Evaluation of the Oral Hygiene Ability Instrument (OHAI): Test of reliability.

OBJECTIVES: To evaluate the reliability of the new Oral Hygiene Ability Instrument (OHAI) developed to assess the cause of any inability for older adults to manage oral hygiene self-care. Oral hygiene is an important part of oral health. The inability to manage oral hygiene, combined with other risk factors, often results in poor oral health and impaired quality of life. A reliable OHAI could benefit preventive oral health care. METHODS: The preliminary OHAI uses 33 items in three parts: (I) interview, (II) clinical examination and (III) observation of oral hygiene activities. A total of 37 older adults participated in a test-retest study of Part I. Inclusion criteria were age ≥ 65 years, have at least one tooth and be able to oral hygiene self-care. The intra- and inter-rater reliability of parts II and III used films and photographs of OHAI assessments of 15 different individuals. These films/photographs were assessed twice by four dental professionals who had participated in the OHAI data collection. For statistical analyses of the reliability, per cent agreement, Krippendorff's alpha and E. Svensson's method were used. RESULTS: The test-retest for Part I items showed acceptable-to-good agreement and no systematic disagreement. In Part II, two items showed somewhat limited reliability. Part III showed good intra- and inter-rater reliability. CONCLUSION: The OHAI items seem stable and reliable for the intended sample, and the instrument may be a valuable tool to identify older adults at risk of impaired oral health. However, two items may need to be reformulated.

Research collaboration with older people as a matter of scientific quality and ethics: a focus group study with researchers in ageing and health.

BACKGROUND: Society is placing increasing demands on collaboration with actors outside the academia to be involved in the research process, and the responsibility for turning this into reality lies with the researchers. As research collaboration is a way to increase the societal relevance of research and since older people have the right to be actively involved in research that concerns them, this study is addressed to researchers who work with and for older people. The purpose of this article is to explore researchers' experiences of research collaboration with the heterogeneous group of older people, from healthy to frail. METHODS: The focus group method was applied based on a qualitative approach that is based on a social constructivist research tradition. It differs from other qualitative methods, such as interviews, in that it encourages interaction between research participants and contributes to shedding light on a collective understanding of the world. A total of 14 researchers participated in four focus groups (three to five participants/group). RESULTS: The results provided support for the overall theme: "Good scientific quality and ethics are balanced against the needs and abilities of older people". This means a balance between the researcher and the older people collaborating with them to receive the best possible scientific quality. This is highlighted in the core category "Positioning for research collaboration" with the subcategories "Involvement or not", "Traditional or innovative thinking" and "Selectivity or representativeness", and the core category "Research collaboration - an ethical issue of power" with the subcategories "Research collaboration a risk for freedom of research", "Research collaboration a risk of abuse of power" and "Discriminatory academic power structures create ethical issues". CONCLUSIONS: Addressing the balancing act of collaborating with older people in research, the findings contribute with an understanding of the importance of researchers' awareness of social and academic structures to minimise the risk of epistemic injustices in research on ageing and health. We want to highlight the researchers' voice and clarify the role that researchers have in terms of the opportunities for older people to become part of the collective understanding of ageing and health and make their voices heard.

Society is increasingly expecting researchers to involve people who are not researchers in their research. To understand how such collaboration could become a reality, this study aimed to explore researchers' experiences of collaborating with older people in research on ageing and health. A total of four focus groups consisting of 14 researchers from two universities were conducted to discuss experiences, approaches, opportunities and obstacles for research collaboration with older people. The results revealed an overarching theme that describes research collaboration as a balancing act with scientific quality and ethics on one side, and the needs and abilities of older people on the other side. This means that researchers need to strike a balance between achieving the highest scientific quality and considering the needs and abilities of older people they are collaborating with. To understand how unethical, it is to not involve older people in research, the concept epistemic injustice has been used. It refers to the systematic exclusion of certain groups from knowledge production and dissemination which can lead to the exploitation of vulnerable populations and the perpetuation of harmful stereotypes. In addressing the challenges of collaborating with older people in research, this study emphasises the importance of researchers being aware of both social and academic structures that might affect whose voices are heard in research. This awareness could help researchers clarify their role in giving older people the opportunity to be part of the collective understanding of ageing and health.

