As the world’s population rapidly ages, age-related diseases pose a challenge for individuals, families, and social, economic, and healthcare systems. By 2050, the global population aged 60 and older is expected to exceed 2 billion, a sharp increase from 900 million in 2015. The number of people over 80 years old will also rise by 50% by 2029.
There is a need for preventive measures and a sustainable home care service so that elderly individuals can live and thrive in their environment. Existing preventive programs need to be included. The purpose of home care interventions is to provide support in daily living activities (ADL), social aspects, and medical support. Nursing assistants and care aides are common in home healthcare in Sweden, and women in this group are overrepresented (less than 80%). Home care staff often work independently and mostly alone, with limited collaboration with colleagues and supervisors. There is a lack of documented best practices to prevent frailty in older people and to offer person-centered home care based on the older person’s needs. The scenario is that there will be an increasing number of older people in society, while the available workforce will decrease, and there is a need for a strategic plan for this.
With aging, several physiological changes occur, and the risk of developing chronic diseases, disabilities, and dependency increases. Instead of focusing on treating specific diseases, changes in healthcare systems are required to prevent functional decline and disability while focusing on ensuring healthy aging. It is crucial for older people to participate in everyday activities at home and in the community to ensure physical, social, and mental well-being.
FRAILTY AND PREVENTION
The estimated prevalence of frailty among older individuals (+65 years) is 7–12%. Frailty is a major public health problem with significant consequences for the health and well-being of the elderly population. Studies that identify signs of physiological dysregulation underlying frailty provide clues for potential strategies to prevent and slow the onset of frailty. So far, several factors have been identified as risks for frailty among older people living in the community. In general, older age, women, low education levels, a sedentary lifestyle, obesity, underweight, cognitive impairment, and comorbidities are associated with the development of frailty. Increasing evidence shows that frailty is potentially reversible with early screening and interventions, including physical activity, a full nutritional assessment, reduced prescription of inappropriate medications, and the preservation of emotional vitality.
Central to the conceptualization of healthy aging is the understanding that neither intrinsic capacity nor functional ability remains constant. Both tend to decline with age. It is suggested that "empowerment," meaning the belief that one has the power to change their circumstances, can be achieved through a person-centered approach. To meet these various challenges arising from frailty, person-centered and empowering daily strategies for elderly individuals, as well as their relatives, must be prioritized.
To continue living at home, there may be a need for preventive measures and support to ensure safety and promote a healthy and meaningful life at home for as long as possible, with respect for dignity and well-being. The future outlook for the provision of healthcare services in Sweden indicates a development of more flexible care, with a focus on outpatient care and home healthcare. In parallel, care must meet both the needs and demands of service users, including increased involvement in the development of new interventions with the help of technology. However, social, economic, and healthcare systems may hinder the ability to influence issues related to personally meaningful and engaging daily activities and life.
INFORMAL CAREGIVER/CARE PARTNER
Older adults with reduced intrinsic ability often need support to manage everyday activities. "Dear child has many names" as the saying goes, and this applies to the societal sphere that exists outside the public organization but is also not part of regular business or a person’s closest family circle. In this research program, we use informal caregiver or care partner as the person who often needs to provide this support and becomes the caregiver. Due to cost-effectiveness and the preferences of dyads (elderly individuals and their care partners), the focus of the care model is shifting from institutions to home environments. Global estimates of informal dementia care at home were over 2,000 hours per year or six hours per day, equivalent to a full-time employee's working hours, indicating that home care significantly impacts the lives of care partners.
As the older adult’s dependency increases due to frailty, the caregiving burden also increases. Living with a frail person can involve a substantial amount of unpaid care, from basic personal activities of daily living (ADL; bathing, dressing, getting in and out of bed/chair, walking, using the toilet, and eating) to instrumental activities of daily living (IADL; shopping, cooking, taking medication, using transport, and managing personal finances), depending on the cognitive and physical functional levels of the elderly person. This can, in turn, lead to worsened physical and mental health for the family caregivers, diminished ability to participate in daily activities, social isolation, and reduced quality of life and well-being.
The informal caregiver/care partner plays an important role in caregiving, but their efforts are often overlooked. The need for support for this group to manage the responsibility of caring for a loved one while also taking care of themselves is unknown. Therefore, it is important to understand the different factors by which a person’s dependency impacts the informal caregiver/care partner’s well-being, and more importantly, how they can be supported in caregiving but also in their daily life. It is necessary to include this group more closely in the care and prevention of older adults at risk for frailty or in a state of frailty. Since increasing frailty often ultimately leads to the elderly person being moved from home to institutional care, which is costly, largely ineffective, and can have serious negative effects. Although care staff provide most of the care, relatively little research has been done to develop affordable, accessible, and practical tools to help them manage everyday challenges. Most evidence-based interventions to support informal caregivers/care partners require personal training by qualified personnel, which can be expensive and time-consuming. Moreover, such services are often not available in the communities where they live. For example, efforts have primarily focused on interventions for people living with cognitive decline, such as dementia, with much less attention given to how technology can be used to mitigate the physical and emotional impact on their informal caregivers/care partners.
SPECIALIZED SERVICES AT HOME - TECHNOLOGY AND AGING
Interventions with technology support can enable older adults to age in place and stay in their homes. Extending the period during which it is possible to stay at home brings personal, societal, and economic benefits while aligning with Swedish national healthcare policy. However, to succeed in this, support is needed for the elderly person and their relatives/informal caregivers and care partners. Technology can also contribute to new ways of working by developing work methods and implementing welfare technology. Research has shown that training in using the internet and computers can reduce loneliness among older people.
This program addresses the role of welfare technology in the lives of older people and whether and how this technology can promote active and healthy aging. Questions about how welfare technology impacts the situation and conditions for relatives and care partners in a broader sense are also important. To enable the implementation of new working methods, a model for staff, elderly individuals, and healthcare that is ready for the implementation of preventive services and home care (including a strategy for reintegration) with the help of digital technology is needed. In this program, the interventions have also been tested with different welfare technologies in previous pilot studies, which will now be further developed and examined to create this model.
