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BACKGROUND: According to Swedish law, older adults in Sweden should be able to live a good, safe, and independent life with social and healthcare provided, based on their individual needs. In assisted living in Swedish eldercare the environment affects the older adults' ability to participate in decision-making and strengthens their ability to feel meaningfulness. The ability of staff working in social and healthcare to invite older adults to participate varies. It is important to examine how older adults perceive their situation, as caregivers in eldercare tend to focus on routine work and experience difficulties in meeting the individual needs of older adults. The aim of this study was to explore how older adults in assisted living experienced participation in daily activities. METHODS: A qualitative interview study was conducted in two municipalities in the western part of Sweden. An exploratory and inductive design was used. Individual interviews were conducted with 11 older adults living in two different assisted living facilities. The data were analysed using thematic analysis. RESULTS: The interviews resulted in three themes: Being involved, Sense of well-being, and Influenced by the context. The older adults' experiences of participation were interpreted as feelings of being involved in daily life activities, and how they felt involved in their own care and nursing. Participation created prerequisites for well-being. Sense of well-being could be related to feelings of security and social community. The organisation and work environment of the healthcare staff had a great impact on their ability to increase the participation of the older adults. The older adults were aware of the everyday work situation of the providers of social and healthcare and were Influenced by the context. DISCUSSION/CONCLUSION: Important conditions for a good quality of life and participation for the older adults are to be treated with respect, receive information, and be able to choose. The older adults expressed several good ideas for improvements and a willingness to be involved in the development of the organisation at different levels. It is essential to invite older adults in assisted living to participate in the design of care and nursing.

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BACKGROUND: In Sweden, 72% of people with dementia live in ordinary housing. Of these, 50% receive home care services. Older people with dementia may benefit from developments in decision-making support which aim to facilitate their ability to communicate their personal needs and preferences with care managers and staff in home care services. In this study, we will test and evaluate the use of TalkingMats in Swedish municipal home care services for older people with mild to moderate dementia. TalkingMats is a low-technology communication tool, to help people with communication difficulties express their views. It uses a simple system of picture symbols which are placed on a textured mat. This study will provide insight into the extent to which TalkingMats benefits older people with dementia to feel more involved in decisions related to home care services. In addition, this study will assess the extent to which the use of TalkingMats promotes service providers' efforts to involve service recipients in decision making. The implementation of TalkingMats in home care services will also be studied. METHODS: A parallel group, two-armed randomized controlled trial design in which TalkingMats and Usual Conversation Method will be compared. Two specific situations where older people with dementia must make decisions about home care services will be studied. First, a follow-up needs-assessment conversation between study participants and care managers will be studied. Second, a conversation between participants and home care staff regarding the delivery of the decided home care services will be studied. In addition, a qualitative approach will be used to gain an understanding of study participant and service provider experiences of the impact and implementation of TalkingMats. DISCUSSION: The combined exploratory, descriptive, and experimental study design is considered an important strength which will facilitate multi-facetted knowledge production concerning the involvement and communication needs of older people with dementia generally and within the context of home care services specifically. Combining qualitative and quantitative methods will maximize our ability to assess the effects of TalkingMats. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05561998 . Registered in September 28, 2022.

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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.

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INTRODUCTION: There is a need for individualized discharge planning to support frail older persons at hospital discharge. In this context, active participation on their behalf cannot be taken for granted. The aim of this study was to elucidate patient participation in discharge planning conferences, with a focus on frail older persons, supported by the theory of positioning described by Harré & van Langenhove. METHODS: The study was designed as a case study based on audio-recordings of multidisciplinary discharge planning conferences and interviews with health professionals elucidating their opinions on preconditions for patient participation in discharge planning. The analysis has been performed using qualitative content analysis and discourse analysis. Data collection took place during 2008-2009 and included 40 health professionals and 13 frail older persons in hospital or municipal settings. RESULTS: Findings revealed four different positions of participation, characterized by the older person's level of activity during the conference and his/her appearance as being reduced (patient) or whole (person). The positions varied dynamically from being an active person, passive person, active patient, or passive patient and the health professionals, next-of-kin, and the older persons themselves contributed to the positioning. CONCLUSIONS: The findings showed how the institutional setting served as a purposeful structure or a confinement to patient participation.