Frail older people with decreased cognition can perceive reduced self-determination in self-care and social relationships.

BACKGROUND: Self-determination in old age is essential for people's experiences of good subjective health and quality of life. The knowledge concerning how frail older people with decreased cognition perceive their ability to be self-determined in the different dimension in daily life is, however, limited. The aim of this study was therefore to explore the relationship of self-determination and cognition in frail older people. METHODS: This study was a cross-sectional secondary data analysis using baseline data with 119 frail people 75 ≥ from a larger randomized control trial. Self-determination was measured with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O). Cognition was measured using the Mini Mental State Examination (MMSE), where decreased cognition was broadly defined as a score below 25 points. Fisher's exact test was used to test differences in proportions of perceiving self-determination in relation to cognition. The Relative Risk (RR) with a 95% Confidence Interval (CI) was used to explore the risk of perceiving reduced self-determination in relation to cognitive functioning. RESULTS: Nearly the entire study population, regardless of cognitive functioning, perceived self-determination in Financial situation. For people with decreased cognition, the relative risk for perceiving reduced self-determination was statistically significant higher in activities related to Self-care and in Social relationships when comparing with the participants with intact cognition. CONCLUSION: Perceiving self-determination when being old, frail and having decreased cognition is possible but is dependent upon which activities that are involved. Organizing healthcare needs according to the older people's wants and wishes is crucial regardless of people having a cognitive decline or not when the effort is to enable the people to be as self-determined as they want. The frail older people with decreased cognition should be treated as being experts in their own lives, and healthcare professionals should navigate the older people to get to their desired direction. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

Uncovering hidden abilities for participation in research through photo-elicitation interviews: a view on participatory research with people living in residential care facilities.

BACKGROUND: Participatory research has been described to improve the relevance of research findings for the society in terms of quality of healthcare services and other public benefits. Nevertheless, there is limited guidance on how to conduct participatory research, and especially in relation to persons living in residential care facilities. To make the voices of this group heard, we therefore take a stance in the democratic approach to participatory research, and we have applied the theoretical framework Model of Human Occupation (MoHO) on participation to evaluate photo-elicitation interviews as a participatory research method with this group. METHODS: A total of 13 persons living in two residential care facilities were involved in the study and asked to take photographs of their everyday life over one week. They were then invited to an individual interview to narrate the meaning of the photographs and to describe how they experienced the photo-elicitation method. The interviews were analysed in the six steps of theoretically driven reflexive thematic analysis. RESULTS: The findings are described in the theme 'Uncovering hidden abilities for participation in research' that describes how photo elicitation interviews facilitated the older persons' participation in research. This is illustrated by four sub-themes: 'Bridging the ageing body', 'Altering habituation to everyday life', 'Empowering storytelling', and 'Negotiating the institutional culture'. CONCLUSIONS: Our study findings support further application and evaluation of photo-elicitation interviews as a method for participatory research in residential care facilities. The major finding is how photo-elicitation interviews were used to reduce the impact of the institutional culture on the older persons' participation in research. The method is, however, not without limitations and we encourage researchers to study the dynamic relationship between physical, social, and cultural aspects of residential care facilities in relation to the use of photo-elicitation interviews with the persons living there.

This study was designed to improve the opportunities for persons living in residential care facilities to participate in research on their own terms. Digital instant print cameras were used by 13 older persons to document their everyday life at two different residential care facilities. The photographs were then followed up with individual interviews, during which the older persons were asked to share their experiences of using the cameras and to tell stories about the meaning of the photographs. Analysing the interviews, we found that the older persons could participate in the study in a way that they did not believe was possible before. They were not used to being given responsibility, and they felt limited by physical and cognitive impairment. Participating in the study, they realised that they had something to contribute with, and that there were aspects of everyday life that they really enjoyed. They felt empowered to share their stories, and we encourage researchers to continue evaluating photographs in combination with interviews in residential care facilities.

