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Background: Heart failure is increasingly common among the elderly, yet many are not referred to specialized care. To better support this group, a co-designed e-health program for patients with heart failure was developed and implemented on Sweden's national health platform, 1177.

Aim: To investigate patients and heart failure nurses' perception of the feasibility of an online support program "Living with Heart Failure".

Methods: A feasibility study including interviews with patients and nurses. Four heart failure nurses recruited patients from outpatient clinics in two Swedish regions through convenience sampling. Patients used the program for 12 weeks before being interviewed about its usability, design, features, and content. Nurses were interviewed in a group setting using similar questions. All interviews were analysed using deductive content analysis, and quantitative data described patient characteristics and program use.

Results: Eleven patients were included, comprising five women and six men, aged 47-84 years (mean 66.8). All had used the program at least once and found the design clear and navigation intuitive. The module content was informative and written in accessible language. They appreciated the variety of content formats. Nurses found the program easy to use and liked the layout but identified limited time as a key barrier to implementation.

Conclusion: Patients and nurses found the support program feasible regarding acceptability, demand, and practicality. The study also indicated a need for future adjustments and showed that the relevance of the program is not restricted to individuals with newly diagnosed heart failure.

Thorough consideration of user experiences and the weighing of advantages and disadvantages are essential when implementing new technology in clinical practice. This article describes a primary care nurse's experience using two technologies to monitor lung congestion in six patient cases: a remote dielectric sensing device for non-invasive lung fluid measurement and a portable handheld ultrasound device. Both can support decision-making when assessing lung congestion in heart failure patients. However, technical difficulties and interpretational complexities are inherent in their use. Balancing these advantages and disadvantages and finding effective strategies to address challenges is crucial for successful clinical implementation.

INTRODUCTION: Despite evidence supporting the effectiveness of exercise-based fall prevention interventions, implementing these programmes in practice remains challenging. Peer-led exercise programmes have demonstrated effectiveness in delivering fall prevention education to older adults. Therefore, this study aimed to explore older adults' experiences of being trained and serving as peer leaders in a group-based fall prevention exercise programme, focusing on the skills and qualities required for leadership. Additionally, the study sought to identify facilitators and barriers influencing training and the programme's long-term implementation.

MATERIALS AND METHODS: Participants were recruited from a randomised controlled trial. Two focus group interviews were conducted with 13 participants from the exercise arm of the randomised controlled trial (nine females and four males). Data were analysed using inductive qualitative content analysis.

RESULTS: Five main categories and nine subcategories emerged, capturing key aspects of the study aim. The categories were: (a) education to prepare fall fitness peer-led trainers; (b) peer-led trainer characteristics and roles during training sessions; (c) physical training environment; (d) psychosocial environment; and (e) prerequisites for the long-term sustainability of the FallFitness programme.

CONCLUSIONS: The 'train-the-trainer' approach for peer-led fall prevention interventions was found to be effective, highlighting the value of integrating theoretical and practical components in training. Participant feedback will inform future improvements to the FallFitness programme, ensuring its continued implementation and effectiveness.

Background: Falls threaten the health and well-being of older adults. While studies have presented effective fall prevention exercises, determining how to deliver these interventions in a way that ensures engagement and long-term sustainability is challenging. Additionally, understanding how older adults perceive and are motivated to participate in such programs is critical for broad public health promotion. This study aimed to explore older adults' experiences and perceptions regarding participation in a newly developed 8-week peer-led group-based exercise program, FallFitness.

Methods: Participants were recruited from a randomized controlled trial (RCT) exploring a newly developed 8-week peer-led group-based exercise program. A total of 2 focus groups were conducted post intervention, comprising ten participants (8 women and 2 men) from the exercise arm of the RCT. Inductive and conventional qualitative content analysis was performed.

Results: From the interviews, 5 main categories and 6 subcategories capturing the study aim are presented. Main categories included: a) social interaction and community, more than just exercise, b) increased motivational drive and self-efficacy, c) group exercise as fun, safe, and inclusive activity, d) enhanced collaboration between healthcare providers and retirement organizations for fall prevention, and e) professional peer-led trainers.

