Elisabeth Rydwik

Research problem and specific questions Rehabilitation is fundamental to all health care, as good care and public health cannot be achieved without access to rehabilitation (WHO). Despite this, research on the effectiveness of home rehabilitation to improve older adults’ ability in performing activities of daily living (ADL) and health-related quality of life (HRQL) is scarce. This project aims to address this knowledge gap by evaluating the effects of a structured home rehabilitation intervention for older adults, called Re@home. Research questions (RQ): 1. What is the effectiveness of the Re@home in comparison to usual rehabilitation among older on a) ability in ADL performance, b) HRQL, c) care utilization, and significant others’ d) perceived caregiver burden? 2. How do older adults and significant others experience their participation in the Re@home? 3. What facilitators and barriers influence the implementation process and the outcome of the Re@home? Data and methods This is a randomised controlled cluster trial that will be conducted in Stockholm, Jönköping and Luleå reflecting differences in population, urban and rural areas, and approaches to organize home rehabilitation. The project adheres to the Medical Research C ouncil framework for complex interventions. The intervention is based on several pre-studies funded by Forte (Dnr 2021-01791)(literature review, field observations, interviews, a feasibility evaluation, a concluded in a mixed-method synthesize of data from the pre-studies). 180 participants over the age of 65 will be recruited from 12 home rehabilitation units (4 clusters /each site). The principles of Re@home consist of content (person-centred assessment and activities), strategies used to engage the older adults in a shared decision-making process, duration and context, taking the home environment into consideration. Occupational therapists and physiotherapists at the units will participate in a preparation training course and receive reminders about the intervention to ensure consistency in delivery. Primary outcome

performance in ADL. Secondary outcomes

HRQL, satisfaction with the intervention, use of care and social services and caregiver burden (RQ1). Interviews with the older adults and their significant others will be performed to grasp their experiences of Re@home (RQ2). Barriers and facilitators of the implementation will be evaluated with focus groups and questionnaires (RQ3). Societal relevance and utilisation Rehabilitation is vital to improve performance in ADL and HRQL. Therefore, it is central that older adults are invited to shared decision-making throughout the intervention process in line with person-centred rehabilitation and integrated care (SOU 2019:29). This project addresses the importance of scientific-based home rehabilitation interventions to improve care and social services for older adults. Effective rehabilitation reducing costs for care and social services is important given the demographic challenges, including an increasing number of people over the age of 80 with potential health issues (SoU 2016: 2). This is combined with fewer people working and contributing taxes to society, as well as the shortage of and difficulties in recruiting staff. This project will contribute to address these societal challenges, and the results can be implemented to counteract these challenges. Plan for project realization The multi-professional project group (i.e. occupational therapists, physiotherapists, social worker, nurse, an implementation scientist), are all well experienced researchers in the design used in this project. We are applying for funding (4.9 million SEK) for three years with costs mainly related to research staff, enabling staff at rehabilitation units to participate, data collection, analysis and dissemination of findings. The ongoing collaboration with rehabilitation units at all sites in the pre-studies will be further deepened, which is vital to proceed with the proposed project plan.

Research problem and specific questionsCoordination of healthcare activities is of particular importance for older people in need of geriatric care as they often have multiple conditions and health related needs, requiring  care from several providers. The overall aim of this research project is to introduce and evaluate a person-centered care transition model that is currently being developed through co-creation with end-users to improve the coordination of care after discharge from geriatric inpatient care. The project is divided in three phases with the following research questions: (1) is the new care transition model feasible in a local setting? (2) is the care transition model effective when evaluated in a cluster randomized-controlled trial (RCT)? (3) what are the prerequisites for implementation and how do patients, next of kin and staff experience the care transitions process?Data and methodPhase I is a feasibility study where the new model will be evaluated in terms of fidelity, applicability and acceptability using focus groups, individual interviews and questionnaires. We will also evaluate the model’s preliminary effect on total costs after discharge, their distribution between payers, and rate of readmission using register data. In phase II and III a refined model (based on the results from the feasibility study) will be introduced and evaluated with an effect and process evaluation using the same type of methods as in phase I. The primary outcome in the cluster RCT will be total costs.Societal relevance and utilizationThis proposal targets the societal challenge of providing coordinated services between social services and healthcare to an aging population in a fragmented system. If coordination of care between different responsible providers of health and social care is improved, it may have significant positive impact for the older adults, involved staff, and the society. This project takes an overarching approach and evaluates costs across the health and social care system.Plan for project realizationFOU nu (asset manager) has a close collaboration with the geriatric departments in the region, the primary care centres and units within the municipalities as well as with patient representative organizations that we are collaborating with in the ongoing project. This, as well as ongoing collaborations with other R&D-units within the region, gives us an excellent possibility to ensure that the project is realized as described.

Research problem and specific questions The overall aim is to develop models that support older adults´ participation in everyday activities that engage and lead to well-being where welfare technology is used to reduce the need for primary- and homecare.The needs of older adults at risk/ with frailty and significant others participating in interventions using digital technologies and what is needed for successful implementation will be studied together with the older adults, significant others, informal carer and staff.Research questions Can a prevention program using technology supporting engaging activities in everyday life reduce risk or maintain/delay the level of frailty in older adults? (project A)How can a prevention program that use technology support “Good quality, local health care “for frail older adults become a self-evident and integrated way of working as an addition to physical care within primary healthcare? (project A)Can a specialized homecare service (Reablement) using technology support older adults’ participation and engagement in everyday life while living at home? (project B)What are the needs of informal carer who provide support to older adults living with frailty at home? (project A-D)What are the systemic factors for and how can co-creation methods contribute to successful implementation of an intervention using technology directed towards older adults to improve primary care and homecare services? (project A-E)                                                                                                                                                                Data and method The interdisciplinary program is based on tested interventions using digital technology with positive effects in the context of older adult’s home. Five projects with qualitative and quantitative methods are planned. A digital platform will be used to compare data. With analyses from projects A-D, a model describing effects of implementation that can change and implement new interventions and working approaches using will be developed (project E).Relevance and utilisation In Europe, more than 1/3 of older adults &lt

75 years live with frailty that causes functional limitations with an impact on well-being of many older adults thats lead to high costs for tax-funded care.The home is an important arena and with an increase of older adults new working models are needed. The result will generate knowledge about how to use digital solutions for preventive efforts, more efficient primary- and homecare that enable participation in everyday life of older adults and support for relatives and staff.Plan for project realisation A close collaboration between staff in Region Stockholm/Uppsala, City of Stockholm, Huddinge municipality and researchers at Karolinska Institutet, Royal Institute of Technology and Uppsala University that will work closely to a reference group of older adults, significant others, and stakeholders.