A real eye-opener: Nursing home staff experiences of co-designing nursing home services together with residents.

INTRODUCTION: Research and healthcare services struggle to fulfil the desires and needs of nursing home residents, and there is a call for person-centredness in both research and healthcare practice. Involvement of people outside academia in research has been advocated in an effort to increase the relevance and impact of research findings for the public. However, little is known on how to involve nursing home residents in research, and the purpose of this study was, therefore, to learn from professional experiences of working with this group. More specifically, the aim of the study was to explore nursing home staff experiences of co-designing nursing home services with the residents. METHOD: Focus group methodology was used. A total of 17 nursing home staff members (15 women and two men) from two nursing homes participated in four focus groups. Both homogeneity and heterogeneity were strived for during recruitment. RESULTS: The analysis is summarised in one theme and five sub-themes, describing the co-design process as an eye-opener for staff in terms of realising their own, as well as the residents', hidden abilities, and the importance of combining personal and professional knowledge of the residents in daily care and services. CONCLUSION: The major finding is the contribution of knowledge on how co-designing processes in nursing homes could change the dynamics of the relationships between the people involved, and that this, in turn, could realise the resources and knowledge within each person. What researchers in ageing and health can learn from the present findings is the importance of developing genuine and person-centred relationships with both nursing home residents and staff.

Barriers for Inter-Organisational Collaboration: What Matters for an Integrated Care Programme?

Introduction: Inter-organisational collaboration is challenging but essential in managing the complex and comprehensive needs of frail older people. Therefore, there is a need to investigate the influence of different barriers to inter-organisational collaboration when implementing an integrated care programme. The aim of this study was to investigate both inpatient and outpatient staff views on the factors they deemed to be influential to inter-organisational collaboration for an integrated care programme. Methods: The study was a cross-sectional study and included staff from hospitals, primary care and municipal health and social care. Results: There were no significant differences between staff from inpatient and outpatient care in measuring factors that may cause difficulties for inter-organisational collaboration. Staff views diverged significantly on all factors, such as educational level at long physical distances, laws and regulations, knowledge of each others work settings, experience from inter-organisational collaboration, different professions, variations in professional status and power, psychosocial factors such as positive work environment and interpersonal chemistry. Discussion: A multidisciplinary team culture and avenues for inter-organisational collaboration need to be developed for improved care continuity. Conclusion: The staffs' educational level influenced what was perceived as barriers to inter-organisational collaboration, and may guide future development of integrated care programmes.

Positive effects on activities of daily living one year after receiving comprehensive geriatric assessment - results from the randomised controlled study CGA-Swed.

BACKGROUND: Today's acute hospital care is poorly adapted to the complex needs of frail older people. This exposes them to avoidable risks, such as loss of functional capacities, leading to unnecessary health and social care needs. Being frail and in need of acute hospital care often leads to higher dependence in Activities of Daily Living (ADL), especially if one's needs are not acknowledged. Comprehensive Geriatric Assessment (CGA) is one way to meet frail older people's complex needs. The study's aim was to investigate the effects on frail older people's ADL 12 months after receiving CGA. METHODS: This is a two-armed randomised controlled intervention study. Participants were frail older people (75+) who sought the emergency department and needed admission to a medical ward. The intervention was CGA performed at a geriatric management unit during the hospital stay. The CGA included comprehensive assessment of medical, functional, psychological, social, and environmental status as well as treatment, rehabilitation, discharge planning, and follow-up. Multidisciplinary teamwork and a person-centred approach were used. The control was care at an ordinary medical hospital ward. The primary outcome was change in dependence in ADL from 2 weeks before admission to the 12-month follow-up. RESULTS: At admission, 155 people participated (77 in the control, 78 in the intervention). At the 12-month follow-up, 78 participated (40 in the control, 38 in the intervention). Attrition was mainly due to mortality. Four participants in the control (5.2%) and twelve in the intervention group (15.4%) had improved in their ADL 1 year after discharge (OR = 3.32; 95% CI = 1.02-10.79). CONCLUSIONS: In-hospital CGA performed at a geriatric management unit improves frail older people's ADL. Being less dependent in ADL increases frail older people's ability to remain in their own housing, which is important for both the individual and society. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02773914 . Retrospectively registered 16 May 2016.

