Papers by Amanda Hellström
BMC Geriatrics, Nov 5, 2010
Background: Insomnia is common among elderly people and associated with poor health. The Minimal ... more Background: Insomnia is common among elderly people and associated with poor health. The Minimal Insomnia Symptom Scale (MISS) is a three item screening instrument that has been found to be psychometrically sound and capable of identifying insomnia in the general population (20-64 years). However, its measurement properties have not been studied in an elderly population. Our aim was to test the measurement properties of the MISS among people aged 65 + in Sweden, by replicating the original study in an elderly sample. Methods: Data from a cross-sectional survey of 548 elderly individuals were analysed in terms of assumptions of summation of items, floor/ceiling effects, reliability and optimal cutoff score by means of ROC-curve analysis and compared with self-reported insomnia criteria. Results: Corrected item-total correlations ranged between 0.64-0.70, floor/ceiling effects were 6.6/0.6% and reliability was 0.81. ROC analysis identified the optimal cutoff score as ≥7 (sensitivity, 0.93; specificity, 0.84; positive/ negative predictive values, 0.256/0.995). Using this cutoff score, the prevalence of insomnia in the study sample was 21.7% and most frequent among women and the oldest old. Conclusions: Data support the measurement properties of the MISS as a possible insomnia screening instrument for elderly persons. This study make evident that the MISS is useful for identifying elderly people with insomnia-like sleep problems. Further studies are needed to assess its usefulness in identifying clinically defined insomnia.
Journal of Nutrition Health & Aging, Sep 29, 2015
Objectives: To describe three-year trends in nutritional status and sleep quality and their impac... more Objectives: To describe three-year trends in nutritional status and sleep quality and their impact on hospital utilisation in the oldest old (80 +) with heart failure (HF). Design: Single-centred longitudinal observational study. Setting: Southeastern Sweden. Participants: 90 elderly (80+) with objectively verified HF. Measurements: Baseline data from the Mini Nutritional Assessment (MNA) and on sleep quality were collected through structured interviews following the HF diagnosis (n=90) and at a three-year follow-up (n=41). Data on hospital utilisation during the three years following the HF diagnosis were also collected. Results: Nineteen percent of the participants were found to have impaired nutritional status, a condition that increased hospital utilisation by four bed days per year. A majority (85%) had impaired sleep quality, but no impact on hospital utilisation was found. Nutritional status and sleep quality were stable over the three-year period. Conclusion: In the oldest old with HF, impaired nutritional status and impaired sleep quality are already common at HF diagnosis. Impaired nutritional status increases hospital utilisation significantly. Therefore, it is of supreme importance to systematically evaluate nutritional status and sleep quality in the oldest old when they are diagnosed with HF, as well as to take action if impairments are present.
PLOS ONE, Mar 14, 2019
Background Insomnia symptoms are common among young adults and affect about 5% to 26% of 19 to 34... more Background Insomnia symptoms are common among young adults and affect about 5% to 26% of 19 to 34-year-olds. In addition, insomnia is associated with poor mental health and may affect daily performance. In research, as well as in clinical practice, sleep questionnaires are used to screen for and diagnose insomnia. However, most questionnaires are not developed according to current DSM-5 diagnostic criteria. An exception is the recently developed Sleep Condition Indicator (SCI), an eight-item scale screening for insomnia. Aim The aim of this study was to perform a Classical Test Theory (CTT) based psychometric evaluation of the SCI in a sample of Swedish university students, by taking the ordinal nature of item level data into account.
BMC Geriatrics, Jan 21, 2016
Background: Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people... more Background: Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis. Methods: The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9 % were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously. Results: We found the prevalence of pain intensity ≥ 5 on the NRS to be 34.8 % in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p < 0.001) and were found in 34.8 % of the total sample. Although more women than men reported pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venousarterial ulcers increased the risk of sleep disturbances, as did higher pain scores. Conclusions: The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met. National guidelines in managing leg ulcers, which also consider consequences such as sleep disturbances, pain and discomfort, are needed.
International Journal of Integrated Care, Nov 4, 2022
BMJ Open, Nov 1, 2022
Objective To explore communication about medication management during annual consultations in pri... more Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations. Setting Two primary care centres in southern Sweden. Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis. Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further. Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.