Conclusion: Peer-led, well-designed group-based exercise programs can holistically support physical, emotional, and social wellbeing. Programs that include enjoyable, multicomponent elements, both physically and mentally stimulating, can enhance participants' motivation and adherence. Additionally, the group setting is thought to promote meaningful social interaction, which is widely recognized as important for overall well-being. From a public health perspective, collaborative models for fall prevention involving older adults as a "golden resource" should be established. Trial Registration: ClinicalTrials.gov, NCT06265480 (2024-02-08).

Health care systems are confronted with an increasing burden of (multi-)morbidity and a shortfall of healthcare providers. Coordination and continuity of care in chronic and multi-morbid patient is especially important. As qualitative patient experience data within care processes is scarce, we aim to increase the understanding of chronically ill patient's perspectives by assessing patient experiences in different health systems while treated in primary care. Patients were recruited via GPs from Germany, Sweden, Switzerland, and the British island of Jersey. To ascertain regular healthcare utilisation, inclusion criteria were either a stroke, and/or a myocardial infarction or heart failure during the past year, and an underlying metabolic syndrome. Identical semi-structured interview-guides were used in the respective language. Transcribed interviews were analysed according to inductive-deductive qualitative content analysis. Based on 22 interviews we derived four main categories (patient centeredness, continuity, coordination, access). Overall, healthcare processes were considered positive if information flow was personal and functional. Non-physician staff seemed to create reassurance. A long-lasting doctor-patient relationship was connected to the context of trust and security. Patients were critical of a perceived lack of time, inducing insufficient counselling and information-flow. This international explorative study suggests that patients' experiences can provide important information about care provision. Patients consistently focused more on relational aspects rather than on structures or functions. This has connotations for healthcare planning; for example, by providing non-physician staff to support patients through their care pathway and to improve the cooperation between providers.

Purpose of Review To summarize articles describing how to personalize care for heart failure (HF) informal caregivers on the basis of the literature review results. We also describe informal caregivers' preferences and wishes regarding personalized care.Recent FindingsRecent interventions to support informal caregivers were delivered face-to-face or online in group or individual sessions. The sessions embraced various elements, including coaching on setting personalized goals and developing problem-solving strategies. The interventions improved a range of variables, such as caregiver burden, quality of life, depression, stress and anxiety. Informal caregivers described personalized care as being in a partnership, clear communication and coordination of care.SummarySeveral intervention studies reported positive caregiver effects; however, they were small, and sometimes, the interventions were only briefly described. A deeper and more comprehensive understanding of the experiences and needs of informal caregivers is essential before new tailored interventions can be developed.

Background

Physical inactivity is a major public health concern worldwide. Psychological distress is linked to physical inactivity, which increases the risk of several diseases. Women tend to be more physically inactive than men. Moreover, physical inactivity increases with age in both sexes. Therefore, this study aimed to investigate the association between psychological distress and physical inactivity in adults aged ≥ 65 years, the role of psychosocial factors and explore sex-based differences.

Methods

This study included 14,213 older adults, comprising 7,069 women (52%) (median age = 75 years), who responded to a survey questionnaire sent to a random population sample in Mid-Sweden in 2022. The response rate in the population aged ≥ 65 years was 61%. The association between psychological distress as defined by the Kessler-6 and physical inactivity (< 150 min/week of physical activity) was analyzed using binary logistic regression, adjusting for sex, age, country of birth, educational level, and psychosocial factors.

Results

Overall, 30% of the participants reported psychological distress, and 45% were physically inactive. Psychological distress and physical inactivity were significantly associated (p < 0.001), being more common among women (p < 0.001). In the fully adjusted model, the Odds Ratio (OR) for physical inactivity was 1.46 (95% confidence interval (CI) 1.43–1.50) for women and 1.70 (95% CI: 1.65–1.74) for men regarding moderate psychological distress and 2.87 (95% CI: 2.72–3.04) for women and 2.43 (95% CI: 2.28–2.58) for men regarding serious psychological distress. Not participating in social activities in the last 12 months was associated with physical inactivity in both women and men.