Everyday life in a Swedish nursing home during the COVID-19 pandemic: a qualitative interview study with persons 85 to 100 years.

OBJECTIVE: To understand and report on the impact of the COVID-19 pandemic on the everyday lives of frail older persons living in nursing homes by exploring their experiences of how the pandemic-related restrictions had influenced them and in what way. DESIGN: Empirical qualitative interview study. SETTING: A publicly run nursing home in an urban area in Sweden in June 2020. The nursing home had visitor restrictions, cancelled activities and physical distancing requirements since March 2020. PARTICIPANTS: A total of 10 persons, 85-100 years, living in a Swedish nursing home during the COVID-19 pandemic, were recruited through nursing home management and interviewed in June 2020 using medically approved visors and physical distancing. ANALYSIS: Interviews were analysed using thematic analysis, which involves familiarisation, coding and definition of themes. Transcripts were coded into data-driven categories before being organised into categories that described and explained the data. RESULTS: The analysis resulted in the main theme 'It is like living in a bubble', that describes everyday life in the nursing home during the pandemic as a world of its own in which the older persons felt both protected and isolated. This is described in four subthemes: living 1 day at a time, without fear of the virus; feeling taken care of; having limited freedom and missing out on the little extras. CONCLUSIONS: Contributing to the growing area of COVID-19-related research, our findings provide novel insights into how pandemic-related restrictions in nursing homes represent a risk of isolating older people from the outside world and diminishing their freedom. Put in relation to the previous research, these findings could be applied beyond the pandemic, to develop research and practice that puts focus on how to support older people to decide for themselves how to spend the rest of their lives.

'I wanted to talk about it, but I couldn't', an H70 focus group study about experiencing depression in early late life.

BACKGROUND: Knowledge about experiences of depression among younger-old adults from the general population is limited. The aim was to explore experiences of depression in early late life. METHODS: Sixteen participants in the population-based Gothenburg H70 Birth Cohort Studies (12 women and 4 men) who had reported a history of depression between ages 60-70 took part in focus group discussions (n = 4). Data were analyzed using focus group methodology. RESULTS: The analysis resulted in the overall theme 'I wanted to talk about it, but I couldn't'. The participants expressed unmet needs of communication about depression with family, friends, and healthcare staff. Participants wanted to know more about the causes and effects of depression, available treatment options and how to avoid recurrence. Lack of knowledge was a source of frustration; trust in health care providers was diminished. Being retired meant that opportunities for communication with co-workers were no longer available, and this made it harder to break negative thought and behavioral patterns. Being depressed meant losing one's normal self, and participants were grieving this. Thoughts of death and suicide were experienced in solitude; knowing that there was an escape could generate a feeling of comfort and control. CONCLUSIONS: Younger-old adults have expressed a need to talk about their experiences of depression. They would like to know more about available treatments, potential side effects, and how to avoid recurrence. Care providers also need to be aware there is a need for an existential dialogue about death.

Can Comprehensive Geriatric Assessment Meet Frail Older People's Needs? Results from the Randomized Controlled Study CGA-Swed.

