Papers by Øyvind Kirkevold
Tidsskrift for Den Norske Laegeforening, May 19, 2005
Tidsskrift for omsorgsforskning, 2016
Journal of Geriatric Oncology, 2023
International Journal for Quality in Health Care, Jul 1, 2022
Background: The number of older adults with cancer is increasing. Radiotherapy is an important tr... more Background: The number of older adults with cancer is increasing. Radiotherapy is an important treatment modality for cancer and may cause side effects and distress. Patient-reported experience measures aim to measure patients' experiences with health care. This can help healthcare services to improve in line with patients' needs. To assess how Norwegian patients receiving radiotherapy experience their care, a valid and reliable tool is required. We selected the person-centred coordinated care experience questionnaire as a tool. Objective: The aim of the study is to validate the Norwegian version of the person-centred coordinated care experience questionnaire in a radiotherapy setting. Methods: A feasibility study of the person-centred coordinated care experience questionnaire and a cross-sectional study-testing psychometric properties of the questionnaire in a Norwegian radiotherapy setting-were conducted. Participants were recruited from two different hospitals in Norway. Patient characteristics and item scores are described using descriptive statistics. We performed an exploratory factor analysis and applied principal component analysis with a varimax rotation. Cronbach's was used to assess internal consistency. Results: In total, 24 patients participated in the feasibility test, and 176 were included in the cross-sectional study where we explored the psychometric properties of the person-centred coordinated care experience questionnaire. Three factors were identified. Internal consistency was established for the 10-item scale, with Cronbach's = 0.698. Conclusions: Conclusions must consider the Norwegian setting and healthcare context. We found that the Norwegian version of the personcentred coordinated care experience questionnaire is a relevant, valid and reliable tool to provide insight into different areas of patients' experiences upon receiving radiotherapy. However, further testing on a larger sample is necessitated.
ABSTRACT In the discussion about legislation and dementia in Europe, it seems there exist an agre... more ABSTRACT In the discussion about legislation and dementia in Europe, it seems there exist an agreement that the terms “competence” and “incompetence” should be restricted to a person’s legal status, whereas physicians should use terms like “capacity” and “incapacity” when evaluating a person’s mental status (Post and Whitehouse, 1995). However, some authors prefer to use the terms “capacity” or “incapacity” for legal status (Gove and Georges, 2001; Jones, 2001). Thus, “capacity” and “competence” are used as synonyms in legal terminology. In cases when a person is incompetent, most Western countries have legal provisions that allow for the appointment of a guardian to handle an adult person’s welfare and financial interests (Gove and Georges, 2001; Kapp, 2001). Apart from that, medical treatment, care or admission to an institution without the patient’s consent is usually part of the mental health legislation.
Scandinavian Journal of Caring Sciences, Dec 1, 2008
Psychiatric and behavioural symptoms and the use of psychotropic medication in Special Care Units... more Psychiatric and behavioural symptoms and the use of psychotropic medication in Special Care Units and Regular Units in Norwegian nursing homes Background: In a number of countries Special Care Units (SCUs) have been established to meet the particular needs of patients with dementia. The criteria for SCUs are poorly defined and often not met. Aim: To assess the frequency distributions of dementia, psychiatric and behavioural symptoms and the use of psychotropic medication in SCUs and Regular Units (RUs) across different regions. Methods and material: By means of a structured interview, comprising the Neuropsychiatric Inventory, the Clinical Dementia Rating Scale and Lawton's Physical Self-maintenance scale, a representative sample of 1163 nonselected nursing home patients was assessed. In addition, information was collected from the patients' records. Results: Overall SCU patients were significantly more likely to be younger, to have higher level of functioning, to have dementia, to exhibit clinically significant psychiatric and behavioural symptoms and to receive psychotropic medication. There were significant differences across regions in terms of psychiatric and behavioural symptoms and the use of psychotropic medication. The ratio of accommodation in SCUs to that in RUs varied across the regions. Conclusion: Patients in SCUs and patients in RUs are distinct nursing home populations. Regional differences, which might be due to diverse ratios of SCUs, are evident.
