National treatment guidelines poorly achieved among older subjects with type 2 diabetes - call to action!

OBJECTIVE: To assess risk factors and factors associated with nonachievement of the treatment target levels among 75-year-old Finns with type 2 diabetes (T2D). DESIGN: Cross-sectional study. SETTING: Outpatient. SUBJECTS: Seventy-five-year-old participants of the Turku Senior Health Clinic Study (N = 1296) with T2D (n = 247). MAIN OUTCOME MEASURES: Nonachievement of fasting blood glucose (FBG), low-density lipoprotein (LDL-C), and blood pressure (BP) levels set by the national treatment guidelines. RESULTS: Nonachievement rates of FBG, BP and LDL-C were 47%, 85%, and 47%, respectively. Non-usage of T2D medication was negatively (adjusted OR 0.38, 95% CI 0.16-0.88) and central obesity positively (1.88, 1.09-3.24) related to nonachievement of FBG target level; alcohol use was positively (3.71, 1.04-13.16) and decreased self-rated health negatively (0.34, 0.12-0.97) related to the nonachievement of BP target level. Nonachievement of LDL-C target level was positively related to poor financial status (3.50, 1.19-10.28) and non-use of lipid-lowering medication (7.70, 4.07-14.56). CONCLUSIONS: Nonachievement rates of the national treatment goals were high among older T2D patients, and nonachievement was related to use of medication, obesity, alcohol use, poor health, and poor financial status. We emphasize the importance of customized target setting by risk factor levels and active treatment.

Senior Health Clinic for 75-year-old home-dwelling Finns - study design, clinic protocol and non-response analysis.

BACKGROUND: In the Finnish policy on older people preventive activities, which maintain functional capacity and independent living, are emphasized. The Turku Senior Health Clinic, aimed at maintaining independent coping of all home-dwelling 75-year-old citizens in the city of Turku, was founded in the beginning of 2020. The aim of this paper is to describe design and protocol of the Turku Senior Health Clinic Study (TSHeC) and provide results of the non-response analysis. METHODS: The non-response analysis used data from 1296 participants (71% of those eligible) and 164 non-participants of the study. Sociodemographic, health status, psychosocial and physical functional ability indicators were included in the analysis. Participants and non-participants were also compared in respect to their neighborhood socioeconomic disadvantage. Differences between participants and non-participants were tested using the Chi squared or Fisher´s exact test for categorical variables and t-test for continuous variable. RESULTS: The proportions of women (43% vs. 61%) and of those with only satisfying, poor or very poor self-rated financial status (38% vs. 49%) were significantly lower in non-participants than in participants. Comparison of the non-participants and participants in respect to their neighborhood socioeconomic disadvantage showed no differences. The prevalence of hypertension (66% vs. 54%), chronic lung disease (20% vs. 11%), and kidney failure (6% vs. 3%) were higher among non-participants compared to participants. Feelings of loneliness were less frequent among non-participants (14%) compared to participants (32%). The proportions of those using assistive mobility devices (18% vs. 8%) as well as those having previous falls (12% vs. 5%) were higher in non-participants than in participants. CONCLUSIONS: The participation rate of TSHeC was high. No neighborhood differences in participation were found. Health status and physical functioning of non-participants seemed to be slightly worse than those of the participants, and more women than men participated. These differences may weaken the generalizability of the findings of the study. The differences have to be taken into account when recommendation for the content and implementation of preventive nurse-managed health clinic in primary health care in Finland is going to be given. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05634239; registration date; 1st of December 2022. Retrospectively registered.

Patient's informational privacy in prehospital emergency care: Paramedics' perspective.

