Papers by Isabelle Andersson Hammar
BMJ open, Apr 1, 2024
To cite: Larsson M, Ahlstrand I, Larsson I, et al. Occupational balance and associated factors am... more To cite: Larsson M, Ahlstrand I, Larsson I, et al. Occupational balance and associated factors among students during higher education within healthcare and social work in Sweden: a multicentre repeated crosssectional study. BMJ Open 2024;14:e080995.
BMC Geriatrics, Jan 2, 2024
Background Self-determination in old age is essential for people's experiences of good subjective... more 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 selfdetermined 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.
Aim: The overall aim of this thesis was to explore self-determination in the context of community... more Aim: The overall aim of this thesis was to explore self-determination in the context of community-dwelling older persons with different degrees of dependence in daily activities. Methods: Using a qualitative, grounded design, study I explored how people 80 years and older experienced their self-determination when developing dependence in daily activities. Study II employed a qualitative and quantitative design where the validity of the questionnaire Impact on Participation and Autonomy (IPA-S) was tested using focus group discussions and individual interviews. The participants were aged 70 years and older. The focus groups were followed by a reliability test-retest of the adjusted version (IPA-O) on persons in the same age. Study III and IV applied an exploratory, cross-sectional design where two sets of data were combined, resulting in a sample of persons aged 80 years and older. Perceived self-determination in daily life was explored in relation to degree of dependence in daily ac...
The importance of daily occupations to subjective health - perceptions among women with rheumatic diseases
The aim of this phenomenographic study was to identify and characterise what women with the diagn... more The aim of this phenomenographic study was to identify and characterise what women with the diagnoses Rheumatoid Arthritis and Juvenile Idiopathic Arthritis consider important in the occupational p ...
International Perspectives on Aging, 2022
This chapter describes the work of the Frail Elderly Support Research Group (FRESH) in relation t... more 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 encoura...
BMC Geriatrics
Background Frail older people are at higher risk of further deterioration if their needs are not ... more 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 i...
Geriatrics, 2020
Background: The comprehensive geriatric assessment (CGA) designed to manage frail older people re... more 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 interventio...
Geriatrics, 2020
The aim of the study is to evaluate the effects of the Comprehensive Geriatric Assessment (CGA) f... more 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...
Health Psychology Research, 2014
In research and healthcare it is important to measure older persons’ self-determination in order ... more In research and healthcare it is important to measure older persons’ self-determination in order to improve their possibilities to decide for themselves in daily life. The questionnaire Impact on Participation and Autonomy (IPA) assesses self-determination, but is not constructed for older persons. The aim of this study was to examine the validity and reliability of the IPA-S questionnaire for persons aged 70 years and older. The study was performed in two steps; first a validity test of the Swedish version of the questionnaire, IPA-S, followed by a reliability test-retest of an adjusted version. The validity was tested with focus groups and individual interviews on persons aged 77-88 years, and the reliability on persons aged 70-99 years. The validity test result showed that IPA-S is valid for older persons but it was too extensive and the phrasing of the items needed adjustments. The reliability test-retest on the adjusted questionnaire, IPA-Older persons (IPA-O), showed that 15 o...
BMC Geriatrics, 2014
Background: Older persons' right to exercise self-determination in daily life is supported by sev... more Background: Older persons' right to exercise self-determination in daily life is supported by several laws. Research shows that older persons' self-determination is not fully respected within the healthcare sector. In order to enable and enhance older persons' self-determination, extensive knowledge of older persons' self-determination is needed. The aim of this study was to explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older. Methods: Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons aged 84-95 years who were beginning to develop dependence in daily activities. Results: The data analysis revealed the core category, "Self-determination-shifting between self-governing and being governed". The core category comprised three categories: "Struggling against the aging body", "Decision-making is relational", and "Guarding one's own independence". Self-determination in daily activities was related to a shifting, which was twofold , and varied between self-governing and being governed by the aging body, or by others. Conclusions: The findings imply a need to adopt a person-centered approach where the older persons' own preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination.
BMC Geriatrics, 2022
Background Today’s acute hospital care is poorly adapted to the complex needs of frail older peop... more 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 w...
