Clinical trials

Cognitive impairment and dementia can cause considerable suffering, both for the person affected and for next of kin. They also pose major challenges for health and social care. At the same time, research shows that many risk factors for cognitive decline can, in fact, be influenced. This is particularly the case when several areas are addressed simultaneously, such as physical activity, healthy eating habits, mental stimulation, social connectedness, and good cardiovascular health. A well-known model for such a multidomain preventive intervention is the FINGER model: the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability. In the randomized controlled FINGER study, the results showed that a two-year programme comprising diet, exercise, cognitive training, social activity, and structured monitoring of vascular risk factors could improve and maintain cognitive function among older people at increased risk of cognitive decline. However, the research evidence is not unequivocal. Other randomized studies found no effect on cognitive outcomes over three years in the studied population, and in a cluster-randomized study reported no clear effects on the incidence of dementia in the older population. In addition, studies are needed that follow changes when the model is implemented in clinical practice. In recent years, the FINGER model has also been adapted and tested in several countries through the FINGER network, with the aim of developing and evaluating interventions that work in different contexts, while also strengthening knowledge and enabling comparisons of results between countries. A recently published qualitative study showed that participants were often motivated by an expectation of personal benefit, both for brain health and physical health, but also by concerns about cognitive decline. Social aspects also played an important role, as did the need for the interventions to feel understandable and for lifestyle changes to be perceived as realistic and feasible in everyday life. The overall aim of the project is to evaluate a municipality-initiated, health-promoting multicomponent programme, based on the FINGER model, for older people, with a focus on health, health-related quality of life, well-being, and lifestyle habits (group A), and to compare it with a programme with fewer components (group B) implemented in the municipality. Furthermore, the aim is to explore older people's experiences of participating in the project, as well as how older people in the study rate their health and well-being before, during, and after completing their participation in the project. The main research questions are: * How do older people rate their health, health-related quality of life, well-being, and lifestyle habits before, during, and after participation in the municipality's project (groups A and B)? * What cognitive and physical functional ability do older people have before, during, and after participation in the municipality's project (group A)? * Are there any differences over time within each group (A and B), and are there any differences over time between the groups in the project? * Do self-rated health and health-related quality of life in this study population differ from the values reported in a previously published study? * How do older people experience participating in the project (group A)?

Elderly care and municipal home care have and are facing several challenges with an increasing number of elderly people and fewer people of working age. In addition, welfare staff also have more sick days on average than other areas. Stress, mental ill health and intention to leave work are common. Furthermore, there is a national and international shortage of staff and especially a shortage of specialist nurses, e.g., elderly care and primary care. Strengthening the positive aspects will be central and creating good conditions for staff and thus hopefully also better care and welfare. A sustainable working life where the staff thrive, experience learning, meaning, well-being, good structural conditions, work-life balance and want to stay in the long term. In one of the municipalities in this research project, they will introduce shortened working hours for registered nurses. A shortened working hours (reduced full-time standard by 3.25 hours/week with maintained salary) during a one-year pilot project for nurses in elderly care and municipal home care. Current full-time standard 38.25 hours/week. The municipality has initiated, decided and will implement the changes and the researchers are asked to follow the project. Nurses from the municipality implementing reduced working hours and nurses from municipalities without changed working hours will be invited to participate in the study. The nurses will answer a questionnaire before and after the changes (6 and 12 months after the first data collection). The overall aim of the research is to investigate registered nurses' experiences of their work environment, health, well-being and intention to quit/remain, as well as the quality of care, nurse turnover and sick leave. To study the relationship between shortening working hours or not, nurses' assessments of the work environment, intention to quit/remain, health, well-being and quality of care. The main research questions are: * What are the relationships over time between working hours reduction or not, sociodemographic factors, nurse-rated work environment, intention to quit/remain, health, well-being and nurse-rated quality of care (follow-up after 12 months)? * What changes occur over time in nurses' assessments of work environment, intention to quit/remain, health, well-being and quality of care, and are there any differences compared to a comparison group/municipalities?