BACKGROUND: As a fundamental human right in healthcare, informational privacy creates the foundation for patient's safety and the quality of care. However, its realization can be a challenge in prehospital emergency care, considering the nature of the work. OBJECTIVES: To describe patient's informational privacy, its realization, and the factors related to the realization in prehospital emergency care from the perspective of paramedics. RESEARCH DESIGN: A descriptive questionnaire study was conducted. The data were analyzed with inductive content analysis. PARTICIPANTS AND RESEARCH CONTEXT: The participants (n = 26) were paramedics in one of the 22 rescue departments in Finland. ETHICAL CONSIDERATIONS: The study received ethical approval from the ethics committee of the University of Turku (Finland). Permission for the study was given by the collaborating rescue department. FINDINGS: Paramedics described patient's informational privacy as patients' right to their own health records, as protection of the patient's health records, and as comprehensive respect of the patient's privacy by the persons involved in the patient's care. In general, informational privacy was described as being realized regarding confidentiality, reporting, and maintaining the patient's health records. However, it was also described as being dependent on the context, and some areas in need of improvement were identified. Promoting and preventing factors related to the realization were also identified. The promoting factors were paramedics' professional activity, environment, training, and guidelines. The preventing factors were the nature of the work, paramedics' attitudes, and the lack of knowledge concerning informational privacy among paramedics, the collaborating authority, patients, and relatives. DISCUSSION AND CONCLUSION: Paramedics had a multidimensional understanding of informational privacy and the factors related to its realization. However, its realization varies, and more research and education are therefore needed to enhance the realization and to provide equal and high-quality care for all the patients in prehospital emergency care.

Experiences of safety among patients receiving home dialysis therapies.

BACKGROUND: Dialysis patients' experience of safety can be seen positively connected with their wellbeing and successful outcomes of their treatment and care. Therefore, it is necessary to identify the factors promoting and weakening the safety experiences and create a basis for empowering interventions. OBJECTIVES: Analyse patients' experiences of safety with dialysis and the factors promoting and weakening their safety. METHODS: A descriptive study design was used. This study analysed Finnish patients' (n = 70) experiences of safety with dialysis and the factors promoting and weakening patients' safety. Data were collected using a questionnaire including one structured question and two open questions. FINDINGS: The patients experienced their care as safe. Thematic analysis provided three factors promoting patients' safety: certainty of patient's own competence in dialysis self-management, competence of personnel in dialysis treatment and care, continuity of ensuring patients' state of health, as well as three factors weakening safety: patients' uncertainty of living with chronic kidney disease, insufficient patient education and uncertain realisation of dialysis treatment and care. CONCLUSION: This study provided new insight into understanding patients' experiences of safety with dialysis. We show that the factors connected with patients' safety were related to the successful realisation of self-management, support for the self-management, and delivery of dialysis treatment and care anticipating high-level outcomes. In light of this study, there are development needs in dialysis treatment and care as a whole in order to ensure patients' safety.

Respect and its associated factors as perceived by older patients.

AIMS AND OBJECTIVES: To investigate older hospital patients' perceptions of respect in a patient-nurse relationship and its associated factors. BACKGROUND: To be cared for with respect is fundamental to ethical nursing care. However, respect has seldom been a main topic of nursing research, and few of these studies have assessed older patients' perceptions of being respected by nurses alongside associated factors. DESIGN: A cross-sectional, descriptive and correlational survey design. METHODS: Hospitalised older patients (n = 200) were interviewed using the ReSpect Scale, measuring respect within the nurse-patient relationship, the EuroQol 5D-5L, measuring perceived health status, and the Patient Satisfaction Scale, measuring satisfaction with nursing care. Sociodemographic characteristics were also collected. Data were analysed using descriptive statistics, Pearson's correlation coefficient, the t test and analysis of variance. The STROBE Statement was used for reporting this research. RESULTS: Older patients reported moderate levels of perceived respect in their patient-nurse relationships. A statistically significant, strong positive correlation between patient satisfaction and their perceptions of respect was found. Poor perceived health status was also statistically significantly associated with older patients' perceptions of respect. No statistically significant associations between patients' other sociodemographic characteristics and their perceptions of respect were found. CONCLUSIONS: The identification of factors and their associations with respect is a basic step towards theory generation. Further empirical research is needed to test the preliminary associations found in this study to further develop the current understanding of respect and its associated factors. RELEVANCE TO CLINICAL PRACTICE: The older patients' perceptions of respect highlighted in this study show the need for the further consideration, reflection and development of this important aspect of the relationship between patients and nurses. The identification and measurement of respect and its associated factors may help to improve respect in nursing care making it more visible in the care of older people.