Self-determination among community-dwelling older persons: explanatory factors
Scandinavian Journal of Occupational Therapy, 2016
Background Although it is acknowledged that exercising self-determination in daily activities aff... more Background Although it is acknowledged that exercising self-determination in daily activities affects older people's health and well-being, few studies have focused on the explanatory factors for self-determination in daily life. Objective To investigate explanatory factors for self-determination in the context of community-dwelling older persons. This cross-sectional study combined two sets of data that included community-dwelling persons 80 years and older (n = 456). A bivariate logistic regression was performed to analyse the association of self-determination and a set of explanatory factors. Results The final bivariate logistic regression model revealed five explanatory factors that were significantly associated with perceiving reduced self-determination: high education (OR = 2.83), frailty (OR = 2.70), poor self-rated health (OR = 2.54), dissatisfaction with physical health (OR = 6.50), and receiving help from public homecare service (OR = 2.46). Conclusion Several explanatory factors related to the ageing body and environmental aspects were associated with reduced self-determination. To help older people maintain self-determination, healthcare professionals should consider using a person-centred and capability approach to care.
Purpose: The purpose of this paper is to explore the relationship of self-determination with degr... more Purpose: The purpose of this paper is to explore the relationship of self-determination with degree of
dependence in daily activities among community-dwelling persons aged 80 years and older.
Design/methodology/approach: This cross-sectional study focused on community-dwelling people
80 years or older with varied degree of dependence in daily activities. Self-determination in daily life was
assessed with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O), and
degree of dependence in daily activities was assessed with the activities of daily living (ADL) staircase.
Data were analysed using Fisher’s exact test, and the relative risk with a 95 per cent confidence interval was
used to explore the risk of perceiving reduced self-determination in daily life.
Findings: Compared to the independent persons, the perceived self-determination was significantly lower
among persons dependent in instrumental activities of daily living (I-ADL), and persons dependent in personal
activities of daily living (P-ADL). Reduced self-determination was most pronounced in persons requiring help
with P-ADL.
Practical implications: Following key features could be applied to strengthen the community-dwelling
older people’s self-determination; incorporating a dialogue where self-determined questions are raised;
adopting a person-centred approach between the persons involved; acknowledging older people’s
capabilities – what they are able to do and to be, and what they value.
Originality/value: This study highlights the need of integrating a self-determined dialogue into healthcare
where the older person and the professional focus on self-determined questions.
Keyword: Decision making, Respect, Activities of daily living, Aged 80 and over, Capability, Cross-sectional study
Paper type: Research paper
In research and healthcare it is important to
measure older persons’ self-determination in
order ... more In research and healthcare it is important to
measure older persons’ self-determination in
order to improve their possibilities to decide
for themselves in daily life. The questionnaire
Impact on Participation and Autonomy (IPA)
assesses self-determination, but is not constructed
for older persons. The aim of this
study was to examine the validity and reliability
of the IPA-S questionnaire for persons aged
70 years and older. The study was performed in
two steps; first a validity test of the Swedish
version of the questionnaire, IPA-S, followed
by a reliability test-retest of an adjusted version.
The validity was tested with focus groups
and individual interviews on persons aged 77-
88 years, and the reliability on persons aged
70-99 years. The validity test result showed
that IPA-S is valid for older persons but it was
too extensive and the phrasing of the items
needed adjustments. The reliability test-retest
on the adjusted questionnaire, IPA- Older persons
(IPA-O), showed that 15 of 22 items had
high agreement. IPA-O can be used to measure
older persons’ self-determination.
Abstract
Background: Older persons’ right to exercise self-determination in daily life is support... more Abstract
Background: Older persons’ right to exercise self-determination in daily life is supported by several laws. Research
shows that older persons’ self-determination is not fully respected within the healthcare sector. In order to enable
and enhance older persons’ self-determination, extensive knowledge of older persons’ self-determination is needed.
The aim of this study was to explore experiences of self-determination when developing dependence in daily
activities among community-dwelling persons 80 years and older.
Methods: Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons
aged 84–95 years who were beginning to develop dependence in daily activities.
Results: The data analysis revealed the core category, “Self-determination - shifting between self-governing and being
governed”. The core category comprised three categories: “Struggling against the aging body”, “Decision-making is
relational”, and “Guarding one’s own independence”. Self-determination in daily activities was related to a shifting,
which was two-fold, and varied between self-governing and being governed by the aging body, or by others.
Conclusions: The findings imply a need to adopt a person-centered approach where the older persons’ own
preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination.
Keywords: Aged 80 and over, Activities of daily living (ADL), Decision-making, Grounded theory, Sweden
Objective:The purpose was to describe and characterize what women with rheumatoid arthritis (RA) ... more Objective:The purpose was to describe and characterize what women with rheumatoid arthritis (RA) and juvenile idiopathic
arthritis (JIA) perceive as important in considering the performance of daily occupations to perceive good health. Methods:By
using a phenomenographic research approach with semi-structured interviews with nine women between the ages of 42 and
65 the core category “Being able to be as active as possible in daily occupations” emerged. Results:The women’s repertoire of
daily occupations had changed as the years had passed. To perceive good health the women expressed the importance of
continuing to be active and to perform occupations as independently as possible despite their chronic rheumatic diseases.
