Household fermentation of leftover bread to nutritious food.

Resource dependency of food production is aggravated when food is wasted. In Sweden, it is estimated that 37% of the total bread waste is generated at the household level. This work aimed to assess whether fermentation using edible filamentous fungi at households can provide a solution to valorize leftover bread in the production of fungi-based food for consumption. Bread was fermented in household and laboratory conditions with Neurospora intermedia and Rhizopus oligosporus. The results show that bread can be successfully and easily fermented at households, without signs of microbial contamination even though the conditions were not sterile. Fermentation at the household resulted in higher protein, fat and fiber content as well as greater starch reduction compared to the samples fermented under laboratory conditions. Household engagement in bread fermentation will likely depend on values that motivate reusing leftover bread. Perceived values that are expected to motivate engagement vary across individuals, but may include improved nutritional benefits, food waste prevention, convenience, responsibilities, and being part of sustainable societies and actions.

Health Promotion Practice Among Older Persons: A Nordic Multi-Professional Focus Group Study Exploring what It Is and How It Could be Achieved.

The growing ageing population in the Nordic region calls for increased focus on health promotion work. To enhance multi-professional understanding and further develop strategies for promoting healthy ageing, it is vital to consider the perspectives of those working with health promotion. The aim of this study was to explore a wide spectrum of practitioners' experiences of community-level health promotion targeting older adults in Finland and Sweden. Nine focus group interviews (34 informants) were conducted in 2019-2020. "Seeing the person" emerged as the ideal for health promotion targeting older adults, but this ideal was not always realized in current practice. Barriers related to organizational structures and the practitioner role were identified. However, work methods connected to user involvement and technology-based tools were considered key facilitators, enabling tailored health promotion initiatives.

Impact of a person-centred group intervention on life satisfaction and engagement in activities among persons aging in the context of migration‡.

Background: There is a growing need to support the health and wellbeing of older persons aging in the context of migration.Objectives: We evaluated whether a group-based health promotion program with person-centred approach, maintained or improved life satisfaction and engagement in activities of older immigrants in Sweden.Methods: A randomised controlled trial with post-intervention follow-ups at 6 months and 1 year was conducted with 131 older independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and a follow-up home visit) and a control group (no intervention). Outcome measures were life satisfaction and engagement in activities. Chi-square and odds ratios were calculated.Results: The odds ratios for maintenance or improvement of life satisfaction (for social contact and psychological health) were higher in the person-centred intervention group. More participants in the intervention group maintained or improved their general participation in activities compared with the control group. However, no significant between-group differences were found.Conclusion: Person-centred interventions can support older person's capability to maintain their health in daily life when aging in migration. Further research is needed with a larger sample and longer intervention period to determine the effectiveness of the intervention.

Viewing oneself as a capable person - experiences of professionals working with older Finnish immigrants.

The proportion of older immigrants in the population is expected to increase in Sweden. Research indicates that older immigrants face the double burden of frailty, caused by a weaker health status, and the immigration process. Health promotion interventions can be used to prevent frailty and support healthy ageing in this population. Healthcare professionals are a crucial part of health promotion and the present study aimed to explore healthcare professionals' experiences of health in context of daily life among older immigrants to and provide a basis for the development of a health promotion intervention targeted at older immigrants. Four focus group discussions were conducted with professionals who worked with home-dwelling older people from Finland, currently living in Sweden. Participants represented a variety of healthcare professions. Data were analysed using qualitative content analysis. The healthcare professionals perceived that health in daily life was (i) connected to the view of oneself as a capable person and (ii) participants strove to maintain their own origin. The findings highlighted that when planning for health promotion interventions for older immigrants, the point of departure should be to recognise the person as a person and the background of immigration is not the first issue to address. Therefore, a person-centred health promotion intervention is recommended to open a dialogue between healthcare professionals and older immigrants, so that a common view of the intervention can be reached.

For whom is a health-promoting intervention effective? Predictive factors for performing activities of daily living independently.