Being respected by nurses: Measuring older patients' perceptions.

AIM AND OBJECTIVE: To investigate older patients' perceptions of respect in hospital nursing care and to test a newly developed instrument measuring the phenomenon. BACKGROUND: Respect manifests itself in the older patient-nurse relationship in terms of nurses being with and doing for the patient. Empirical studies investigating respect from the older patients' perspective are rare. There is a need to maintain respectful behaviours and attitudes within hospital-based nursing practice. Furthermore, there is a lack of instruments measuring respect in the care provided by nurses. DESIGN AND METHODS: A descriptive, cross-sectional explorative survey design was used. Data were collected between February and May 2016 by interviewing face-to-face 196 older patients in two hospitals in Finland. Respect was measured using the ReSpect scale (Parts A and B) developed for this study. Respect is based on the two dimensions of respect, nurses' Being with and Doing for patients. Data were analysed using descriptive and inferential statistical methods including the psychometric testing of the new instrument. RESULTS: Older patients perceived respect in their care frequently and to a great extent, although there were also shortcomings. The findings highlight the need to improve respect to patients in care delivery by showing an interest in their views, acknowledging them positively and supporting their individual capacities. A two-factor structure of the ReSpect scale Part A and a four-factor structure of the Part B were confirmed. CONCLUSIONS: Findings from this study suggest that older hospital patients perceived respect by nurses overall, but the area where there is the most room for improvement is that of listening and encouraging. The psychometric analysis demonstrated that the ReSpect scale shows promise in measuring respect. IMPLICATIONS FOR PRACTICE: The ReSpect scale could be a useful tool to measure respect, an important element of value-based health care.

Older persons with dementia at risk for institutionalization in eight European countries: a cross-sectional study on the perceptions of informal caregivers and healthcare professionals.

AIMS: To explore the perceptions of informal caregivers and healthcare professionals regarding potential reasons for the institutionalization of older persons with dementia in eight European countries. BACKGROUND: Healthcare professionals may have an important role in facilitating informal caregivers' decision-making regarding institutionalization. Little is known about the perceptions of informal caregivers and healthcare professionals prior to institutionalization. DESIGN: Cross-sectional survey in eight European countries (November 2010-January 2012). METHODS: Healthcare professionals reported why they clinically judged persons with dementia at risk for institutionalization. Informal caregivers reported potential reasons from their perspectives. Answers were openly coded and categorized. Variation between informal caregivers and healthcare professionals was investigated (agreement on at least one potential reason per case/proportion of maximum attainable kappa). RESULTS: Judgements of healthcare professionals and informal caregivers on 1160 persons with dementia were included. A total of 22 categories emerged. Approximately 90% of informal caregivers reported potential reasons. In 41% of the cases, informal caregivers and healthcare professionals agreed on at least one reason. Discrepancy was high for potential reasons related to caregiver burden. For the most frequent categories (caregiver burden, caregiver unable to provide care, neuropsychiatric symptoms, overall deterioration, care dependency), 24-41% of the attainable kappa was achieved. Differences between countries emerged indicating more favourable agreement in Finland, Sweden and Estonia and lowest agreement in England and Spain. CONCLUSION: Agreement between healthcare professionals and informal caregivers on potential reasons for institutionalization was low-to-moderate. Healthcare professionals are challenged to develop a detailed understanding of the perspectives and perceived burden of informal caregivers.

Right for knowledge - the perspective of significant others of Persons with Memory Disorders.

RATIONALE: People have a fundamental right to know about care and services within health care. This right is also important for persons with memory disorders (PwMD) and their significant others (SO) for empowering them to manage with difficult situations at home and in institution. AIM: This study explores the self-assessed level of received knowledge about care and services of the SOs of PwMDs and the understandability of that knowledge. METHODS: This study employed an exploratory and correlational survey design in multisite settings for older people. Data were collected in Finland in 2010-2011 from the SOs of PwMDs (N = 304, n = 264, response rate 87%) using questionnaires, including the Knowledge of Care and Services for Persons with Memory Disorders; the level of knowledge and the understandability of the knowledge were assessed using visual analogue scale (VAS 0-100). Data were analysed statistically using descriptive statistics, independent samples t-test, one-way analysis of variance and Pearson's correlations coefficients. RESULTS: The self-assessed level of received knowledge of SOs about care and services was low (mean 47.7 ± 25.3 out of 100), with the highest level seen in medication (54.5 ± 31.1) and memory disorder as a disease (54.3 ± 30.3) and the lowest level in the services provided at home for PwMDs (45 ± 30.6) and generally for SOs (38.5 ± 31.7). SOs assessed the received knowledge as being understandable to a moderate degree (53.7 ± 25.5). CONCLUSION: More knowledge could be delivered to PwMDs to manage in their homes and especially to SOs to take care of PwMDs. New educational solutions could be created aimed at improving the understandability of the knowledge.

