How to adopt technologies in home care: a mixed methods study on user experiences and change of home care in Finland.

BACKGROUND: There is a need for better adoption of technology to meet the needs of home care professionals, older people, and informal caregivers. METHODS: Mixed methods were used to describe and analyse quantitative and qualitative data in a Finnish governmental programme called KATI. The study was three-fold: it 1) listed what kinds of technologies were piloted and deployed in a national study, 2) provided information from the perspectives of home care professionals about requirements to use technology by using focus-group interviews, and 3) assessed experiences of how the adoption of technology changes work and work processes over time by using repeated surveys. Informants in interviews (n = 25) and surveys (n = 90) were home care professionals, who also described the perspectives of older people and informal caregivers. The conceptual models framing the study were adapted from the Technology Acceptance Model and DirVA PROVE-IT. RESULTS: There were 80 technology pilots, in which variety of technologies were followed in home care. Familiarity with, commitment to and understanding of technology benefits were considered to be requirements for the technology to be used. The adoption of technology provided new skills and information about older people's wellbeing, realisation of treatment and new possibilities in home care. It developed new procedures to focus on older people's needs and motivated professionals by gained concrete aid. It enabled them to leave out some concrete procedures as unnecessary. On the other hand, there were also pessimistic and negative experiences when technology use provided nothing new or did not change anything. CONCLUSIONS: The adoption of technology is dependent on the technology and its integration into the prevailing service practice. When they both work, it is possible to leave out unnecessary procedures in care, allocate resources and save time. It is possible to be aware of older people's safety and how they cope at home, find new ways to get involved in older people's lives, gain insight, and make changes at work. Continuous on-site training, modifications in service practices and communication throughout organisations is needed.

Surgery, Limb Edema and Health-related Quality of Life: A Prospective Follow-up Study on Patients With Cutaneous Malignant Melanoma.

BACKGROUND/AIM: The latest developments in oncological therapies for malignant melanoma, and the discovery that complete lymph node dissection offers no survival benefit, are changing the landscape of melanoma surgery. There is a need for more information on health-related quality of life (HRQoL) consequences of melanoma surgery. PATIENTS AND METHODS: This longitudinal cohort study was carried out from 2004 to 2009 in the Helsinki and Uusimaa Hospital District and patients were followed-up at 6, 12 and 24 months. The patients were asked to fill in the generic 15D questionnaire and the cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). In addition, they were asked selected questions from the EORTC Item Library regarding upper and lower limb edema. RESULTS: A total of 169 (64.5%) patients with local or locally advanced melanoma referred for surgical treatment responded, of whom 161 were included in the final analysis. For the whole patient group, distress, depression and emotional function improved over time. Worse HRQoL in some of the dimensions were associated with female sex, skin transplant versus direct wound closure and complications 30 days or more after surgery, but none was associated with worse overall HRQoL. Postoperative complications, type of wound closure or lymph node surgery had no effect on overall HRQoL. Patient-reported limb edema was associated with worse overall HRQoL at baseline and during follow-up by both instruments. Patients reporting limb edema reported worse mobility and more pain throughout the study. CONCLUSION: Patient-reported limb edema, regardless of the cause, seems to be an important predictor of worse HRQoL among patients with melanoma.

Changes in older people's quality of life in the COVID-19 era: a population-based study in Finland.

PURPOSE: We investigated how quality of life (QoL) changed between 2018 and 2020, and how its related factors, i.e., communication with friends and family, loneliness, and sleeping difficulties changed amid the early-phase COVID-19 pandemic among Finnish older people. METHODS: This study utilizes data from a repeated cross-sectional, population-based FinSote survey in 2018 and 2020. Participants were community-dwelling people aged 75 years or older (N = 9781 in 2018 and N = 9919 in 2020). QoL was assessed with the EUROHIS-QoL-8 scale. Changes in QoL-related factors were self-evaluated in 2020. Statistical methods included t test, Cohen's D, and chi-square test. To identify potential risk groups, all analyses were stratified by socio-demographic features including sex, age, economic deprivation, living alone, and difficulties in Instrumental Activities of Daily Living (IADL). RESULTS: QoL improved slightly from 2018 to 2020 (means 3.68 and 3.81, respectively). Only those reporting economic deprivation demonstrated a slight decrease in QoL (3.24 vs. 3.14). Of respondents, 63% reported having less communication with friends and family, 42% having felt lonelier, and 20% having more sleeping difficulties amid the pandemic. Negative changes were more often reported by women, the oldest old, those living alone, reporting economic deprivation, or manifesting IADL difficulties. CONCLUSION: Finnish older people's QoL was not affected as much as expected amid the pandemic, although some population groups were, however, more susceptible to the negative effects of the pandemic on QoL-related factors. Results imply that various socio-demographic features may shape the effects of a global pandemic and its control measures on wellbeing.

