The Research Group for Frail, Seriously Ill Patients
About the research
Our interdisciplinary research group includes nurses, physicians, and professionals from other fields within healthcare and community medicine.
The group's research aims to improve care for frail older adults and prevent deterioration in health-related quality of life through health-promoting conversations. We also develop support for frail patients with cardiovascular disease to help them manage symptoms and improve functioning during the first year after surgery. Another area of focus is improving life after cardiac arrest for survivors and their family members. Sudden cardiac arrest is common and is one of the leading causes of death in the Western world. Survivors may experience substantial health problems, including anxiety, depression, memory difficulties, and sleep disturbances. Their family members may experience prolonged grief, anxiety, and poorer self-reported health. Our research seeks to increase knowledge of the health and support needs of cardiac arrest survivors and their families so that appropriate support can be provided.
Neurodegenerative diseases are common among older adults and are associated with high healthcare costs and reduced quality of life for affected individuals and their families. As the global population ages, the number of people living with neurodegenerative diseases is expected to double over the coming decades.
Parkinson's disease is one of the most common neurodegenerative diseases. It is associated with motor symptoms such as impaired mobility, balance problems, and tremor, as well as non-motor symptoms including cognitive and emotional difficulties, pain, and increased sensitivity to stress.
To meet the care and follow-up needs of this growing patient group, both now and in the future, it is important to develop approaches that take account of patients' needs and the resources available within the healthcare system. Another important area is the prevention and early detection of healthcare-associated infections (HAIs), particularly sepsis. Reducing HAIs may decrease the need for intensive care, limit antibiotic resistance, and reduce societal costs. For individuals, HAIs and sepsis may result in increased suffering, permanent disability, or death. Our research aims to identify and validate early signs and symptoms of ongoing HAIs.
These indicators are incorporated into a clinical decision-support system that is subsequently evaluated in practice to determine its ability to detect HAIs and how it can be used most effectively. Person-centred care benefits patients and their family members throughout illness and treatment. It may improve adherence and, ultimately, clinical outcomes. A conversation in which the person is heard by a nurse provides the basis for jointly developing a plan for the forthcoming treatment period. Central to this approach is an understanding of the person's situation and the development of an individualised plan based on that understanding. The group conducts research across several areas relevant to frail patients, with a focus on preventing deterioration and strengthening person-centred care through health support and decision support. We use qualitative and quantitative methods in both retrospective and prospective studies.
FrailHeart
Supporting patients with heart disease can help them identify problems, become more involved in their care, manage their health, and improve their quality of life.
Such support is also valuable to patients' family members. Follow-up is advisory and supportive, with the aims of preventing and detecting complications and strengthening patients' capacity for self-care. The findings are expected to increase knowledge of patients' physical and psychological well-being before and after cardiac surgery.
Collectively, the questionnaires provide insight into the health of frail patients undergoing cardiac surgery and how additional support can best be provided. The projects are well established at the Department of Cardiothoracic and Vascular Surgery in Link枚ping, where clinical management has emphasised the well-being of frail patients undergoing cardiac surgery.
The projects are innovative in that they will increase fundamental understanding of how the degree of frailty can inform preoperative assessments and help align patients' expectations with likely surgical outcomes. They are also expected to identify which preoperative factors are most strongly associated with better quality of life after surgery. Knowledge of how frail patients experience their health in connection with cardiac surgery can support the adaptation of care.
By responding to patients' needs for tailored information, continued rehabilitation can be optimised. We also aim to increase knowledge of family members' health, life satisfaction, anxiety, depression, and sleep in relation to family functioning and social support after a next of kin survives cardiac arrest.
FrailBrain
Cognitive impairment is a relatively common phenomenon after cardiovascular surgery.
It is of the utmost importance that healthcare professionals are aware of risk factors for suffering from cognitive impairment and to prevent and take early action as far as possible.
We can improve and improve and develop care in connection with heart surgery, both in terms of the reception of the patient at admission, during the hospital stay and what the follow-up should look like. This is to improve support from the health care system when the patient has a deteriorating health, is fragile and has insufficient support. It is of great importance for improving the physical and mental well-being of the frail patients after cardiovascular surgery.
A sudden cardiac arrest immediately results in a circulatory pause, a life-threatening condition that leads to death unless circulation is restored immediately. The condition leads directly to a lack of oxygen in the brain and cognitive impairment is therefore common in survivors, even after shorter circulatory pauses. Studies that specifically examined the prevalence of cognitive impairment in cardiac arrest survivors show that between 6% and 100% have an affected cognitive function. A likely explanation for this strong variation is that the studies used different assessment methods, probably due to the lack of consensus on which assessment instruments should be used to screen for cognitive impairment after a cardiac arrest. Another importance is to detect mild cognitive impairment early, this is emphasized in the Diagnostic and Statistical Manual of Mental Disorders -5 criteria. In today's health care, follow up in cardiac arrest does not include systematic screening for cognitive impairments. As cognitive problems increase with age, this group of survivors is likely to be more vulnerable than younger cardiac arrest survivors and therefore needs to be identified to an even greater extent. In summary, there is a great need for valid self-assessment instruments that can increase the possibility of detecting and treating mild cognitive impairment in elderly cardiac arrest survivors.
