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Little is known on how students experience navigating the field between disciplinary boundaries and interdisciplinary educational contexts. Therefore, it is of great concern to explore how this kind of interdisciplinary doctoral education is perceived and can contribute to their preparation for interdisciplinary research on ageing and health. The overall ambition with this paper is, therefore, to describe the establishment and development of one novel interdisciplinary Research School by using The Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH) as case example. Moreover, to explore doctoral students' perceptions of being part of SWEAH and to provide implications and recommendations for institutions and supervisors to accomplish an interdisciplinary Graduate School aiming to prepare junior researchers for strong careers in interedisciplinary research on ageing and health. The aim is to describe the development of a novel interdisciplinary graduate school, using the Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH) as a case example. We explore doctoral students’ perceptions of being part of SWEAH and provide implications for practice. Written self-reports reflecting 78 students’ experiences and perceptions were analyzed using thematic analysis. The findings reveal that affiliation with SWEAH is highly valued. The students emphasized the tailored courses and learning activities and reported that it was instrumental in deepening their knowledge and broadening their research perspectives. The findings demonstrate how students navigate between disciplinary and interdisciplinary contexts and become enculturated with intellectual mindset and understanding of the importance of network building. The graduate school adds an interdisciplinary layer of learning, influenced by peers and researchers, and demonstrates the importance of community building within interdisciplinary environments and how it can be achieved.

Research is needed to understand attitudes and adoption of the broad range of technologies currently available to support active and healthy ageing, in different generations. Previous and current research tends to neglect the diversity of products and services, as well as typically focuses on current older people rather than those representing future generations. Research-based knowledge is warranted to support development of future technologies that successfully promote active and healthy ageing. The present study aims to give an overview of the (Blinded) survey and sample, followed by a description of attitudes and acceptance related to technology in general and as a means to support active and healthy ageing. A national cross-sectional survey was conducted with a randomised sample (N = 2,121) including men and women from three age cohorts (30–39, 50–59 and 70–79 year-old persons) in Sweden, including questions on attitudes and acceptance related to a broad perspective of technology. The results show that perspectives were shared across generations rather than just within, especially in the younger and middle-aged generations. However, there were significant generational differences regarding what kind of technologies are preferred to support active and healthy ageing as well as reasons for using certain technologies. Our study described generational perspectives rarely displayed in research and shows that attitudes toward and acceptance of technologies for active and healthy ageing are shared across generations. Notable differences were displayed concerning choosing and adopting new technology, which deserve attention when developing new products and services. The study shows that research applying a comparative generational perspective has potential to nurture the understanding of acceptance and adoption throughout the ageing process, and guide development and implementation of technologies for active and healthy ageing.

Research has shown that positive evaluations of home are important for very old people’s health, well-being and independence in daily life. The rationale for the present study derives from our survey study findings, confirming such associations also in a younger cohort (N = 371). The purpose of this study was to further increase the understanding of the dynamics of meaning of home and health among community-living healthy younger older people, in the present and in a projected future. Data were collected through semi-structured interviews with 13 persons aged 67–70 years living in ordinary housing in Sweden, followed by a qualitative content analysis. Findings suggest that the home becomes progressively important after retirement. Not only the immediate home environment but also local neighbourhoods influence perceptions about home. Home brings emotional and social benefits but also worries about how to cope with complex home ambivalence when reflecting upon future housing arrangements. The findings suggest that it is important to consider the role of perceived aspects of home for health and well-being in early phases of the ageing process. The findings could be used to raise awareness among policymakers, housing authorities and professionals involved in housing-related counselling.

The aim of this study was to explore the usefulness of research circle methodology in the later stages of the research process. In an active collaboration with the researchers, participants, that is, users of research, discussed and prioritized research on home and health dynamics. Reflections, comments, and evaluations from both leaders and users were analyzed, applying content analysis. The usefulness of the research circle methodology from the users´ perspective reflected the importance of the content, form for research presentations, leadership methods, and the mix of participants. Research leaders reflect on the role as challenging and demanding, where the composition of users plays an important role for the usefulness of the methodology, as well as for practicalities, form, and content of the research presentations. Research circle methodology offers opportunities for knowledge translation; however, it is demanding and presents a range of challenges, such as the heterogeneity of the group, that needs further exploration. (Less)