Sleep Medicine, Dec 1, 2017
Health and Quality of Life Outcomes, Sep 6, 2022
Background: The EQ-5D index often fails to detect the effect of ophthalmic diseases and sight los... more Background: The EQ-5D index often fails to detect the effect of ophthalmic diseases and sight loss. Investigating predictors of individual EQ-5D health dimensions might reveal the underlying reasons. The aim of this study was to investigate predictors of health dimension ratings obtained with the EQ-5D-3L from participants with impaired vision representing a spectrum of eye diseases. Methods: Observational cross-sectional study with participants recruited at four public hospitals in Portugal. Outpatients with visual acuity of 0.30 logMAR(6/12) or worse in the better-seeing eye were invited to participate. Participants completed two instruments: the EQ-5D-3L (measures participants' perceived health-related quality-of-life) and the Massof Activity Inventory (measures visual ability-ability to perform vision-related activities). This study used logistic regression models to identify factors associated with responses to the EQ-5D-3L. Results: The study included 492 participants, mean age 63.4 years (range = 18-93), 50% females. The most common diagnosis was diabetic retinopathy (37%). The mean visual acuity in the better seeing eye was 0.65 logMAR (SD = 0.48) and the mean visual ability was 0.62 logits (SD = 2.04), the correlation between the two was r = − 0.511 (p < 0.001). Mobility and self-care were the health dimensions with the fewest problems (1% reported extreme problems), anxiety and depression the dimension with the most problems (24% reported extreme problems). ROC curve analysis showed that the EQ-5D index was a poor predictor of cases of vision impairment whilst visual ability given was a good predictor of cases of vision impairment. Visual ability was an independent predictor of the response for all dimensions, higher ability was always associated with a reduced odds of reporting problems. The odds of reporting problems were increased for females in 3 out of 5 dimensions. Comorbidities, visual acuity and age-category were predictors of the odds of reporting problems for one dimension each. Conclusions: The odds of reporting problems for the five health dimensions of the EQ-5D-3L were strongly influenced by the ability to perform vision-related activities (visual ability). The EQ-5D index showed poor performance at detecting vision impairment. These findings are informative and relevant for the clinic and for research evaluating the impact of eye diseases and disease treatments in ophthalmology.
Research Square (Research Square), Mar 15, 2022
Background The EQ-5D index often fails to detect the effect of ophthalmic diseases and sight loss... more Background The EQ-5D index often fails to detect the effect of ophthalmic diseases and sight loss. Investigating predictors of individual EQ-5D health dimensions might reveal the underlying reasons. The aim of this study was to investigate predictors of health dimension ratings obtained with the EQ-5D-3L from participants with impaired vision representing a spectrum of eye diseases. Methods Observational cross-sectional study with participants recruited at four public hospitals in the north of Portugal. Outpatients with visual acuity of 0.30 logMAR (6/12) or worse in the better-seeing eye were invited to take part in the study. Higher values of acuity in logMAR correspond to worse vision. Participants completed two instruments: the EQ-5D-3L and the Massof Activity Inventory (MAI). The MAI provides a measure of visual ability-the ability to perform vision-related activities. Higher values of visual ability correspond to greater ease performing activities. The EQ-5D-3L is a generic instrument that frequently is used to quantify the participants' perceived health-related quality of life. This study used logistic regression models to identify factors associated with self-reported health status estimated from patient responses to the EQ-5D-3L. Results The study included 492 participants, mean age 63.4 years (range = 18-93) and 50% females. The most common diagnosis was diabetic retinopathy (37%). The mean visual acuity in the better seeing eye was 0.65 logMAR (SD = 0.48) and the mean visual ability was 0.62 logits (SD = 2.04), correlation between the two was − 0.511 (p < 0.001). Mobility and self-care were the health dimensions with the fewest problems (1% reported extreme problems), anxiety and depression the dimension with the most problems (24% reported extreme problems). Visual ability was an independent predictor of the response for all dimensions, higher ability was always associated with a reduced odds of reporting problems. The odds of reporting problems were increased for females in 3 out of 5 dimensions. Comorbidities, visual acuity and age-category were predictors of the odds of reporting problems for one dimension each. Conclusions The odds of reporting problems for the ve health dimensions of the EQ-5D-3L are strongly in uenced by the ability to perform vision-related activities (visual ability). These ndings are informative and relevant for the clinic and for research evaluating the impact of eye diseases and disease treatments in ophthalmology.