International Journal of Geriatric Psychiatry, 2007
Background Psychiatric and behavioural symptoms in dementia are associated with a range of negati... more Background Psychiatric and behavioural symptoms in dementia are associated with a range of negative outcomes, including institutional placement and the widespread use of psychotropic drugs in spite of limited evidence for their efficacy. Aims To determine the prevalence of psychiatric and behavioural symptoms and the pattern of psychotropic drug prescription in patients with various degrees of dementia. Methods A sample of 1,163 non-selected nursing home patients were assessed by means of the Neuropsychiatric Inventory, the Clinical Dementia Rating scale and Lawton's activities of daily living scale. In addition, information was collected from the patients' records. Results Dementia was found in 81% of the patients and 72% of them had clinically significant psychiatric and behavioural symptoms. The frequencies of symptoms increased with the severity of the dementia. Psychotropic medication was being prescribed to 75% of patients with dementia. There was a significant relationship between the type of drug and the symptom for which it had been dispensed. Conclusion Psychiatric and behavioural symptoms are frequent in nursing homes and the rate increases with the progression of the dementia. Systematic programmes are needed for disseminating skills and providing guidance regarding the evaluation and treatment of these symptoms in nursing homes.
European Journal of Oncology Nursing, Aug 1, 2021
To explore and describe experiences of older patients with cancer throughout their radiotherapy t... more To explore and describe experiences of older patients with cancer throughout their radiotherapy treatment, from diagnosis until follow-up after treatment. Methods: Individual interviews were conducted to explore different phases of radiotherapy. Interviews were recorded and transcribed verbatim. Inductive content analysis was applied. Each interview was coded separately. Then to the codes were analyzed further, and an overall theme was developed. Results: Twelve older patients with cancer, (7 male, 5 female) aged ≥ 65 related their experiences from radiotherapy treatment. A main theme describes the essence of their experiences; Understanding "just enough". The theme comprises five main categories: Understandable, adapted information is crucial for trusting health services; Previous experiences influence patients' perception and understanding; Involvement of next of kin is crucial to patients' comprehension; Professional treatment decisions and well-organized treatment determines satisfaction and Experiences of cooperation and coordination of services affects dependability. Conclusions: Findings from this study describe how understanding "just enough"-not too much nor too littlemay assist older patients with cancer in participating in treatment decisions, preventing false beliefs, feeling reassured during treatment and in navigating the complex health care system. Next of kin are important assets for older patients with cancer in understanding "just enough". Cancer nurses may map comprehension of information, as well as reveal patients' previous experiences.
American Journal of Geriatric Psychiatry, Jul 1, 2008
This study investigates the natural course of neuropsychiatric symptoms and the concomitant use o... more This study investigates the natural course of neuropsychiatric symptoms and the concomitant use of psychotropic medication among a large and representative sample of nursing-home patients with dementia. The authors performed two data collections with structured interviews in a 1-year follow-up cohort-study including 26 nursing homes in four counties in two Norwegian health regions. The main outcome measures were baseline and follow-up frequencies, persistence and incidence of neuropsychiatric symptoms, and the change in neuropsychiatric symptoms with regard to the use of psychotropic medication. At baseline a representative sample of 1,163 nursing-home patients participated, of whom 933 had dementia. At the follow-up interview after 1 year, 633 of the patients who had dementia at baseline were assessed. Clinically significant neuropsychiatric symptoms were exhibited by 84% of patients with dementia at the baseline or follow-up interviews. Overall persistence of symptoms was 79%. Individual symptoms, such as depression (58%), delusions (56%), and agitation/aggression (47%) had resolved at a high rate. Persistent use of antidepressants (79%), antipsychotics (75%), or any psychotropic drug (88%) was common. There were no differences between users and nonusers of antipsychotics or antidepressants regarding the course of psychosis, agitation, or depression over the 1-year observation period. Neuropsychiatric symptoms are ubiquitous in nursing home patients with dementia. Overall the symptoms are chronically present, whereas individual symptoms often show an intermittent course. Long-term use of psychotropic medication is extensive. Uncertainty about treatment effects emphasizes the need for further treatment trials.