Long-Term Quality of Life of Melanoma Survivors Is Comparable to that of the General Population.

BACKGROUND/AIM: There is a growing need for information regarding the Health-Related Quality of Life (HRQoL) of cancer survivors. This study aimed to assess the HRQoL of patients treated for cutaneous malignant melanoma between 1980 and 2004 in the Helsinki and Uusimaa Hospital district and compare the results to the general population. MATERIALS AND METHODS: HRQoL of 981 cutaneous melanoma patients (aged 13 to 97 years, 56.1% female) was assessed using the generic 15D instrument and compared to the general population. The association between demographic and clinical factors and HRQoL was analyzed using oneway ANOVA, student's t-test and multivariate regression. RESULTS: The mean 15D score of melanoma patients was slightly lower (0.904) than that of the general population (0.911, p=0.027), but the difference was not statistically significant. HRQoL deteriorates with age and metastatic disease and improves with time. CONCLUSION: No evidence was found that long-term HRQoL of melanoma survivors was worse than the general population.

Risk factors of severity of abuse against older women in the home setting: A multinational European study.

This article examines the ecological risk factors of abuse against older women. Data from 2,880 older women were randomly collected in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal) using a standardized questionnaire. Results indicate that overall 30.1 % older women had at least one experience of abuse in the past year. The findings demonstrate that a single emphasis on personal risk factors (e.g., health, coping) is important but too simple: Abuse is multifaceted and is embedded in environmental (e.g., loneliness, household income) as well as macrocultural contexts (e.g., old age dependency ratio).

Experiences of breast cancer survivors participating in a tailored exercise intervention -a qualitative study.

AIM: The aim of the study was to investigate how tailored exercise is experienced by cancer survivors. PATIENTS AND METHODS: Twenty-five breast cancer survivors who were recently treated with systemic adjuvant treatments attended tailored exercise classes as a part of a randomized controlled exercise intervention study (Breast Cancer and Exercise, BREX). Focus group discussions with a median of four (range 3-6) participants in each group were conducted to capture their individual experiences of their course of illness, taking part in the exercise trial, the personal meaning of tailored exercise classes and the group. RESULTS: Attending the intervention in which the focus of attention was on physical rehabilitation was highly valued, since the participants experienced both improved physical fitness and improved coping. Due to altered physical appearance and poor physical fitness, the participants felt that tailored exercise for patients with breast cancer reduced their barrier to start exercising. Peer support from the group was valued, especially that of sharing experiences, receiving psychological support and gaining a sense of normality. A sense of mastery over their disease through participating in the intervention, i.e. better psychological functioning and improved mood, was a consequence of better physical fitness and of meeting other breast cancer survivors. Also participating in the study per se increases a sense of comfort and security with extra medical examinations and follow-up. CONCLUSION: Participating in the tailored exercise group for breast cancer survivors helped patients gain a sense of mastery, restoring their self-esteem and constructing a meaning for their cancer experience and its impact on their lives.

Item non-response when measuring elder abuse: influence of methodological choices.

BACKGROUND: Efficient actions to fight elder abuse are highly dependent on reliable dimensions of the phenomenon. Accurate measures are nevertheless difficult to achieve owing to the sensitivity of the topic. Different research endeavours indicate varying prevalence rates, which are explained by different research designs and definitions used, but little is known about measurement errors such as item non-responses and how outcomes are affected by modes of administration. METHODS: A multi-national study was developed to measure domestic abuse against home-dwelling older women (aged >60 years) in Europe. The measurement instrument covered six forms of abuse, adapted from the Conflict Tactics Scale. 2880 individuals were interviewed by three different data collection methods (i.e. postal, face-to-face, telephone). RESULTS: Principal component analysis of missing values of 34 indicators of abuse showed various patterns of item non-response. Moreover, principal component analysis indicated several response patterns across different types of data collection. A binary logistic regression explained that item non-response and abuse prevalence is influenced by individual characteristics (social status, vulnerability), method effects such as content (sensitivity), the order of the questions (forms of abuse), by type of data collection and the presence of assistance in survey completion. CONCLUSION: The discussion revolves around how these findings could help improving measuring elder abuse. Advantages and disadvantages of the questionnaire and type of data collection methods are discussed in relation to three potential types of response errors: item positioning effect, acquiescence and social desirability.

Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors.

AIM: The study aimed at determining whether physical exercise training improves the quality of life (QoL) and physical fitness of breast cancer survivors. PATIENTS AND METHODS: A total of 573 breast cancer survivors were randomized into an exercise or a control group, 12-months after adjuvant treatments. EORTC QLQ-C30 and BR-23 questionnaires were used for evaluation of QoL, FACIT-F for fatigue and the Finnish modified version of Beck's 13-item depression scale (RBDI) for depression. Physical fitness was assessed by a 2-km walking test, and a figure-8 running test and physical activity (PA) by metabolic equivalent (MET) hours per week (MET-h/wk). RESULTS: Figure-8 running time improved significantly among the patients of the intervention group compared with the controls (p<0.001). No significant between-group differences were observed in 2-km walking time, in PA, EORTC-QLQ-C30, BR-23, FACIT-F or BDI. However, there was a linear relationship between increased PA and improved QoL (p=0.006), irrespective of the intervention. CONCLUSION: Increase in physical activity was associated with improved QoL, but no effect of the exercise intervention was observed.

European map of prevalence rates of elder abuse and its impact for future research.

This article aims to map existing prevalence research on abuse and neglect of older people and to provide a critical overview of existing methodologies, which have been adopted to survey the prevalence rates of abuse against elders. This article is part of the prevalence study of Abuse and Violence against Older Women (AVOW) study, which was conducted in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal). The article provides an overview of the state of the art of prevalence data, survey designs and methods, instruments and results in Europe. Therefore, this draws on an extensive literature search and qualitative content analysis, which was conducted as an early part of the AVOW study. Results indicate that some EU countries have a rich history of prevalence research, whereas other countries have just begun to tackle this aspect of research on of elder abuse. One of the lacunae concerns reliable numbers on the prevalence rates of elder abuse. Research about where, when and how often elder abuse occurs, is inadequate and inconsistent. Data in some cases are based on professionals' reports rather than on information from older people themselves. Surveying elders about such a sensitive topic, however, implies the need for an adequate research instrument (questionnaire) and research design, and an adapted data collection method. In conclusion, substantial attention is paid to outlining possible guidelines for future research.

The meaning of quality of life in patients being treated for advanced breast cancer: a qualitative study.

The purpose of the present study was to investigate the meaning of advanced breast cancer patients' quality of life (QoL). A semi-structured interview was used, and the phenomenological research method chosen to analyse the data. The findings show that limitations in physical functioning translate into dependency on others, leading to decreased autonomy. Patients tended to ensure their autonomy by participating in easier activities or changing their internal standards. Changes in appearance and decreased condition affected patients' ability to carry out roles and responsibilities, which led to changes in lifestyle and also affected patients' social functioning, often resulting in isolation. The meaning of being able to sustain reciprocal relationships was emphasized. Patients maintained control of to what extent their illness was recognized in social relationships, which was crucial to their feelings of autonomy. Close families were a main source of social support, but also a major source of concern. Meaning of emotional functioning was often expressed in terms of the ability to enjoy life day-by-day and of commitment to treatment. Patients' cognitive functioning was largely intact while their difficulties in cognitive functioning were more characteristic of anxiety. Global QoL was often expressed in terms of a normal life. In addition there were 3 meta themes which emerged from the data: the patients' ability to control the illness experience, personal growth and hope.

Physical performance, toxicity, and quality of life as assessed by the physician and the patient.

The aim of this study was to study the relationship between physician-assessed quality of life parameters, i.e., toxicity and physical performance, and patients' self-reports of their quality of life (QoL). QoL was assessed at baseline and before each treatment, using the EORTC QLQ-C30. The WHO performance score (PS) and toxicity were assessed in physician interviews. The correlations between the WHO PS and the QLQ-C30 functioning scale scores varied from weak to moderate, depending on the scale. Strongest associations were found in physical-, social-, and role functioning, and in the global QoL. The QLQ-C30 nausea/vomiting and diarrhea scales correlated moderately to corresponding WHO scores. A multiple linear regression analysis was used to analyze the contribution of WHO PS and toxicity variables to the global QoL. The best model explained only 16% of the variance of the global QoL score. The present findings highlight the importance of independent QoL assessments focused on those aspects of QoL not captured in clinical interviews with the physician.