FrailHealth
From a healthcare perspective, it is important to reduce the need for intensive care, limit antibiotic resistance, and, in the longer term, reduce societal costs associated with sepsis.
Early identification of patients with HAI, before the infection becomes severe, is crucial. Earlier detection may reduce patient suffering, shorten hospital stays, and lower healthcare costs. It is therefore important to investigate the signs and symptoms shown by patients with severe HAIs, as well as their clinical characteristics and diagnoses. Vigilant nursing assessment is essential for the early identification of signs and symptoms of a severe HAI, particularly sepsis.
Improving care processes for frail older adults through the clinical evaluation of body temperature and oxygen saturation in relation to each individual's normal range. The aim is to clinically evaluate the value of calculating individual normal ranges and interpreting deviations in body temperature and oxygen saturation accordingly.
Frail older adults often present with non-specific symptoms and may not develop a fever during infection, increasing the risk of delayed diagnosis, severe illness, and death. Changes in body temperature are important indicators when assessing health deterioration. Current assessments are based on measurements from the mid-nineteenth century, which traditionally defined 37 degrees Celsius as normal body temperature and values above 38 degrees Celsius as fever. Subsequent research has demonstrated substantial variation between groups and shown that normal body temperature may be lower than traditionally assumed.
In addition to age, sex, and circadian rhythm, physiological variation, chronic disease, and inflammatory processes contribute to individual differences. Measurements should therefore be interpreted in relation to each individual's normal range. Interpretation based solely on group-level reference values may be misleading because a value that is abnormal for an individual may still fall within the population reference range. Research therefore supports interpreting measured values in relation to individual normal ranges.
As with body temperature, thresholds for normal oxygen saturation vary. Several factors can affect the accuracy of pulse oximetry measurements taken from a finger, including poor circulation, skin pigmentation, skin thickness, skin temperature, tobacco use, and nail polish. A pulse oximeter may record a value that is higher than the actual arterial oxygen saturation, creating a risk that hypoxia will not be detected. The COVID-19 pandemic further highlighted the importance of accurate assessment and interpretation of oxygen saturation.
In this project, the interpretation of deviations in body temperature and oxygen saturation from individual normal ranges is compared with interpretation based on group-level reference values in frail older adults. Interpreting individual changes may enable earlier detection and treatment of infection, thereby reducing suffering, supporting recovery, and preventing hospital admissions. For healthcare professionals, this approach may provide a more reliable basis for assessment and contribute to more efficient work processes and care pathways. In the longer term, it may also reduce healthcare costs.
The project is conducted in collaboration between Link枚ping University, the emergency department in Region Kronoberg, and two residential care facilities for older people in Kronoberg County, one in V盲xj枚 and one in Ljungby.
FrailSleep
Insomnia has a major impact on both physical and mental health and is therefore important to detect and treat.
Insomnia increases the risk of suffering from cardiovascular diseases. Poor sleep efficiency (problems with sleep onset and waking up after sleep onset) is associated with mortality, metabolic syndrome and cardiovascular disease.
About one-fifth of survivors of a cardiac arrest have insomnia problems shortly after the event. A long-term study has described that sleep problems are common in people who survived a cardiac arrest and who did not improve after two years of follow-up. It is therefore important to screen for insomnia problems so that they can be identified and treated. One problem is that the question of sleep is not asked, and then due to lack of knowledge about sleep and that sleep is not a priority area during recovery and follow-up in cardiac follow-up care.
Cooperation
The research project Frail has close collaboration with the infection clinic, ThoraxVascular Clinic at 一本道 Hospital, and Linnaeus University Kalmar.
Research Group
Facts
Detecting early stage infections in critically ill patients (Vigilance health-associated infections)
In Sweden, approximately 65,000 patients are affected by healthcare-associated infections (HAIs) every year, which more than doubles the length of care for these and contributes to the death of 1500, most commonly from healthcare-associated sepsis on the basis of healthcare-associated pneumonia or healthcare-associated urinary tract infection.
Vigilance is based on the nurse having the ability to understand the meaning of an observation, anticipate what may happen and also understand the risks of an action. It is also important to be ready to act and know when it is appropriate to act. Finally, vigilance also implies the responsibility to monitor the results of one's own and others' actions. The aim of this project is to identify signs and symptoms to detect severe HAIs in hospitalized surgical patients at an early stage.