Dementia and Geriatric Cognitive Disorders, 2017
Background/Aims: Little is known about anxiety and its associations among persons with dementia i... more Background/Aims: Little is known about anxiety and its associations among persons with dementia in nursing homes. This study aims to examine anxiety, anxiety symptoms, and their correlates in persons with dementia in Norwegian nursing homes. Methods: In all, 298 participants with dementia ≥65 years old from 17 nursing homes were assessed with a validated Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Associations between anxiety (RAID-N score) and demographic and clinical characteristics were analyzed with linear regression models. Results: Anxiety, according to a cutoff of ≥12 on the RAID-N, was found in 34.2% (n = 102) of the participants. Irritability (59.7%) and restlessness (53.0%) were the most frequent anxiety symptoms. The participants' general physical health, a wide range of neuropsychiatric symptoms, and anxiolytic use were significant correlates of higher RAID-N scores. Conclusion: Knowledge about anxiety, anxiety symptoms, and their correlates may enhance early detection of anxiety and planning of necessary treatment and proactive measures among this population residing in nursing homes.
Dementia and Geriatric Cognitive Disorders, 2015
Background: Person-centered care (PCC) is regarded as good quality care for persons with dementia... more Background: Person-centered care (PCC) is regarded as good quality care for persons with dementia. This study aimed to explore and understand the association between PCC and organizational, staff and unit characteristics in nursing homes (NHs). Methods: Staff from 175 NH units in Norway (n = 1,161) completed a survey, including measures of PCC and questions about staff characteristics and work-related psychosocial factors. In addition, data about organizational and structural factors and assessment of the physical environment in the units were obtained. The distribution of these factors in regular units (RUs) and special care units (SCUs) is described, and the differences between the two types of units are analyzed. Furthermore, multilevel linear regression analyses explored the extent to which variables were associated with PCC. Results: Higher levels of PCC were associated with a greater job satisfaction, three years or more of healthrelated education, a lower level of quantitative demands and role conflict, a higher level of perception of mastery, empowering leadership, innovative climate and perception of group work, in addition to the type of unit and the physical environment in the NH unit designed for people with dementia. SCU and staff job satisfaction explained most of the variation in PCC. Conclusion: This study shows an association between PCC and organizational, staff and unit characteristics in NH. These findings indicate that providing PCC in NH care is closely linked to how the staff experiences their job situation in addition to both organizational and structural factors and the physical environment. Attention needs to be given to such factors when planning NH care.
International Journal of Nursing Practice, Feb 1, 2010
What is the matter with crushing pills and opening capsules? This study aims to map out to what d... more What is the matter with crushing pills and opening capsules? This study aims to map out to what degree medication is being crushed and mixed into the patients' food and beverages and how often this practice included medication, which has a statement in the Norwegian pharmaceutical compendium that this should not be done (inappropriately altered medication (IAM)). Data from a total of 2108 patients in 151 wards in 65 nursing homes were collected. The data contained information about the kind of drugs the patient received, in which form it was given and how it was given. Patient characteristics and ward characteristics were also recorded. Twenty-three per cent were given at least one drug mixed into their food or beverages and 10% were given at least one IAM. This study shows a malpractice regarding one aspect of medication in nursing homes. Even though we need more knowledge, we know enough to take action to raise the quality of the administration of medicines in nursing homes.