BACKGROUND: The comprehensive geriatric assessment (CGA) designed to manage frail older people requiring acute medical care, is responsible for diagnostics, assessment, treatment, and planning while addressing a person's medical, psychological, social, and functional capabilities. The aim was to investigate if CGA had an impact on frail older people's activities of daily living (ADL) status, self-rated health, and satisfaction with hospital care. METHODS: A two-armed design with frail people aged 75 or older who required an unplanned hospital admission were randomized to either the CGA ward or to an acute medical ward. Analyses were made based on the intention-to-treat principle (ITT). The primary outcome was ADL. Data were analyzed using Chi-square and odds ratio. A subgroup analysis was performed due to non-adherence and contamination. RESULTS: One-hundred and fifty-five people participated in the study; 78 in the intervention and 77 in the control. Participants in the intervention group had a higher odds ratio of reporting having received written information and felt that care met their needs during their hospital stay. No additional statistically significant results for the primary or secondary outcomes in the ITT analysis were achieved. CONCLUSION: Participants felt that the care they received with the CGA ward met their needs. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings, and because a CGA during one hospital stay is probably not enough to have long-term effects.

Challenging oneself on the threshold to the world of research - frail older people's experiences of involvement in research.

BACKGROUND: User involvement of people outside academia in research is argued to increase relevance of research for society and to empower the involved lay persons. Frail older people can be a hard to reach group for research and thus an underrepresented group in research. There is a lack of knowledge how collaboration with frail older people should be best performed. Therefore, the aim of this study was to explore frail older people's experiences of involvement in research. METHODS: In this study we have invited people, 75 years of age or older screened as physically frail and who have previously participated in a study as data sources, to share their experiences by intensive interviewing. Data was collected and analysed in parallel inspired by a constructivist grounded theory approach. RESULTS: The results demonstrate how frail older people have different incentives, how their context of ageing and the unusual position of being involved in research altogether influenced how, where and in what way they wished to be involved in research. This is described in three categories: Contributing to making a difference for oneself and others, Living a frail existence and Being on somebody else's turf. The categories compose the core category, Challenging oneself on the threshold to the world of research, which symbolises the perceived distance between the frail older people themselves and the research world, but also the challenges the frail older people could go through when choosing to be involved in research. CONCLUSIONS: Frail older people have a varied capacity to participate in research, but in what way and how is difficult to know before they have been involved in the process of research. Our results advocate that it is problematic to exclude frail older people a priori and that there is a potential for new perspectives and knowledge to be shaped in the encounter and in the relationship between the researcher and the frail older person. For research to be able to cater for frail older people's needs of health services, their voices need to be heard and taken into consideration.

Positioning work related stress - GPs' reasoning about using the WSQ combined with feedback at consultation.

BACKGROUND: General practitioners (GPs) regularly handle cases related to stress and work capacity, but often find this work difficult. However, using an assessment tool in a structured way can increase GPs' awareness of the risk for sick leave and need of referrals to preventive measures. Today there is no established methodical practice for this in primary health care. The aim of this study was to explore GPs' reasoning about using the Work Stress Questionnaire combined with feedback at consultation as an early intervention to reduce sick leave. METHODS: A focus group study was performed with 23 GPs at six primary health care centres. The discussions were analysed based on a method by Krueger. RESULTS: Three themes emerged. Positioning work-related stress describes the need to make fundamental standpoints on stress and how it should be handled, to make sense of their work concerning work-related stress. Making use of resources focuses on GPs performing to the best of their ability using assigned resources to treat patients with stress-related ill health, even if the resources were perceived as insufficient. Practising daily work focuses on the GPs' regular and preferred way of working set against the degree of intrusion and benefits. The two related themes making use of resources and practising daily work were mirrored through the third theme, positioning work-related stress, to form an understanding of how GPs should work with patients perceiving work-related stress. CONCLUSIONS: The GPs own competence and tools, those of other professionals and the time allocated were seen as important when treating patients perceiving ill health due to work-related stress. When resources were insufficient though, the GPs questioned their responsibility for these patients. The results also indicate that the GPs viewed their ordinary consultative way of working as sufficient to identify these patients. The intervention was therefore not seen as useful for early treatment of patients at risk of sick leave due to work-related stress. However, prevention is an important part of the PHC's responsibility, and strategies concerning stress-related ill health therefore need to be more thoroughly formulated and incorporated. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02480855 . Registered 20 May 2015.