Background Participation in everyday life and society is generally seen as essential for health-related outcomes and acknowledged to affect older people’s well-being. Aims To investigate if aspects of performance- and togetherness-related participation influence on mortality among very old single living people in Sweden. Methods ENABLE-AGE Survey Study data involving single-living participants in Sweden (N = 314, aged 81–91 years), followed over 10 years were used. Multivariate Cox regression models adjusted for demographic and health-related variables were used to analyse specific items influencing mortality. Results Participation in performance- or togetherness-oriented activities was found to significantly influence mortality [HR 0.62 (0.44–0.88), P value 0.006, and HR 0.72 (0.53–0.97), P value 0.031, respectively]. Talking to neighbours and following local politics had a protective effect on mortality, speaking to relatives on the phone (CI 1.10–2.02) and performing leisure activities together with others (CI 1.10–2.00) had the opposite influence. That is, those performing the latter activities were significantly more likely to die earlier. Discussion The main contribution of this study is the facet of the results showing that aspects of performance- and togetherness-related participation have a protective effect on mortality in very old age. This is important knowledge for designing health promotion and preventive efforts for the ageing population. Moreover, it constitutes a contribution to the development of instruments capturing aspects of participation influencing on mortality. Conclusion In the development of health promotion and preventive efforts the inclusion of participation facets could be considered in favour of potential positive influences on longevity.

AimTo explore experiences of health services and unmet care needs by people with late-stage Parkinson's in England.MethodTen participants, at Hoehn and Yahr stage 4 or 5, were interviewed using semi-structured open-ended questions. Data were analysed using qualitative thematic analysis.FindingsParticipants reported that whilst under the treatment of specialist hospitals, the majority of care provision had shifted into the community, often because hospital-based services were felt to be difficult to access and have limited benefit to them. When using health-care services, participants frequently experienced having to 'fit-in' to service structures that did not always accommodate their complex needs. Despite high levels of disability, participants expressed their desire to maintain their identity, normality of interests and activities in their lives, including remaining in their own homes. This was facilitated by bespoke care and equipment, and positive relationships with care providers. Knowledge on disease management was a key factor in their perceived ability to remain in control. Family caregivers had a central role in facilitating care at home. There was uncertainty about and little planning for the future, and moving to a residential nursing home was perceived an undesirable but potentially necessary option for future care.ConclusionUnmet care needs identified by people with late stage Parkinson's in England include greater flexibility of healthcare structures and bespoke service provision, to accommodate their individual complex needs. Support in their own homes and positive relationships with healthcare providers help People with Parkinson's (PwP) to maintain a degree of normality and identity, and provision of information help them maintain some control. There is a need for more informed discussions on future care planning for this specific population.

Housing is the main spatial context for aging, important for well-being, a sense of identity and independence in daily life. Yet, as people grow older housing needs change and knowledge about how people reason about their future home when they enter retirement age is lacking. This qualitative study presents findings that explored meaning of home and health dynamics in the present and in a projected future among community-living people aged 67 – 70 years. Findings suggest that the home becomes progressively important after retirement. Not only the immediate home environment but also local neighborhoods influence perceptions about home. Home brings emotional and social benefits but also worries about how to cope with complex home ambivalence when reflecting upon future housing arrangements. The findings highlight the importance of considering perceived aspects of home and could be used to raise awareness among policymakers, housing authorities and professionals involved in housing-related counselling.

New technologies are being touted as solutions to many societal challenges not least of which are ageing and health. However, the rapid development of new technologies is proceeding with little input from older adults. This presentation highlights the perceptions and attitudes of three age cohorts related to the continuous technological advancement of products intended to support active and healthy aging. Participants were 30-39 (n= 639), 50-59 (n=703), 70-79 (n=779) years-old randomly sampled from the Swedish population registry. Results showed both similarities and difference across generations. For example, 24%-35% of older adults would like to use home monitoring devices (e.g. fall sensors, smart home devices) to support active and healthy aging, compared to 35%-56% of younger groups. More than 82% of all groups highlighted the importance of involving intended users in the development process. Results can be used to support the needs and desires of current older adults and future generations.