BMC Health Services Research
Background Chronic diseases are increasing worldwide, and the complexity of disease management is... more Background Chronic diseases are increasing worldwide, and the complexity of disease management is putting new demands on safe healthcare. Telemonitoring technology has the potential to improve self-care management with the support of healthcare professionals for people with chronic diseases living at home. Patient safety threats related to telemonitoring and how they may affect patients’ and healthcare professionals’ sense of security need attention. This study aimed to explore patients’ and healthcare professionals’ experiences of safety and sense of security when using telemonitoring of chronic conditions at home. Methods Semi-structured interviews were conducted with twenty patients and nine healthcare professionals (nurses and physicians), recruited from four primary healthcare centers and one medical department in a region in southern Sweden using telemonitoring service for chronic conditions in home healthcare. Results The main theme was that experiences of safety and a sense ...
Lund University Faculty of Medicine Doctoral Dissertation Series, 2013
Insomnia symptoms in elderly persons-assessment, associated factors and nonpharmacological nursin... more Insomnia symptoms in elderly persons-assessment, associated factors and nonpharmacological nursing interventions Hellström, Amanda 2013 Link to publication Citation for published version (APA): Hellström, A. (2013). Insomnia symptoms in elderly persons-assessment, associated factors and nonpharmacological nursing interventions. Division of Nursing, Lund University.
Sleep disorders, 2014
It has been suggested that physical or social activity is associated with fewer sleep disturbance... more It has been suggested that physical or social activity is associated with fewer sleep disturbances among elderly people. Women report more sleep disturbances than men, which could indicate a variation in activity patterns between the genders. The aim of this study was to investigate associations between sleep disturbances and leisure activities in men and women (n = 945) aged ≥60 years in a Swedish population. Sleep disturbances were measured using eight dichotomous questions and seventeen variables, covering a wide range of leisure activities. Few leisure activities were found to be associated with sleep disturbances and their importance decreased when the models were adjusted for confounders and gender interactions. After clustering the leisure activities and investigating individual activities, sociointellectual activities were shown to be significant for sleep. However, following adjustment for confounders and gender interactions, home maintenance was the only activity significa...
Sleep is found to be a fundamental part in experiencing health. Sleep is needed for memory consol... more Sleep is found to be a fundamental part in experiencing health. Sleep is needed for memory consolidation, metabolic balance, immune functioning and alertness at day time and experiencing quality of life. Insomnia has also been found to be associated with cardiac disorders. Elderly people are especially vulnerable for poor sleep, why prevention of sleep disturbances should be of regard when caring for older persons. MISS is a 3 item questionnaire, with a total-score of 0-12 that could be used to find insomnia in elderly persons. Aim: To test of the measurement properties of the Minimal Insomnia Symptom Scale in an elderly sample ≥65 years in Sweden. Study sample Persons participating in the Swedish National Study on Ageing and Care – Blekinge were invited. ● 548 participated (response-rate 61.4%) ● Mean age 77.8 (SD 8.63) years ● Female 57.5% Results Reliability was found to be 0.81. ROC analysis where MISS was compared with self-reported insomnia criteria (i.e. day-time sleepiness, not feeling refreshed by sleep, experiencing sleep difficulties) identified optimal cut-off score as ≥7, and sensitivity 93%, specificity 84%. Area under curve = 0.93. Conclusion Data support the measurement properties of MISS as an insomnia screening instrument among elderly persons and its brevity makes it appealing. Through insomnia-screening, older persons at risk of health problems can be found and offered treatment and thereby health and quality of life can be restored.