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.

Development of an instrument to assess oral hygiene ability in older adults: The oral hygiene ability instrument.

OBJECTIVES: To describe the development process of an instrument to assess the ability to manage daily oral hygiene and the cause of impaired oral hygiene. The instrument is initially aimed for use by the dental team in the ageing population. BACKGROUND: Oral hygiene is an important component of oral health. Inability to manage oral hygiene combined with other risk factors often results in poor oral health and impaired quality of life. METHODS: A guideline for instrument development was used during the construction of the instrument. The method included three phases: I. planning: the purpose and target group of the instrument were determined, and a literature review and qualitative focus-group study were conducted; II. construction: objectives were formulated, and a pool of items was built; and III. evaluation and validation, which included two pilot studies, interviews, item analyses and revision of the instrument. RESULTS: The planning and construction phases resulted in an instrument with 47 items comprising three parts: (a) interview, (b) clinical examination and (c) observation of activities of daily living (oral hygiene). After two pilot studies, the instrument was found to have good content validity. Analyses of qualitative and quantitative data resulted in a reduction in the number of items to 33. CONCLUSION: OHAI can be a valuable tool as a preventive method to identify older adults at risk of impaired oral health. However, the instrument needs further evaluation before wider use.

Modelling long-term cost-effectiveness of health promotion for community-dwelling older people.

The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

Effect of a care process programme on frail older people's life satisfaction.

AIM: The aim of this study was to analyse the effects of a full-scale implementation of a care process programme on life satisfaction among frail older people, as compared with those receiving usual care. DESIGN: The study includes participants from a full-scale care process programme (N = 77) and participants from a historical control group (N = 66). The care process programme establishes a comprehensive continuum of care through components including case management, interprofessional teamwork and care-planning meetings in the older people's own homes. METHODS: Questionnaires were used and data were collected at baseline, with follow-ups at three, six and 12 months. RESULTS: The implementation of the full-scale care process programme had a positive effect on life satisfaction among frail older people. From 6-month-12-month follow-ups, a higher proportion of participants in the care process programme had positive life satisfaction outcomes, as compared with the historical control group.

Was it worth it? Older adults' experiences of participating in a population-based cohort study - a focus group study.

BACKGROUND: At present, we know relatively little about priorities and problems with topics that older adults experience when completing different examinations in longitudinal population-based studies. To examine these topics, research must be adapted to investigate the meanings, motivations, and interpretations of the individual participants themselves. Therefore, the present study aimed to explore older adults' motives, understandings and experiences regarding participating in the Gothenburg H70 Birth Cohort Studies (the H-70 study). METHODS: Focus group discussions were used. A total of thirty-eight persons, 19 women and 19 men participated in nine focus groups. A strategic sampling technique was used to ensure that the focus group participants represented the larger population. RESULTS: The results supported the overall theme: "It was well worth the effort," which summarized how the participants felt about the population health study. The following specific themes were also identified: an intense event, for the benefit of oneself and others, confidence in health research and the researcher, key decisions about test outcomes and the survey raising questions and providing few answers. CONCLUSIONS: Knowledge of priorities and problems with topics experienced by older adults completing different examinations when participating in longitudinal population-based studies is crucial for research to improve the health and wellbeing of older people. To date, older people's involvement in population-based cohort studies has largely been as research subjects. This study is a first step toward the participants taking a more active part by allowing them to share their experiences which can be used to improve the research procedures. This requires the participation of older adults in collaboration with the researchers, to ensure the quality of longitudinal studies of older adults. Therefore, our intention when it comes to future research will be to involve older adults-the target group-in the research procedure.

