Abstract Background It has been suggested that the university environment, to improve students’ health status and educational outcomes, should be based on a health promoting approach. More knowledge is needed about health promoting resources and lifestyle factors that may be of value for students in higher education and their future work-life balance. The aim of this study was to explore health-promoting resources, general health and wellbeing, and health promoting lifestyle factors among fourth and final semester students in higher education in healthcare and social work. Methods This longitudinal study is based on self-reported data collected through a web-based questionnaire that included questions about general health, wellbeing, and healthy lifestyle factors and made use of instruments: the Sense of Coherence (SOC) scale, the Salutogenic Health Indicator Scale (SHIS), and five questions from the General Nordic Questionnaire (QPS Nordic). The questionnaire was distributed among students enrolled in seven different healthcare and social work programmes at six universities in Sweden. Data was collected when students were in their fourth (2019/2020) and final (2020/2021) semesters analysed with multiple linear and logistic regressions. Results The survey included responses from students during the fourth (n = 498) and the final (n = 343) semester of higher education programmes in health and social work. Total SOC scores decreased between the fourth semester and the final semester. The prevalence of the health promoting lifestyle factor of physical exercise decreased between the fourth and final semesters. Students in their final semester reported valuing group work more highly than did students in their fourth semester. Despite this, students in both the fourth and the final semester reported high SOC, low levels of good general health and perceived wellbeing, and sleeping problems. Conclusions Students’ report of good general health were associated with wellbeing, high-intensity physical training, and no sleeping problems A high SOC level was associated with good general health, perceived wellbeing, and no sleeping problems. A higher SHIS level was also associated with wellbeing and no sleeping problems. Therefore, we suggest further research focusing on how to prepare students in healthcare and social work during higher education for a future work-life in balance targeting effects on sleep quality.

Objective The aim was to explore whether occupational balance is associated with health, health-promoting resources, healthy lifestyle and social study factors among students during higher education within healthcare and social work.Design The study has a multicentre repeated cross-sectional design. Data were collected via a self-reported, web-based questionnaire based on the validated instruments: the 11-item Occupational Balance Questionnaire (OBQ11), the Sense of Coherence (SOC) Scale, the Salutogenic Health Indicator Scale (SHIS) and five questions from the General Nordic Questionnaire (QPS Nordic) together with questions about general health and lifestyle factors.Setting Students at six universities in western Sweden at one of the following healthcare or social work programmes: biomedical scientists, dental hygienists, nurses, occupational therapists, physiotherapists, radiology nurses and social workers.Participants Of 2283 students, 851 (37.3%) participated.Results The students experienced that occupational balance increased during education. The total OBQ11 score was higher among students in semesters 4 and 6/7, compared with semester 1 students. Students with higher OBQ11 also reported higher SOC throughout their education, while health seemed to decrease. Students who reported higher levels of OBQ11 reported lower levels of health and well-being in semesters 4 and 6/7, compared with semester 1. There was an opposite pattern for students reporting lower levels of OBQ11.Conclusions The association between higher levels of OBQ11 and lower levels of health and well-being is remarkable. There is a need for more research on this contradiction and what it means for students’ health and well-being in the long run.

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.

Background Frail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment. Aims The aims of this study were threefold: to investigate the prevalence of depression in frail hospital patients, to identify factors associated with depression, and to compare depression management in patients receiving and not receiving Comprehensive Geriatric Assessment (CGA). Methods This secondary analysis from the CGA-Swed randomized control trial included 155 frail older people aged 75 years and above . Instruments included Montgomery Åsberg Depression Rating Scale (MADRS), the ICE Capability measure for older people ( ICECAP-O) and the Fugl-Meyer Life Satisfaction scale (Fugl-Meyer Lisat). Depression was broadly defined as MADRS score ≥ 7. Regression models were used to identify variables associated with depression and to compare groups with and without the CGA intervention. Results The prevalence of a MADRS score indicating depression at baseline was 60.7%. The inability to do things that make one feel valued (ICECAP-O) was associated with a fourfold increase in depression (OR 4.37, CI 1.50–12.75, p = 0.007). There was a two-fold increase in odds of receiving antidepressant medication in the CGA intervention group (OR 2.33, CI 1.15–4.71, p = 0.019) compared to patients in the control group who received regular medical care. Conclusion Symptoms of depression were common among frail older people with unplanned hospital admission. Being unable to do things that make one feel valued was associated with depression. People who received CGA intervention had higher odds of receiving antidepressant treatment, suggesting that CGA improves recognition of mental health needs during unplanned hospital admissions in frail older people. Trial registration ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

This chapter describes the work of the Frail Elderly Support Research Group (FRESH) in relation to the capability approach as a theoretical framework. The FRESH research group works with people who are at risk of developing frailty, as well as those who are already frail or very frail. In this chapter, FRESH aims to utilise the capability approach as a theoretical framework for research with and for frail older people, and to focus on the older people’s opportunities to realise their goals in relation to contextual factors that may influence them. A broad understanding of the concept of frailty in general is also presented. The capability approach makes a fundamental contribution to the understanding of the process of becoming frail, and how it may influence people as they age, because it focuses on people’s real opportunities, what it is possible to achieve and what people have reason to value, in relation to the resources that they have at hand. This chapter will hopefully encourage future researchers to consider evaluating the capability approach and implementing it in their own research.

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.

The aim of the study is to evaluate the effects of the Comprehensive Geriatric Assessment (CGA) for frail older people in Swedish acute hospital settings - the CGA-Swed study. In this study protocol, we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants. The study is a randomised controlled trial with an intervention group receiving the CGA and a control group receiving medical assessment without the CGA. Follow-ups were conducted after 1, 6 and 12 months, with dependence in activities of daily living (ADL) as the primary outcome measure. The study group consisted of frail older people (75 years and older) in need of acute medical hospital care. The study design, randomisation and process evaluation carried out were intended to ensure the quality of the study. Baseline data show that the randomisation was successful and that the sample included frail older people with high dependence in ADL and with a high comorbidity. The CGA contributed to early recognition of frail older people's needs and ensured a care plan and follow-up. This study is expected to show positive effects on frail older people's dependence in ADL, life satisfaction and satisfaction with health and social care.

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.