Perceived aspects of home, such as usability and the meaning of home, are important for very old people’s health. This study is a synthesis of quantitative (N=371) and qualitative (N=13) findings that explored associations between perceived aspects of home, health and well-being among younger older people. Participants were aged 67 - 70 years, and lived in ordinary housing in south Sweden. Participants with positive evaluations of perceived aspects of home had better psychological well-being and reported fewer physical and depressive symptoms. Perceptions about home become more important after retirement and include not only the immediate home environment but also local neighborhoods. The findings highlight the importance of considering both subjective and objective aspects of home when developing housing policies and standards as the former has largely been neglected in decision making.

Introduction Opportunities for leisure activities and physical mobility are important for the ageing population. Therefore, we aim to describe leisure activities outside the home among very old (over 80 years of age) users and non-users of mobility devices in two European countries. Method Survey data on mobility device use, self-rated physical mobility and leisure activities outside the home were utilised for a Latvian ( n = 225) and Swedish ( n = 314) sample. Differences in type and number of leisure activities were studied between the countries and for four groups of participants according to use/non-use of and level of physical mobility. Results Significant differences in type and number of leisure activities were seen between the national samples and among the participant groups. In general, each participant group in the Swedish sample reported more leisure activities than did those in the Latvian sample. Non-users with good physical mobility reported significantly more leisure activities than all other participant groups. Conclusion There are differences between the two national contexts in the type and number of leisure activities reported. To support very old people’s participation in outdoor leisure activities, we need more knowledge as to how physical, institutional and sociocultural environments affect very old people’s opportunities to engage in and perform such activities.

As the quest for knowledge translation from research to practice and policy contexts is growing stronger, researchers need to develop strategies for synthesizing research findings. Since home environments constitute an important context for the delivery of health care and social services to older adults and people aging with disabilities, research in this field can serve as an example for such endeavors. Using 35 original publications and one unpublished doctoral dissertation based on the European ENABLE-AGE Project, we aimed to demonstrate a systematic approach to synthesize research findings generated by large research projects as the basis for evidence-based interventions. The synthesized findings highlighted the complex interactions between objective and perceived aspects of housing and aspects of health in very old age, impacting on, for example, residential decision making. Independence in daily activity is influenced by the sociocultural care and service context. A familiar and safe neighborhood, a social network, and a good supply of services are important to perceptions of participation. Going further, we suggest housing-related interventions that address problems and challenges related to ongoing demographic changes. This article contributes to the development of strategies for knowledge translation, connecting research and practice and policy contexts struggling to meet the societal challenges that accompany population aging.

Objective: To investigate test-retest reliability and internal consistency of a new instrument for evaluation of mobility device interventions. Material and methods: The instrument comprised 4 scales and one summed index. Two test-retest interviews involved 147 mobility device users (mean age 60 years) with a broad range of functional limitations, living at home. Results: For 2 scales and the summed index the reliability was substantial or almost perfect (K 0.71/ K-W 0.76/intraclass correlation coefficient = 0.93; confidence interval = 0.90-0.95). The reliability of one scale was moderate (K-w 0.4 1), but after reduction of grades and combination with another scale, it was substantial (K-w 0.66). The reliability of the fourth scale was moderate (K-w 0.55). The internal consistency of 3 scales varied from a 0.63 to 0.76. Conclusion: Even thou,,h the test-retest reliability of all but one of the scales of the new instrument was substantial to almost perfect, this study demonstrated that revision is required. The challenges identified were probably due to the highly complex relationship between outdoor participation while using mobility devices and accessibility to the outdoor physical environment. Thus. based on the results of this study the instrument will be revised and subsequently launched as the "Nordic mobility-related participation outcome evaluation of assistive device intervention" (NOMO instrument). More research on the concept of mobility-related participation and the psychometric qualities of the instrument is required. (Less)

OBJECTIVE. The objective of this study was to compare environmental barriers, housing accessibility, and usability before and after relocation of very old, single-living people in the community. It also examined whether accessibility improved after relocation compared with a simulated scenario in which participants would have remained in their former dwellings. METHOD. Data from the Swedish part of the longitudinal Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing database were analyzed with a before-and-after design (N = 29). Mean time from before to after data collection was 2.6 yr. RESULTS. The number of environmental barriers was significantly reduced after relocation, especially barriers at entrances and in bathrooms. In addition, usability was stable and accessibility improved compared with the simulated scenario of remaining in the former dwelling. CONCLUSION. Community-based moves to new dwellings may lead to fewer environmental barriers and stable levels of usability and accessibility. This relocation is a positive outcome, considering the expected functional decline in old age.