Feeling Respected as a Person: a Qualitative Analysis of Frail Older People's Experiences on an Acute Geriatric Ward Practicing a Comprehensive Geriatric Assessment.

Comprehensive geriatric assessment (CGA) practices multidimensional, interdisciplinary, and diagnostic processes as a means to identify care needs, plan care, and improve outcomes of frail older people. Conventional content analysis was used to analyze frail older people's experiences of receiving CGA. Through a secondary analysis, interviews and transcripts were revisited in an attempt to discover the meaning behind the participants' implied, ambiguous, and verbalized thoughts that were not illuminated in the primary study. Feeling "respected as a person" is the phenomenon participants described on a CGA acute geriatric ward, achieved by having a reciprocal relationship with the ward staff, enabling their participation in decisions when engaged in communication and understanding. However, when a person was too ill to participate, then care was person-supportive care. CGA, when delivered by staff practicing person-centered care, can keep the frail older person in focus despite them being a patient. If a person-centered care approach does not work because the person is too ill, then person-supportive care is delivered. However, when staff and/or organizational practices do not implement a person-centered care approach, this can hinder patients feeling "respected as a person".

The Gothenburg H70 Birth cohort study 2014-16: design, methods and study population.

To improve health care for older persons, we need to learn more about ageing, e.g. identify protective factors and early markers for diseases. The Gothenburg H70 Birth Cohort Studies (the H70 studies) are multidisciplinary epidemiological studies examining representative birth cohorts of older populations in Gothenburg, Sweden. So far, six birth cohorts of 70-year-olds have been examined over time, and examinations have been virtually identical between studies. This paper describes the study procedures for the baseline examination of the Birth cohort 1944, conducted in 2014-16. In this study, all men and women born 1944 on specific dates, and registered as residents in Gothenburg, were eligible for participation (n = 1839). A total of 1203 (response rate 72.2%; 559 men and 644 women; mean age 70.5 years) agreed to participate in the study. The study comprised sampling of blood and cerebrospinal fluid, psychiatric, cognitive, and physical health examinations, examinations of genetics and family history, use of medications, social factors, functional ability and disability, physical fitness and activity, body composition, lung function, audiological and ophthalmological examinations, diet, brain imaging, as well as a close informant interview, and qualitative studies. As in previous examinations, data collection serves as a basis for future longitudinal follow-up examinations. The research gained from the H70 studies has clinical relevance in relation to prevention, early diagnosis, clinical course, experience of illness, understanding pathogenesis and prognosis. Results will increase our understanding of ageing and inform service development, which may lead to enhanced quality of care for older persons.

Perspectives of Older Adults on Aging Well: A Focus Group Study.

BACKGROUND: With increasing number of older adults worldwide, promoting health and well-being becomes a priority for aging well. Well-being and physical and mental health are closely related, and this relation may become more vital at older ages as it may contribute to aging well. The state of well-being is a multifaceted phenomenon that refers to an individual's subjective feelings, and exploring perspectives of older adults on aging well is developing to be an important area of research. Therefore, the aim of this study was to explore perceptions on aging well among older adult Palestinians ≥60 years. METHODS: A qualitative research design in the context of focus group discussions was used; seven focus groups were conducted including fifty-six participants (aged 63-81 years). Data were analyzed using a qualitative interpretative thematic approach described by Braun and Clarke. RESULTS: Three major themes were identified, "sense of well-being," "having good physical health," and "preserving good mental health." The participants perceived that aging well is influenced by positive feelings such as being joyous, staying independent, having a life purpose, self-possessed contentment, and financially secured, in addition to be socially engaged and enjoying good physical and mental health. CONCLUSION: This study contributes to get a better insight concerning older adults' perspectives on aging well. Enhancing physically active lifestyle, participation in social and leisure activities, healthy eating habits, having a purpose in life, and being intellectually engaged are all contributing factors to aging well. Vital factors are to be considered in developing strategic health and rehabilitative plans for promoting aging well among older adults.