BACKGROUND: Health-promoting interventions tailored to support older persons to remain in their homes, so-called "ageing in place" is important for supporting or improving their health. The health-promoting programme "Elderly Persons in the Risk Zone," (EPRZ) was set up for this purpose and has shown positive results for maintaining independence in activities of daily living for older persons 80 years and above at 1- and 2 year follow-ups. The aim of this study was to explore factors for maintaining independence in the EPRZ health-promoting programme. METHODS: Total of 459 participants in the original trial was included in the analysis; 345 in the programme arm and 114 in the control arm. Thirteen variables, including demographic, health, and programme-specific indicators, were chosen as predictors for independence of activities of daily living. Logistic regression was performed separately for participants in the health promotion programme and in the control arm. RESULTS: In the programme arm, being younger, living alone and self-rated lack of tiredness in performing mobility activities predicted a positive effect of independence in activities of daily living at 1-year follow-up (odds ratio [OR] 1.18, 1.73, 3.02) and 2-year, (OR 1.13, 2.01, 2.02). In the control arm, being less frail was the only predictor at 1-year follow up (OR 1.6 1.09, 2.4); no variables predicted the outcome at the 2-year follow-up. CONCLUSIONS: Older persons living alone - as a risk of ill health - should be especially recognized and offered an opportunity to participate in health-promoting programmes such as "Elderly Persons in the Risk Zone". Further, screening for subjective frailty could form an advantageous guiding principle to target the right population when deciding to whom health-promoting intervention should be offered. TRIAL REGISTRATION: The original clinical trial was registered at ClinicalTrials.gov. Identifier: NCT00877058 , April 6, 2009.

Health promotion programme design and efficacy in relation to ageing persons with culturally and linguistically diverse backgrounds: a systematic literature review and meta-analysis.

BACKGROUND: Health promotion has the potential to empower people to develop or maintain healthy lifestyles. However, previous research has visualised serious health and healthcare inequities associated with ageing, cultural affiliations and linguistic preferences. Therefore, this study was part of a larger health promotion project, set out to bridge barriers to health for ageing persons who have migrated to Sweden. More specifically, the present study aimed to elucidate the content and effects of multidimensional health promotion programmes in the context of ageing persons with culturally and linguistically diverse backgrounds. METHODS: Databases were systematically searched to identify relevant randomised controlled trial publications. All potentially relevant publications were assessed for relevance and design and after this screening, a final sample of eight publications could be included in the review. Those publications evaluated six different programmes and a mixed-methods approach to data analysis was applied, using a combination of narrative synthesis, meta-analyses and evidence grading. RESULTS: The findings suggest a multidimensional health promotion programme design for ageing persons with culturally and linguistically diverse backgrounds, involving culturally and linguistically modified activities and health information that should be provided by professionals with a person-centred approach. In addition, the meta-analyses revealed statistically significant effects in favour of health promotion on: general health, depression, mental health, physical health, and vitality. However, the evidence for the identified effects is low, and further research findings are likely to change the estimations. CONCLUSIONS: The present study provides an aggregation of health promotion intervention research with older persons with culturally and linguistically diverse backgrounds; a group of people who are commonly excluded from research, and marginalised when it comes to health and healthcare. By visualising the core components of health promotion programmes with proven efficacy, the findings provide guidance for further explorations of how health promotion should be designed to minimise inequities in health.

A person-centred approach to health promotion for persons 70+ who have migrated to Sweden: promoting aging migrants' capabilities implementation and RCT study protocol.

BACKGROUND: There are inequities in health status associated with ethnicity, which may limit older foreign-born persons' ability to age optimally. Health promotion for older persons who have experienced migration is thus an area of public health importance. However, since research related to this issue is very limited, the study 'Promoting Aging Migrants' Capabilities' was initiated to improve our understanding. The study aims to implement and evaluate a linguistically adapted, evidence-based, health-promoting intervention with a person-centred approach for two of the largest groups of aging persons who have migrated to Sweden: persons from Finland and persons from the Balkan Peninsula. METHODS/DESIGN: This study has a descriptive, analytical, and experimental design. It is both a randomised controlled trial and an implementation study, containing the collection and analysis of both qualitative and quantitative data. The setting is an urban district in a medium-sized Swedish city with a high proportion of persons who were born abroad and whose socio-economic status is low. The intervention comprises four group meetings ('senior meetings') and one follow-up home visit made by a multi-professional team. For the randomised controlled trial, the plan is to recruit at least 130 community-dwelling persons 70 years or older from the target group. Additional persons from involved organisations will participate in the study of the implementation. Both the intervention effects in the target group (outcome) and the results of the implementation process (output) will be evaluated. DISCUSSION: The results of this forthcoming randomised controlled trial and implementation study may be useful for optimising implementation of person-centred, health-promoting initiatives for older persons who have experienced migration. It is also hoped that this combined study will show that the capabilities for optimal aging among older persons born in Finland and the Balkan countries can be improved in the Swedish healthcare context. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov April 10, 2013, identifier: NCT01841853.