To explore the experiences over time of using mobility devices (MDs) among very old women in the context of everyday life in Latvia.This study utilized a multiple case-study design that employed an explanatory mixed-methods approach. A combination of quantitative survey data on home and health and qualitative interview data for each participant were used to create three narratives to describe the experiences of MD use in everyday life over time, followed by a cross-case analysis.The three cases illustrate that very old women accept and use MDs due to walking difficulties and related needs. Over time, functional decline combined with physical environmental barriers and changes in their social networks limited the supportive role that available MDs could offer these women.The findings contribute to the understanding of the complexity of MD use in everyday life among very old women in Latvia and the need for different kinds of MDs. These findings illustrate the importance of considering the interaction between people's everyday life situation and their physical environment for their optimal use of MDs. This is important information for policy-makers who can optimize the services for old people in Latvia and support the need for occupational therapists' professional competence for the planning and development of MD provision.

Relocation in very old age is considered to be a major life event and a move could be triggered by many different economic, social, health-related, or environmental reasons. Based on the notion of person–environment (P–E) fit as expressed in the Ecological Theory of Ageing, the aim of this prospective study over 4 years was to explore which aspects of housing and health predict relocation to ordinary or special housing among very old people. At baseline, the participants (80–89 years old) lived alone in ordinary housing in Sweden (N = 384). Data collection at home visits included assessments and observations on aspects of objective and perceived housing as well as on aspects of health. After 4 years, 18 % (n = 70) of the participants had moved, either to ordinary housing (n = 24) or to special housing (n = 46). Cox regression models showed dependence in cleaning, perceived functional independence, and living in a one-family house to predict moves to ordinary housing. Dependence in cooking, cognitive deficits, and accessibility problems predicted moves to special housing. In conclusion, aspects of housing and health are related to relocation in very old age, but in different patterns for relocation to ordinary housing and special housing, respectively. This kind of knowledge has practical implications for relocation counselling and societal planning targeting very old people.

National laws and regulations on service delivery systems (SDS) for assistive technology (AT) in Europe aim to support the activity and participation of people with disabilities. The aim of this paper was to study similarities and differences in the SDS for AT of one Eastern and one Western EU member state. The legislation and regulations, and their operationalization were described from the perspective of key actors, with a focus on the ageing population. Semi-structured interviews (N = 14) were conducted in Sweden and Latvia. The informants had various professional backgrounds and organizational roles, and represented different areas of work. Similarities found were connected to legislation and policy, the aim of AT provision, the growth of a private sector and how financial resources affect the SDS. Differences were related to the availability of AT, and to how, and for and by whom the devices were provided, with Latvia prioritizing certain groups over others and excluding older people. In Latvia, despite it not being stated in the legislation, a medical perspective on AT provision was applied, whereas in Sweden, in congruence with the legislation, the perspective was explicitly biopsychosocial. Despite similarities on the legislation and policy level, interpreted based on the perceptions of professionals there are marked differences between Latvia and Sweden in the operationalization of the SDS of AT. To support activity and participation for the ageing population, the services connected to AT need to be carefully thought out and executed, making efficient use of financial resources and professional competencies.

The decision to relocate in old age is intricately linked to thoughts and desires to stay put. However, most research focuses either on strategies that allow people to age in place or on their reasons for relocation. There is a need for more knowledge on very old peoples' residential reasoning, including thoughts about aging in place and thoughts about relocation as one intertwined process evolving in everyday life. The aim of this study was to explore what we refer to as the process of residential reasoning and how it changes over time among very old people, and to contribute to the theoretical development regarding aging in place and relocation. Taking a longitudinal perspective, data stem from the ENABLE-AGE In-depth Study, with interviews conducted in 2003 followed up in interviews in 2011. The 16 participants of the present study were 80-89years at the time of the first interview. During analysis the Theoretical Model of Residential Normalcy by Golant and the Life Course Model of Environmental Experience by Rowles & Watkins were used as sensitizing concepts. The findings revealed changes in the process of residential reasoning that related to a wide variety of issues. Such issues included the way very old people use their environmental experience, their striving to build upon or dismiss attachment to place, and their attempts to maintain or regain residential normalcy during years of declining health and loss of independence. In addition, the changes in reasoning were related to end-of-life issues. The findings contribute to the theoretical discussion on aging in place, relocation as a coping strategy, and reattachment after moving in very old age.