Manifestation of respect in the care of older patients in long-term care settings.

BACKGROUND: Respect is fundamental to ethical nursing practice. However, respect in the care of older people is seldom investigated from the perspective of patients and their next of kin. AIM: To describe the manifestation of respect in the care of older patients in long-term care settings from the perspective of older patients with memory disorders and their next of kin. DESIGN AND METHODS: A narrative inquiry on research methodology using open interviews was employed. Transcribed interviews were analysed using inductive content analysis, and from this analysis a typology was produced. SETTINGS: The study settings were patients' own homes supported by professional home care, and nursing homes in three cities in southern Finland. PARTICIPANTS: A purposeful sample (N = 40) of participants (older patient, n = 20 and their next of kin, n = 20) was recruited. Half of the older patient lived at home where they received professional care and the other half lived in nursing homes. RESULTS: Respect in long-term care settings is manifested in patient care through the being and doing of the nurse. A typology of nurses' being and doing described three ways nurses manifested respect: 'I'm here for you', 'I'm here for work' and 'I'm not here for you'. Patient's responses to the typology were as follows: sharing, exploring and withdrawing, respectively. CONCLUSIONS: The analysis and typology of nurses' being and doing increases the understanding of respect in patient care in long-term care settings. Furthermore, this knowledge of respect will make it possible to develop measureable respect indices for use in the evaluation of care.

The association between positive-negative reactions of informal caregivers of people with dementia and health outcomes in eight European countries: a cross-sectional study.

AIM: To describe the associations between positive and negative reactions of informal caregivers of people with dementia and health outcomes across eight European Countries. BACKGROUND: Caring for someone with dementia may have implications for the caregiver's own health and for the care recipient. These consequences could be associated with caregivers' reactions to the process of care. DESIGN: Association study based on cross-sectional data. METHODS: Participants were people with dementia and their informal caregivers living at home or in long-term care institutions. Data were collected between November 2010-April 2012 using the Caregiver Reaction Assessment (with dimensions of self-esteem, lack of family support, financial problems, disrupted schedule and health problems) and associations were sought with informal caregiver burden, quality of life and psychological well-being and with dementia sufferers' neuropsychiatric symptoms, comorbidity and dependency in activities of daily living using correlation coefficients. RESULTS: Data from 2014 participants were used. Variability across countries was noted, as well as differences between care at home and in long-term care institutions. In general, self-esteem and lack of family support correlated with caregiver burden and psychological well-being. Associations were also found between disrupted schedule and caregiver burden, psychological well-being and quality of life. Health problems were clearly associated with caregiver burden, psychological well-being and quality of life. CONCLUSION: Study results support links between the reactions of informal caregivers of people with dementia and health outcomes. These may have implications in terms of how services are addressed.

Respect in the care of older patients in acute hospitals.

The aim of this study was to describe the experiences of older patients and their next of kin with regards to respect in the care given in an acute hospital. The data were collected using tape-recorded interviews (10 patients and 10 next of kin) and analysed via inductive content analysis. Based on the analysis, the concept of respect can be defined by the actions taken by nurses (polite behaviour, the patience to listen, reassurance, response to information needs, assistance in basic needs, provision of pain relief, response to wishes and time management) and next of kin (support, assistance and advocacy) and by factors related to the environment (appreciation of older people in society, management of health-care organizations, the nursing culture, the flow of information and patient placement). The information will be used to develop an instrument for assessing how well respect is maintained in the care of older patients.