Physical function and fear of falling 2 years after the health-promoting randomized controlled trial: elderly persons in the risk zone.

PURPOSE OF THE STUDY: To investigate the effects of 2 different health-promoting interventions on physical performance, fear of falling, and physical activity at 3-month, 1-year, and 2-year follow-ups of the study Elderly Persons in the Risk Zone. DESIGN AND METHODS: A randomized, three-armed, single-blind, and controlled study in which 459 independent and community-dwelling people aged 80 years or older were included. A single preventive home visit including health-promoting information and advice and 4 weekly senior group meetings focused on health strategies and peer learning, with a follow-up home visit, were compared with control. Functional balance, walking speed, fear of falling, falls efficacy, and frequency of physical activities were measured 3 months, 1 year, and 2 years after baseline. RESULTS: There were no or limited differences between the groups at the 3-month and 1-year follow-ups. At 2 years, the odds ratio for having a total score of 48 or more on the Berg Balance scale compared with control was 1.80 (confidence interval 1.11-2.90) for a preventive home visit and 1.96 (confidence interval 1.21-3.17) for the senior meetings. A significantly larger proportion of intervention participants than controls maintained walking speed and reported higher falls efficacy. At 1 and 2 years, a significantly higher proportion of intervention participants performed regular physical activities than control. IMPLICATIONS: Both a preventive home visit and senior meetings reduced the deterioration in functional balance, walking speed, and falls efficacy after 2 years. The long-term effects of both interventions indicate a positive impact on postponement of physical frailty among independent older people.

Experiences of daily occupations at 99 years of age.

The aim was to explore experiences of daily occupations among the oldest old. Ten 99-year-old persons were interviewed in their living environment about an ordinary day. The interviews were analysed according to the phenomenographic approach. The result showed that participants regarded themselves as competent and that they felt proud because they were involved in daily occupations. Being challenged was experienced as a way of performing difficult tasks, thus being confirmed as a capable person who performs and learns new things. The participants' occupational patterns preserve occupational ability and continuity in life in that they have a rhythm and allow the individuals to predict and handle interruptions. Participants experienced being incapable and being restricted as a result of personal, environmental, and social hindrances. The participants adapted to and reshaped their sense of self, which has been disrupted due to the discrepancy between self, the person's ability, and the real world "outside". Experience of daily occupation is unique, supports the sense of self, builds identities, and describes engagement and creative processes. Individual experience must be recognized as it can mean the difference between success and failure in maintaining meaningful daily occupation.

Use of assistive devices--a reality full of contradictions in elderly persons' everyday life.

PURPOSE: The aim was to explore very old persons' use and experience of assistive devices in daily occupations and changes over a ten-year period. METHOD: This study focuses on 86-year olds (n=201) and following a retrospective longitudinal design, reviews their situation at the age of 76 (n=199). Data were collected by structured and open-ended interviews during home visits and subjected to statistical and content analysis. RESULTS: A significantly higher proportion (69%) used assistive devices at the age of 86 than at age 76 (43%). During the interval about one third became new users, 35% were permanent users and 23% did not use assistive devices at all. Among those being dependent on personal help in ADL a higher proportion were users of assistive devices (81%) than among those being independent (55%) (p = 0.00013). The result regarding the usefulness, reason for use and experience of using assistive devices showed that very old persons' perspectives on personal, practical and social aspects varied greatly and were often contradictory. CONCLUSIONS: An assistive device is generally regarded as an enabler in daily occupation, but it can also become a 'disabler'. There is a need for a deeper and broader understanding of these ambivalent perspectives and an ethical discussion of subtle factors that might influence the use and experience of assistive devices.