Journal of Geriatric Oncology, Nov 1, 2019
Background: Maintaining physical function and quality of life (QoL) are prioritized outcomes amon... more Background: Maintaining physical function and quality of life (QoL) are prioritized outcomes among older adults. We aimed to identify potentially modifiable factors affecting older patients' physical function and QoL during cancer treatment. Methods: Prospective, multicenter study of 307 patients with cancer ≥70 years, referred for systemic treatment. Pre-treatment, a modified geriatric assessment (mGA) was performed, including registration of comorbidities, medications, nutritional status, cognitive function, depressive symptoms (Geriatric Depression Scale-15 [GDS]), and mobility (Timed Up and Go [TUG]). Patient-reported physical function (PF)-, global QoL-, and symptom scores were assessed at baseline, two, four, and six months by the EORTC Quality of Life Core Questionnaire-C30. The impact of mGA components and symptoms on patients' PF and global QoL scores during six months was investigated by linear mixed models. To identify groups following distinct PF trajectories, a growth mixture model was estimated. Results: 288 patients were eligible, mean age was 76.9 years, 68% received palliative treatment. Higher GDSscores and poorer TUG were independently associated with an overall level of poorer PF and global QoL throughout follow-up, as were more pain, dyspnea, and appetite loss, and sleep disturbance. Three groups with distinct PF trajectories were identified: a poor group exhibiting a non-linear statistically (p b .001) and clinically significant decline (≥10 points), an intermediate group with a statistically (p = .003), but not clinically significant linear decline, and a good group with a stable trajectory. Higher GDS-scores and poorer TUG, more pre-treatment pain and dyspnea were associated with higher odds of belonging to the poor compared to the good PF group. Conclusion: Depressive symptoms, reduced mobility, and more physical symptoms increased the risk of decrements in older patients' PF and global QoL scores during cancer treatment, and represent potential targets for interventions aiming at improving these outcomes.
International Psychogeriatrics, Dec 4, 2017
Background: Person-centered care (PCC) is regarded as good quality care for persons with dementia... more Background: Person-centered care (PCC) is regarded as good quality care for persons with dementia. This study aimed to explore and understand the association between PCC and organizational, staff and unit characteristics in nursing homes (NHs). Methods: Staff from 175 NH units in Norway (n = 1,161) completed a survey, including measures of PCC and questions about staff characteristics and work-related psychosocial factors. In addition, data about organizational and structural factors and assessment of the physical environment in the units were obtained. The distribution of these factors in regular units (RUs) and special care units (SCUs) is described, and the differences between the two types of units are analyzed. Furthermore, multilevel linear regression analyses explored the extent to which variables were associated with PCC. Results: Higher levels of PCC were associated with a greater job satisfaction, three years or more of healthrelated education, a lower level of quantitative demands and role conflict, a higher level of perception of mastery, empowering leadership, innovative climate and perception of group work, in addition to the type of unit and the physical environment in the NH unit designed for people with dementia. SCU and staff job satisfaction explained most of the variation in PCC. Conclusion: This study shows an association between PCC and organizational, staff and unit characteristics in NH. These findings indicate that providing PCC in NH care is closely linked to how the staff experiences their job situation in addition to both organizational and structural factors and the physical environment. Attention needs to be given to such factors when planning NH care.
International Psychogeriatrics, Jun 11, 2007
Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing... more Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing homes. The Neuropsychiatric Inventory (NPI) is a commonly used scale for the assessment of such symptoms in diverse settings. We have conducted a study of the reliability and the validity of the Norwegian version of the NPI nursing home version (NPI-NH). The reliability study comprised 41 patients. We established inter-rater reliability between raters with various levels of health education using kappa statistics. Fifty patients were included in the validity study. The patients were examined by a physician, who also rated the patient's behavior using "behavioral pathology in Alzheimer's disease" (BEHAVE-AD). Subsequently, a research nurse performed a standardized interview using the NPI and the Cornell scale. Concurrent validity of the NPI and the BEHAVE-AD was analyzed. Internal consistency, as measured by Cronbach's alpha was above 0.8. Inter-rater reliability was, except for one item, between 0.85 and 1.0 across assessors with different levels of health education. All correlations between the NPI and the BEHAVE-AD were significant, ranging from 0.38 to 0.72. The weakest correlations were between items assessing affective and anxiety symptoms. The Norwegian version of the NPI-NH is a reliable and valid instrument for assessing psychiatric symptoms and behavioral disturbances in the residents of nursing homes. The investigation of depressive symptoms merits particular attention.