Identify fragile heart surgery patients
In Sweden, around 5800 open heart surgeries are performed annually. The patient group consists of elderly people who often carry a multimorbidity, which can mean greater vulnerability. In connection with cardiac surgery, the patient faces challenges that affect both physically and mentally. Increased knowledge about how fragile patients undergoing heart surgery experience their health can contribute with an opportunity for healthcare to better understand how nursing can be improved. The nurse's understanding of the patient's life situation becomes an important prerequisite for providing person-centred nursing.
The aim was to explore how fragile patients experience health, anxiety and anxiety in connection with heart surgery.
The aim was to explore how fragile patients experience health, anxiety and anxiety in connection with heart surgery.
Health solutions for increased patient engagement and better quality of life for frail elderly heart surgery patients
In Sweden, approximately 5800 open heart surgeries are performed annually. The patient group consists of older people who often carry a multimorbidity, which can
mean greater vulnerability. There is a need for a better understanding of this and follow-up and support with an Health intervention to help the heart surgery patients manage their symptoms and improve their function in the first year after heart surgery. Increased knowledge of how fragile patients undergoing heart surgery experience their health can contribute with an opportunity for healthcare to better understand how nursing can be improved. The nurse's knowledge of the patient's life situation becomes an important prerequisite for be able to provide person-centred care. Our main goal is to improve the care of heart surgery on fragile patients.
mean greater vulnerability. There is a need for a better understanding of this and follow-up and support with an Health intervention to help the heart surgery patients manage their symptoms and improve their function in the first year after heart surgery. Increased knowledge of how fragile patients undergoing heart surgery experience their health can contribute with an opportunity for healthcare to better understand how nursing can be improved. The nurse's knowledge of the patient's life situation becomes an important prerequisite for be able to provide person-centred care. Our main goal is to improve the care of heart surgery on fragile patients.
Cognitive self-assessment, function, assessment in cardiac arrest survivors
Cardiac Arrest (CA) is an important global health problem. Survival rates vary between countries, but according to a more recent overview guide, the survival rate for cardiac arrest is 20% in hospital and 10% if people are affected outside hospital. Despite poor prognosis, survival rates have increased in recent decades. The survivors have reported good health after their cardiac arrest, but despite this, CA survivors report health problems with cognitive impairments that can negatively affect their lives. Not all people affected by CA are routinely screened for cognitive impairments. Healthcare professionals have an important role in detecting cognitive impairment in the follow up of CA care. There is little research and knowledge about how healthcare professionals perceive and understand cognitive impairment in people who have survived a cardiac arrest. Most assessments of cognitive function are made by health care professionals and sometimes by next of kin, but there are no self-reported instruments for detecting cognitive impairments that are developed for those who have survived a cardiac arrest. We want to expand the knowledge of cognitive function and cognitive self-assessment in these people.
The impact of sleep on health and quality of life after cardiac arrest
Sleep is an important element in all aspects of health-related quality of life. Sleep problems today are strongly associated with various health problems. Today, there is research that shows that both too short and too long sleep increase the risk of premature death. Sleep problems also increase the risk of cardiovascular disease. A study in the Netherlands, which followed over 18,000 healthy people for 10-14 years, shows that people with sleep for 6 hours or over 9 hours had an increased risk of heart disease by 23% and by 15% for vascular diseases. For people who also had a reduced sleep quality, the risk of vascular disease increased up to 63% and for heart disease up to 79% compared to people with normal sleep. With this project, we want to increase knowledge about cardiac arrest survivors' health-related quality of life with a focus on symptoms of insomnia.
Next of kins' health and life situation after cardiac arrest
Sudden cardiac arrest is common and is one of the most common causes of death in the Western world. The sudden loss after cardiac arrest can have a significant impact on the health of grieving family members. Family members report prolonged grief and problems with self-reported health, and then associated with anxiety. Spouses report more problems with long-term grief and self-reported health compared to non-spouses.
Next of kin experience contradictory feelings and concerns. The feeling of unexpectedly being alone and being given responsibility for the common life is particularly burdensome. The fear of losing one's family member increased the burden and after discharge an adapted everyday life emerged, influenced by the needs of the survivor, such as emotional, social, socio-economic and practical changes within the family. Increased knowledge of how next of kin experience their life situation can help to improve contact after discharge. There is a risk that these family members will also develop serious health problems and professional support should be offered. The goal is to describe and explore next of kins' health, satisfaction with life, sleep, family function and develop increased social support after a cardiac arrest.
Experiences of tuberculosis treatment in Sweden, perspectives from patients, next of kin and healthcare professionals
In Sweden, 365 cases of turbercolosis (TB) were reported in 2021. Of these, 90% were infected abroad and this reflects that the incidence of TB in Sweden correlates well with migration flows from countries where the disease is still common. It can be stated that in Sweden there are no major problems with interrupted TB treatments, but there is no knowledge of how people with TB and next of kin and healthcare professionals in Sweden experience the treatment period. The aim is to describe, explore and evaluate how patients, next of kin and healthcare professionals experience the treatment period of TB and support based on a person-centered approach.