Nursing in critical care, Sep 27, 2022
Background: Insomnia, sleep apnoea and sleep loss are risk factors for the development of cardiov... more Background: Insomnia, sleep apnoea and sleep loss are risk factors for the development of cardiovascular diseases. Most research on sleep disturbances includes patients with heart failure, while the role of sleep in sudden cardiac arrest survivors (SCA) has been only partially investigated and understood. Sleep-related breathing disorders and obstructive sleep apnoea increase illness and mortality in the aftermath of SCA. Also, post-traumatic stress is evident in SCA survivors, where sleep disruptions are some of the main symptoms of the condition. Consequently, it is important to identify sleep problems in SCA survivors at an early stage to avoid unnecessary suffering. Purpose: The aim of this study was to investigate registered nurses' perceptions of SCA survivors' sleep, both in hospital and after discharge. Methods: This was an explorative interview study with a phenomenographic approach. Nineteen registered nurses (RNs) varying in age, sex and years in the profession participated. Findings: The nurses' perceptions of SCA survivors' sleep were categorized as: "The observernoticing behaviours, emotions and habits of the patient that affect sleep", "The oblivious witnessattitudes that hinder the ability to recognise sleep behaviours", and "The practitioneradvising and medicating for sleep". The outcome space showed that the nurses detected both obvious and subtle signs relating to patients' sleep. However, attitudes hindering the recognition of sleep behaviours were independent of acting as an observer or practitioner. If nothing unforeseen was observed, or if the patient did not spontaneously raise the subject, sleep was considered less important than other health problems in SCA survivors. Conclusions: Although the nurses knew that SCA survivors suffered from poor sleep, they failed to reflect on the consequences for the patient. Nurses' feelings of insufficient knowledge about sleep, as well as their omittance of sleep in the follow-up documentation could leave sleep issues unaddressed and cause unnecessary patient suffering. Relevance to clinical practice: Nurses need increased knowledge and training to enable them to detect subtle signs of sleep problems in SCA survivors.
BMC Public Health, Dec 1, 2019
Background: The Patient Activation Measure (PAM) is a recognized measure of how active patients a... more Background: The Patient Activation Measure (PAM) is a recognized measure of how active patients are in their care, and has been translated into several languages and cultural contexts. Patient activity, self-care, and health literacy have become increasingly important aspects of health care, and thus reliable measures of these are needed. However, a Swedish translation of PAM is currently lacking. The aim of the study was to translate and assess the validity and reliability of the Swedish PAM-13. Methods: A self-report questionnaire was handed out to 521 patients at ten medical, geriatric, and surgical wards, and one Virtual Health Room. The Rasch model was employed, using the partial credit model, to assess the functioning of the PAM scale, item fit, targeting, unidimensionality, local independence, differential item functioning (DIF), and person-separation index. Evidence of substantive, content, structural, and external validity was examined. Results: Of the 521 patients who were consecutively handed a questionnaire, 248 consented to participate, yielding a response rate of 47.6%. The average measure for each category advanced monotonically. The difficulty of the PAM items ranged from − 1.55 to 1.26. The infit and outfit values for the individual items were acceptable. Items 1, 2, and 4 showed disordered thresholds. The mean person location was 1.48 (SD = 1.66). The person-item map revealed that there were no item representations at the top of the scale. The evidence for unidimensionality was ambiguous and response dependency was seen in some items. DIF was found for age. The person separation index was 0.85. Conclusion: The Swedish PAM-13 was reliable, but was not conclusively found to represent one underlying construct. It seems that the Swedish PAM-13 lacks strong evidence for substantive, content, and structural validity. Although valid and reliable measures of ability for activation in self-care among patients are highly warranted, we recommend further development of PAM-13 before application in everyday clinical care.
Sleep Medicine, Mar 1, 2015
The psychometric properties of the three-item Minimal Insomnia Symptom Scale (MISS) were evaluate... more The psychometric properties of the three-item Minimal Insomnia Symptom Scale (MISS) were evaluated using the classical test theory. Different cut-offs for identifying insomnia were suggested in two age groups (≥6 and ≥7 among adult and elderly people, respectively). The aim of the present study was to test the measurement properties of the MISS using the Rasch measurement model, with special emphasis on differential item functioning by gender and age. Cross-sectional MISS data from adult (age 20-64 years, n = 1075) and elderly (age 65+, n = 548) populations were analysed using the Rasch measurement model. Data generally met Rasch model requirements and the scale could separate between two distinct groups of people. Differential item functioning was found by age but not gender. The difference between the adult and elderly samples was lower for the originally recommended ≥6 points cut-off (0.09 logits) than for the ≥7 points cut-off (0.23 logits), but greater at the lower and higher ends of the scale. This study provides general support for the measurement properties of the MISS. Caution should be exercised in comparing raw MISS scores between age groups, but applying a ≥6 cut-off appears to allow for valid comparisons between adults and the elderly regarding the presence of insomnia. Nevertheless, additional studies are needed to determine the clinically optimal cut-score for identification of insomnia.
BACKGROUND Prostate cancer is a common form of cancer that is often treated with radical prostate... more BACKGROUND Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms. OBJECTIVE This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy. METHODS A multicenter randomized controll...
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Papers by Amanda Hellström