Conclusions:By adapting to their level of physical function and strength and by compensation with assistive devices, selecting
adjusted environment, and by getting support from others, the women perceived good health. The results also suggested that
training in different ways, medical treatment, and rheumatologic team care were related to increased performance of daily
occupations and the perceptions of good health.
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Papers by Isabelle Andersson Hammar
dependence in daily activities among community-dwelling persons aged 80 years and older.
Design/methodology/approach: This cross-sectional study focused on community-dwelling people
80 years or older with varied degree of dependence in daily activities. Self-determination in daily life was
assessed with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O), and
degree of dependence in daily activities was assessed with the activities of daily living (ADL) staircase.
Data were analysed using Fisher’s exact test, and the relative risk with a 95 per cent confidence interval was
used to explore the risk of perceiving reduced self-determination in daily life.
Findings: Compared to the independent persons, the perceived self-determination was significantly lower
among persons dependent in instrumental activities of daily living (I-ADL), and persons dependent in personal
activities of daily living (P-ADL). Reduced self-determination was most pronounced in persons requiring help
with P-ADL.
Practical implications: Following key features could be applied to strengthen the community-dwelling
older people’s self-determination; incorporating a dialogue where self-determined questions are raised;
adopting a person-centred approach between the persons involved; acknowledging older people’s
capabilities – what they are able to do and to be, and what they value.
Originality/value: This study highlights the need of integrating a self-determined dialogue into healthcare
where the older person and the professional focus on self-determined questions.
Keyword: Decision making, Respect, Activities of daily living, Aged 80 and over, Capability, Cross-sectional study
Paper type: Research paper
measure older persons’ self-determination in
order to improve their possibilities to decide
for themselves in daily life. The questionnaire
Impact on Participation and Autonomy (IPA)
assesses self-determination, but is not constructed
for older persons. The aim of this
study was to examine the validity and reliability
of the IPA-S questionnaire for persons aged
70 years and older. The study was performed in
two steps; first a validity test of the Swedish
version of the questionnaire, IPA-S, followed
by a reliability test-retest of an adjusted version.
The validity was tested with focus groups
and individual interviews on persons aged 77-
88 years, and the reliability on persons aged
70-99 years. The validity test result showed
that IPA-S is valid for older persons but it was
too extensive and the phrasing of the items
needed adjustments. The reliability test-retest
on the adjusted questionnaire, IPA- Older persons
(IPA-O), showed that 15 of 22 items had
high agreement. IPA-O can be used to measure
older persons’ self-determination.
Background: Older persons’ right to exercise self-determination in daily life is supported by several laws. Research
shows that older persons’ self-determination is not fully respected within the healthcare sector. In order to enable
and enhance older persons’ self-determination, extensive knowledge of older persons’ self-determination is needed.
The aim of this study was to explore experiences of self-determination when developing dependence in daily
activities among community-dwelling persons 80 years and older.
Methods: Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons
aged 84–95 years who were beginning to develop dependence in daily activities.
Results: The data analysis revealed the core category, “Self-determination - shifting between self-governing and being
governed”. The core category comprised three categories: “Struggling against the aging body”, “Decision-making is
relational”, and “Guarding one’s own independence”. Self-determination in daily activities was related to a shifting,
which was two-fold, and varied between self-governing and being governed by the aging body, or by others.
Conclusions: The findings imply a need to adopt a person-centered approach where the older persons’ own
preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination.
Keywords: Aged 80 and over, Activities of daily living (ADL), Decision-making, Grounded theory, Sweden
arthritis (JIA) perceive as important in considering the performance of daily occupations to perceive good health. Methods:By
using a phenomenographic research approach with semi-structured interviews with nine women between the ages of 42 and
65 the core category “Being able to be as active as possible in daily occupations” emerged. Results:The women’s repertoire of
daily occupations had changed as the years had passed. To perceive good health the women expressed the importance of
continuing to be active and to perform occupations as independently as possible despite their chronic rheumatic diseases.
Conclusions:By adapting to their level of physical function and strength and by compensation with assistive devices, selecting
adjusted environment, and by getting support from others, the women perceived good health. The results also suggested that
training in different ways, medical treatment, and rheumatologic team care were related to increased performance of daily
occupations and the perceptions of good health.