Conclusions

Psychological distress is significantly associated with physical inactivity among older adults. Participation in social activities was identified as an essential factor in addressing physical inactivity. Social connections and physical inactivity are important factors to consider when supporting older adults’ mental health. Public health interventions should promote and raise awareness of physical and mental health as well as the social dimensions of aging, while also considering age and sex-based differences.

AIMS: Discussions about severe illness and the coming death do not often take place with patients with heart failure and their family. We therefore aimed to investigate how patients with end-stage heart failure and their family who discussed terminal illness and the imminence of death with a physician, experienced such communication, how they handled life emotionally and practically after said discussions, and if/how this changed over time.

METHODS: A longitudinal interview study. Ten patients with end-stage heart failure and their closest kin were visited by a physician at home and discussed terminal illness during one visit and the imminence of death during another visit. They were interviewed three times about how they experienced the communication and how they handled life in this situation and in relation to the discussions. The interviews were analysed using qualitative thematic analysis by Braun and Clarke.

FINDINGS: Two main themes and five subthemes were found. The first theme was 'an honest and clear message hurts, but it would be worse if nothing was said', and the subthemes included information on the experiences of communication, the desired level of communication by patients and family members and factors facilitating communication. The second theme was 'A clear message helps in handling life' with the subthemes of coping psychologically and practically. The findings indicate that for some patients and family members it was hard to have discussions about end-stage heart failure and the imminence of death. However, they found the discussions important and were happy that the information was not withheld from them. The discussions helped in handling life and most patients and family seemed to have found a way to accept and handle the situation. Practical planning often did not start until they heard from the physician that death could come soon.

CONCLUSION: This study confirms that patients and family members want and appreciate discussions about severe illness and the imminence of death and find them important. This can encourage physicians to change behaviour and engage in honest discussions, and to educate and train colleagues to do the same.

Objectives

Up to 10% of bereaved individuals can develop prolonged grief disorder. Several risk factors for prolonged grief symptom severity in family members have been identified, but there is a lack of knowledge regarding the multivariable effects between family members coping with loss and patient-related factors for prolonged grief symptom severity during bereavement. The aim was to identify risk factors for prolonged grief symptom severity in family members 1 year after patient death in relation to (1) the family member and the patient during ongoing palliative care and (2) the family member during bereavement.

Methods

The participants consisted of family members (n = 99) of patients admitted to palliative home care in Sweden. The participants completed a survey during ongoing palliative care and at a follow-up 1 year after the patient’s death.

Results

The model selection chose 4 demographic and 4 preloss variables: family member’s nervousness and stress, the patient’s sense of security during palliative care, family members’ sense of security during palliative care, and a family member attachment security anxiety dimension. Two postloss variables were positively associated with prolonged grief symptom severity: family members’ continuing bond – internalized and continuing bond – externalized.

Significance of results

How family members coped depended on (i) variables linked to the family members themselves, (ii) the relationship to the patient, and (iii) some patient-specific variables. There was also a link between preloss variables and postloss prolonged grief symptom severity. Hence, it should be possible to identify family members with a heightened risk for longer-term prolonged grief symptoms.

OBJECTIVE: Heart failure (HF) is the leading cause of hospitalizations among the older population. However, the need for healthcare persists after hospitalization due to the fluctuating nature of HF, which includes stable, unstable, and acute phases. The aim of this study was to explore older individuals' experiences of receiving follow-up care in the primary care setting after being discharged from hospital with HF.

DESIGN: This study used a qualitative design with interviews; qualitative content analysis with a manifest, inductive approach was used for data analysis.

SETTING: The study was conducted in primary healthcare within one Swedish healthcare region.

RESULTS: The analysis revealed a central category, ‟Inside or Outside the Safe Sphere of Care", with two sub-categories: ‟A Safety Net" and "A Sense of Abandonment".

CONCLUSION: The result showed that for some patients the chain of care worked well, and they felt safe and cared for. For others the current system of care sometimes might be too complicated for these older comorbid patients to understand and manage.