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Title [sv]
Covid-19 i svensk äldreomsorg – har kvaliteten på äldreboendena något samband med den höga dödligheten?
Title [en]
Covid-19 in Swedish eldercare – Is nursing home quality associated with high mortality rates?
Abstract [sv]
Sverige har högre dödlighet relaterad till covid-19 än våra grannländer och en stor del av dödsfallen har skett på landets äldreboenden. Den viktigaste orsaken till detta förefaller vara den allmänna smittspridningen i samhället, men det finns indikationer på att dödligheten mellan olika äldreboenden varierar markant. Resultat från internationell forskning visar att olika aspekter av kvalitet på äldreboenden, såsom boendets storlek, personaltäthet eller arbetsrutiner, verkar ha ett samband med smittspridning och dödlighet i covid-19. I Sveriges saknas dock detaljerad kunskap om hur skillnaderna ser ut mellan enskilda äldreboenden och vad som kan förklara olika grad av smittspridning och dödlighet. Syftet med forskningsprojektet är därför att undersöka hur smittspridning och dödlighet i covid-19 skiljer sig åt mellan olika äldreboenden i Sverige samt i vilken utsträckning kända kvalitetsindikatorer samt tillgång till sjukhusvård för äldre kan förklara skillnaderna. Projektet genomförs genom att ett nytt dataset som kopplar samman olika relevanta registerdata sammanställs i delstudie 1. Detta dataset utvecklas och används sedan för kvantitativa analyser i delstudie 2 & 3. I delstudie 4 genomförs en kvalitativ studie som syftar till att identifiera framgångsrika arbetssätt på äldreboendena för att förhindra smittspridning och dödlighet i covid-19. När nya smittsamma sjukdomar sprider sig över världen är det avgörande att äldreomsorgen står bättre rustad för att minimera smittspridning och dödsfall. Genom att studera vilka faktorer som har påverkat dödlighet i covid-19 på svenska äldreboenden kan detta projekt bidra med kunskap om hur smittspridning kan undvikas och hur vi bäst utvecklar äldreomsorgen för att möta framtida pandemier och andra smittsamma sjukdomar.  
Abstract [en]
 Sweden has had a higher rate of covid-19 related mortality than its neighbors, and a large proportion of this mortality has occurred at nursing homes. While the most important driver of this appears to be the prevalence of covid-19 at large, there are signs that substantial unexplained variation between nursing homes exists. There is however a lack of detailed knowledge about the degree of variation between nursing homes, and the cause of the differences in covid-19 mortality rates. The results of international research suggest that many aspects of nursing home quality may drive the spread of and mortality due to covid-19, including nursing home size, staffing ratios, and care routines. The impact of these aspects of quality on the spread of covid-19 in Swedish nursing home care has however not yet been established due to a lack of suitable data. The aim of this research project is therefore to evaluate the impact of nursing home quality on covid-19-related mortality rates in Swedish nursing homes. The project is carried out by compiling a new dataset in study 1 that connects relevant information from different data registers. The dataset will be further developed and used for quantitative analyses in study 2 & 3. A final qualitative study aims to identify nursing home processes that have been successfully used to avoid the spread of infection and mortality. It is of utmost importance that the Swedish eldercare system is better prepared to minimize transmission and mortality when the next contagious disease spreads across the world. By studying the factors which impacted covid-19 mortality rates at Swedish nursing homes, this project contributes valuable knowledge on how to best develop the eldercare system to mitigate the effects of future pandemics.
Publications (1 of 1) Show all publications
Linder, W., Spangler, D., Doheny, M., Grönström, A., Isaksson, D. & Winblad, U. (2025). Variation in emergency department visits among residents of Swedish nursing homes between 2019 and 2020: a population-based cohort study. BMC Health Services Research, 25(1), Article ID 1196.
Open this publication in new window or tab >>Variation in emergency department visits among residents of Swedish nursing homes between 2019 and 2020: a population-based cohort study
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2025 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 25, no 1, article id 1196Article in journal (Refereed) Published
Abstract [en]

Background

Nursing homes have limited capacity to provide medical care to clinically frail residents and therefore rely on transferring residents to hospital-based emergency departments when acute medical needs arise. The utilization of emergency department care varies between nursing homes but the extent of this variation is unexplored. Further, the effect of organizational characteristics of nursing homes on emergency department utilization is unknown. This study aims to characterize the variation in emergency department visit rates between nursing homes, and to identify contextual and organizational characteristics that contribute to this variation.

Study design

Population-based cohort study of individuals living in nursing homes during 2019 and 2020 in Sweden.

Methods

National registry data on nursing home residents were linked to nursing homes based on civil- and business registration addresses. Emergency department visits were identified for each resident in the national patient registry and measured as incidence rates per nursing home. Multi-level analysis was performed to investigate the association between emergency department visit rates, and contextual and organizational characteristics of nursing homes.

Results

The median incidence rate of emergency department visits from nursing homes was 5.2 per 100 person-months in 2019 (IQR = 3.7–6.9) and 4.4 per 100 person-months in 2020 (IQR = 3.0–5.7). Individuals living in nursing homes in the most rural locations had lower odds of emergency department visits (OR 0.51, 95% CI 0.41–0.61 versus the most urban locations). Moreover, individuals in nursing homes specialized in dementia care had lower odds of emergency department visits (OR 0.90, 95% CI 0.87–0.94 versus somatic care).

Conclusion

The results suggest that the location and organizational characteristics of nursing homes may have an impact on the utilization of medical services by the nursing home resident population. Further research is warranted to investigate any ensuing health inequities.
Place, publisher, year, edition, pages
BioMed Central (BMC), 2025
Keywords
Nursing homes, Long-term care facilities, Emergency departments, COVID-19
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
urn:nbn:se:uu:diva-568659 (URN)10.1186/s12913-025-13443-9 (DOI)001569299400002 ()40931342 (PubMedID)2-s2.0-105015575450 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-00678
Available from: 2025-10-08 Created: 2025-10-08 Last updated: 2025-10-08Bibliographically approved
Blomqvist, Paula
Principal InvestigatorSpångberg, Ulrika
Coordinating organisation
Uppsala University
Funder
Period
2022-01-01 － 2023-12-31
National Category
Public Administration Studies
Identifiers
DiVA, id: project:8484Project, id: 2021-00678_Forte

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