Preventive home visits among older people : risk assessment, self-rated health and experiences of healthy ageing

Sammanfattning: Background: The worldwide population is ageing and life expectancy is increasing. This increase in age is associated with physiological and psychosocial challenges and changes that lead to decreased intrinsic capacity and functional ability. To meet these challenges, preventive home visits have been reported to help older people meet their needs with regard to age-related changes, the intention being to enable older people to live at home for as long as possible. Although preventive home visits may have a positive impact on the lives of older people, it is still necessary to gain more knowledge not only about approaches and content, so as to optimise preventive home visits, but also about how older people perceive the ageing process and their need for support from the healthcare services and the environment. Aim: The aim of this thesis is to increase the level of knowledge about the content of preventive home visits to older people who are living at home and about how older people who live at home perceive the ageing process; the overall purpose is to contribute knowledge to help develop risk prevention and health-promotion activities within this population. Methods: The setting is three municipalities in Western Norway, representing a small, a medium and a large municipality. Older persons aged 75 and older participated in preventive home visits performed by trained nurses using a questionnaire. The questionnaire included questions and tests on falls, nutrition, polypharmacy and cognitive impairment as well as questions regarding lifestyle, health and medical diagnoses, including medications. Descriptive and inferential statistics were applied (Studies I to III), including logistic regression (Study II) and linear blockwise regression (Study III). Study IV used focus group interviews of participants aged 65 and older from the medium and large municipalities. The data was analysed using qualitative content analysis. Results: In Study I, 60% (n=166) of the invited persons accepted a preventive home visit invitation. The main reason for declining a visit was that the person was “feeling too healthy”. Thirty-six persons (21.7%) were identified as being at increased risk of developing illness. Study II showed that 34% were at risk of polypharmacy, 13% at risk of falls and 12% at risk of malnutrition. Of the 106 persons who completed the Mini-Cog test, 28% were at risk of cognitive impairment. Poor self-rated health was associated with increased risk of falls, malnutrition and polypharmacy as well as increased risk of developing illness. In Study III, the blockwise regression model showed that being limited by disease and had pain were negatively associated with self-rated health and that use of the internet was positively associated with self-rated health. The model had a R2 0.432. Being limited by disease was the variable that resulted in the largest change in the model (R2 Change=0.297, p-value < 0.001). Study IV suggests that most old persons enjoy life and they want to continue enjoying life for as long as possible. It is important to sustain networks and feel useful. Unexpected changes were described as threats, and the need to use healthcare services was associated with illness and being dependent. The results are categorised according to: embracing life, dealing with challenges and considering the future. Conclusion and implications: The findings from the overall study show that the focus areas of falls, nutrition, polypharmacy and cognitive impairment are relevant and should be assessed in preventive home visits for the purpose of risk identification. Self-rated health had associations with various risks and other factors related to everyday life. Therefore, self-rated health is suggested as starting point in preventive home visits for a personalised conversation regarding positive and negative factors in the older person’s life. The findings from the focus interviews show that social networks and activities are important in order for older persons to maintain good quality of life and to age well. Therefore, it is suggested that preventive homes visits are used to identify social needs and the ability to meet these needs. The findings also show that older persons did not included or wanted services from healthcare professionals as long they were feeling healthy. The older persons view their appreciation of social arenas and contributing to society as health promotion, and healthcare services and other sectors must contribute to health promotion in these areas.