Elderly care in Sweden faces several significant challenges. The number of older people is increasing at the same time as there are fewer of working age. Elderly care staff, such as nurses, care assistants and nurses, have on average more sick days than many other professional groups and often experience high work-related stress. In some municipalities, there are also problems with high staff turnover and a lack of formal competence. At the same time, research shows that many employees experience work in elderly care as meaningful and valuable. Taking advantage of and strengthening these positive aspects is central to creating good conditions for the health and well-being of staff and for the quality of care and care for older people. An important area of development in elderly care is person-centred care, which means that care is based on the individual person's needs, wishes, life history and resources. Person-centred practice emphasises the relationship between the older person, the staff and, if the person so wishes, relatives. Although person-centered care is often seen as an obvious part of good care, research shows that it is not fully implemented in practice and that the introduction of person-centered working methods can be complex and demanding. This study is being carried out in collaboration between municipalities and the University of Gävle and is linked to the establishment of nursing homes for the elderly that will function as academic nursing homes. In these nursing homes, person-centered care will be a pronounced focus area. Through recurring measurements, the activities will be monitored and developed in close collaboration between practice and research. The overall aim of the study is to investigate older people's experience of academic nursing homes with a focus on person-centered care and nursing, outdoor environment, health and well-being, and to investigate the staff's experience of person-centered working methods, learning, structural conditions and work-related well-being. The study also aims to analyze the relationship between older people's experiences of person-centered care, outdoor environment, health and well-being, both among older people living in academic nursing homes and among older people living in their own homes. The study has a longitudinal design and data will be collected at several points in time using questionnaires and interviews, which enables both statistical analyses and an in-depth understanding of the participants' experiences over time. By highlighting the perspectives of both older people and staff, the study can contribute new knowledge about how person-centered care can be developed and maintained in practice. In the long term, the results can contribute to a more health-promoting, sustainable and attractive elderly care for both older people and staff.

Elderly care has and is facing several challenges with an increasing number of older people and fewer of working age. Strengthening the positive aspects will be central and creating good conditions for older people and staff for high quality care. Elderly care where both staff and the older people enjoy a health-promoting, preventive and person-centered approach and with good accessibility to services that facilitate faster transitions. In one of the municipalities in this research project, they will introduce measures without individual needs assessment by an social welfare officer and they will carry out a training program for staff. The training will focus on changes in legislation (SoL 2025:400), changed working methods with a focus on the person and their needs (person-centered approach, participation, accessibility, health promotion and prevention) and motivational interviews. Every person with elderly care will have a permanent care contact who has undergone the training. A new preventive unit will be formed. The project is part of a larger program at the University of Gävle where the focus is on person-centered care for older people. In the other municipality (comparison) certain changes are also taking place but to a lesser extent, interventions without individual needs assessment are not planned within the next year on any large scale. On the other hand, preventive and health-promoting activities are being expanded, but on a smaller scale. The changes are the responsibility of the municipalities and the researchers intend to follow the changes that are taking place and has nothing to do with the changes themselves. Questionnaires will be given to older people covered by home care in two municipalities (one where the changes are taking place and a comparison municipality) and to the staff working in home care before and after the changes have taken place. The overall aim of the study is to investigate 1) the experience of older people and 2) staff of a changed way of working in home care in one of the municipalities and compare it with a municipality where smaller changes are taking place. In addition, to study the relationship between estimates of person-centered care/service, quality of care, health and well-being in elderly care for the older people and the relationship between estimates of person-centered care/service, quality of care and quality of working life for the staff. • What changes occur over time 1. in older peoples' rating of person-centered care/service, quality of care/service, health and well-being before and after the introduction of the new working method in one of the municipalities and are there any differences in these variables over time compared to another municipality where minor changes are implemented? 2. in staff-rated person-centered care/service, quality of care/service, and quality of working life, and are there any differences compared to a comparison municipality? The main question that the study aims to answer is: are there any changes in person-centered care, as rated by older people and staff, over time in the municipality with changed working methods within home care and compared to a comparison group/municipality?