where are we today and where are we going?

Ageing of the population, together with population growth, has brought along an ample increase in the number of older individuals living with dementia and disabilities. Dementia is the main cause of disability in old age, and promoting healthy brain ageing is considered as a key element in diminishing the burden of age-related disabilities. The World Health Organization recently launched the first risk reduction guidelines for cognitive impairment and dementia. According to recent estimates, approximately 40% of dementia cases worldwide could be attributable to 12 modifiable risk factors: low education; midlife hypertension and obesity; diabetes, smoking, excessive alcohol use, physical inactivity, depression, low social contact, hearing loss, traumatic brain injury and air pollution indicating clear prevention potential. Dementia and physical disability are closely linked with shared risk factors and possible shared underlying mechanisms supporting the possibility of integrated preventive interventions. FINGER trial was the first large randomized controlled trial indicating that multidomain lifestyle-based intervention can prevent cognitive and functional decline amongst at-risk older adults from the general population. Within the World-Wide FINGERS network, the multidomain FINGER concept is now tested and adapted worldwide proving evidence and tools for effective and easily implementable preventive strategies. Close collaboration between researchers, policymakers and healthcare practitioners, involvement of older adults and utilization of new technologies to support self-management is needed to facilitate the implementation of the research findings. In this scoping review, we present the current scientific evidence in the field of dementia and disability prevention and discuss future directions in the field.

Acute kidney injury and mortality risk in older adults with and without COVID-19: Data from gerocovid study

BACKGROUND AND AIMS: Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated the risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. METHOD: Observational study of patients admitted to two geriatric clinics in the Stockholm Region of Sweden during the first wave of the COVID-19 pandemic from March 1st to June 15th 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (ORs) for AKI were obtained from logistic regressions. The hazard ratios (HRs) for the risk of in-hospital death were calculated from Cox proportional hazard regression models. RESULTS: We analyzed 316 older patients hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. The mean age was 8369 years, 57% were women, and mean baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) was 62623 ml/min/1.73m2. AKI occurred in 92 (29%) of patients with COVID-19 vs. 159 (18%) without COVID-19. The severity of AKI was significantly worse in patients with COVID-19 compared with non-COVID patients. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70;95% CI, 1.04-2.76), low baseline kidney function [4.19 (2.48-7.05), for eGFR 30 ≥ <60 ml/min/1.73m2, and 20.3 (9.95-41.3) for eGFR <30ml/min/1.73m2], and higher C-reactive protein (CRP) level (OR 1.81(1.11-2.95)). The risk of in-hospital death was highest in patients with COVID-19 and AKI [adjusted HR 23.5, 95% CI (8.75-63.0)], followed by COVID-19 without AKI [9.10 (3.52-23.6)] and by patients without COVID-19 and with AKI [6.38 (2.28-17.9)] after adjusting for patient demographics, vital signs, baseline kidney function and medications and using non-COVID patients with no AKI as reference. CONCLUSION: Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared with patients hospitalized with other diagnoses. AKI and COVID-19 were associated with in-hospital death. Optimal management of AKI may improve the outcome of COVID-19 in geriatric patients.

Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19.

BACKGROUND & AIMS: Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. METHODS: We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020-January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. RESULTS: After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17-4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0-7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16-3.68) and other causes (OR = 6.01; CI = 2.73-15.91). CONCLUSIONS: Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.

[Almost two-thirds of the elderly with covid-19 surviving in nursing homes]

A large proportion of deaths worldwide have occurred among elderly living in nursing homes. Sweden is no exception with a comparable proportion making up around half of all deaths. The elderly, frail individuals living in nursing homes are among the most vulnerable and with the highest risk to die of covid-19. In spite of that we see almost two-thirds of the infected are still alive with a majority recovering fully after receiving treatment at the nursing home. Of 8 057 residents living in nursing homes in Stockholm, 1 464 (18 %) individuals have so far been diagnosed with covid-19 and 532 have died (6 % of all residents). Importantly, this means that a great majority of the residents are still alive including almost two-thirds (932/1 464) of the infected individuals.