Scandinavian Journal of Caring Sciences, Dec 1, 2008
Quality of care in Norwegian nursing homesdeficiencies and their correlates Background: Quality o... more Quality of care in Norwegian nursing homesdeficiencies and their correlates Background: Quality of care (QoC) in nursing homes has many aspects and various proxies have been used to evaluate it. In only a few studies several proxies for quality have been combined into a common variable. Objective: To explore which variables are associated with low QoC in few and several areas respectively. Methods: A structured interview of the patients' primary carer of 1926 patients in 251 wards was carried out. Questions about different kinds of quality deficiencies during the last 7 days were recorded. Eight main types of quality deficiencies were used to construct a linear outcome variable called number of quality deficiencies (NQD) with values from zero to eight. Patient characteristics such as sex, age, function in activities of daily living (ADL), behaviour and mental capacity were recorded. Type of ward, staffing, size of ward, type of institution and formal education of the staff, were also recorded. Results: More than half of the patients in Norwegian nursing homes experienced two or more quality deficiencies in the care during 1 week. The variables that were strongest associated with NQD, were present of aggressive behaviour, low level of functioning in ADL and moderateto-severe dementia. Staffing level and type of ward had also a significant influence on the model.
Research Square (Research Square), Apr 28, 2021
Background PSA density has previously been identi ed as a predictor of histological upgrading at ... more Background PSA density has previously been identi ed as a predictor of histological upgrading at radical prostatectomy in men eligible for active surveillance, but how information from pretreatment biparametric magnetic resonance imaging (bpMRI) contributes needs further clari cation. The objective of this register-based study was to identify predictors of upgrading at prostatectomy in men with Gleason Grade (GG) group 1 and pretreatment bpMRI. Methods This study included all 130 men with GG 1 cancer who between March 2014 and September 2019 had a robotic-assisted radical prostatectomy (RARP) at Innlandet Hospital Trust and a bpMRI before their diagnostic biopsy. The outcome measure was upgrading from GG 1 on biopsy to GG 2-5 in the radical prostatectomy specimen. Logistic regression models were used to explore predictors for upgrading. Odds ratios (ORs) and con dence intervals (CIs) were calculated. The association between PSA density and the probability of upgrading was assessed after stratifying by Prostate Imaging-Reporting and Data System and Reporting Datasystem (PI-RADS): PI-RADS 1-3 versus 4-5. Results Upgrading was present in 56% (73/130) of the cancers. PSA density was the only signi cant predictor for upgrading (OR = 1.7, 95% CI 1.2; 2.5). The probability of upgrading was higher for men with a PIRADS 1-3 than for men with PIRADS 4-5, but the difference was not statistically signi cant (adjusted OR 0.4, 95% CI 0.2; 1.1, p = 0.082). However, among men with PI-RADS 1-3, the probability gradually increased with increasing PSA density (p = 0.036). With PI-RADS 4-5 the probability of upgrading was high over the entire PSA density range.
BMC Geriatrics, Oct 27, 2020
Background: Farm-based day care services (FDCs) for people with dementia are intending to provide... more Background: Farm-based day care services (FDCs) for people with dementia are intending to provide social relationships and meaningful activities in an agricultural landscape and offer respite for next of kin. As this requires a certain cognitive and physical functioning, it is of interest to investigate how this service contribute during the course of dementia. In this study we aim to explore the individual characteristics predicting dropout from FDC. Furthermore, we investigate whether the participants who drop out of the service continue to live at home with another day care service or if they move to a residential care facility. Methods: The study includes 92 people with dementia attending FDCs in Norway, assessed with standardized instruments at baseline between January 2017 and January 2018. They were followed for 1 year, and dropouts from FDC during this period were mapped. The association between individual characteristics and dropout was assessed using a Cox proportional hazards regression analysis. Results: Thirty-eight people stopped attending FDCs during the study. Twenty-six moved to residential care. Among the 12 who continued to live in their own homes, 9 people started in a regular day care service. Higher score on educational level and more severe dementia, as well as lower scores on social support, increased the probability of stopping FDC. Conclusion: FDCs appeared as a service that is stable over time for most participants, as more than two-third could use the care facility until the need of residential care. The transfers within care services and levels of care seemed to be characterized by continuity. More research on the growing population of educated older adults with dementia are warranted, to facilitate for their course of care needs. Finally, extended knowledge is needed to improve the collaboration between private and public networks, such as day care services, to improve the experience of social support for people with dementia.
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Papers by Øyvind Kirkevold