Maria Haak, Björn Slaug, Charlotte Löfqvist, Maria H Nilsson Department of Health Sciences, Lund University, Lund, Sweden Background and aim: This study aimed to explore the use and perceived unmet need of technical aids and housing adaptations among very old people, living alone in ordinary housing with self-reported Parkinson's disease, compared to matched controls. Methods: Data collected in the European ENABLE-AGE study were used to identify people with self-reported Parkinson's disease (n = 20) and to select three matched controls per individual (n = 60). The matching criteria were age (mean = 82 years), sex, country, and type of housing. Analyses targeted use and perceived unmet need of technical aids and housing adaptations. Results: Very old people with self-reported Parkinson's disease use significantly more aids for personal mobility than very old people in general. They have, furthermore, a significant increased unmet need concerning aids for personal care and protection. Housing adaptations did not differ between the two groups. Conclusion: Since people with Parkinson's disease use technical aids to a higher extent and express an unmet need, they may require more thorough counseling regarding technical aids. Thus, this explorative study provides important information for health care professionals, rehabilitation, and future research. Moreover, in order to develop knowledge about specific challenges connected to Parkinson's disease among the very old, further and larger studies targeting environmental resources are needed. Such studies should preferably include people with a verified diagnosis. Keywords: technical aids, environment, rehabilitation, activities of daily life

PURPOSE: This cross-national qualitative study explores how very old people reflect upon relocation and aging in place. DESIGN AND METHODS: Swedish and German data are utilized in this study. About 80 community-living participants, 80-89 years of age, were interviewed with open-ended questions at home by trained interviewers. The interviews were analyzed by using conventional qualitative content analyses. RESULTS: Reasoning about relocation or aging in place in very old age is a complex and ambivalent matter. A variety of reflections, emotions, and behaviors for and against a move are revealed. Reasons to move reflect the urge to maintain independence, to stay in control, and to avoid loneliness. This is mainly expressed reactively. Reasons not to move reflect a strong attachment to the home and neighborhood. Moreover, reasons not to move reflect practical aspect such as economy and strain, as well as fear of losing continuity of habits and routines. IMPLICATIONS: There is a need for society to develop counseling systems to meet very old people's ambivalence and practical considerations to move or not to move. Thus, the ambivalence to stay put or to relocate needs to be further explored from an applied perspective by also taking nonmovers into account.

Aim: The aim of this study was to explore experiences of mobility device (MD) use among very old single-living Swedish men. Methods: A multiple case study of three men, involving quantitative and qualitative data, was used in an embedded mixed methods design and presented in three narrative stories. To capture differences and similarities in the use of MDs a cross-case analysis was conducted. Results: The findings show that the devices were important for retaining independence in everyday life and for participation in social activities. Use of MDs impacted on everyday activities by enabling, restricting, or changing the performance. Planning and careful thinking were new strategies developed for managing everyday life. The devices were purchased, received from relatives, or prescribed by professionals at a time point when there was a need. The function and form of the devices and a supportive environment were considered important for optimal use. Conclusions: These narrative stories nurture our understanding of complex and multifaceted aspects impacting on MD use in everyday life for very old men. To support active ageing, occupational therapists and other health professionals need to seek information on personal needs and expectations, in order to understand individual perspectives on MD use.

Purpose: To investigate the characteristics and change in use among very old Swedish users and non-users of assistive devices (ADs) for mobility and personal care, over a six-year period, and to investigate factors predicting AD use over a six-year period. Method: Descriptive statistics and logistic regression were used to analyse quantitative data from a subsample from the Swedish part of the ENABLE-AGE Survey Study, n = 154. Variables according to socio-demographics, environment and health were utilized. Results: The number of users increased over time, particularly those using both types of ADs (mobility and personal care). There were differences in health between users and non-users, while no such differences were seen regarding socio-demographics or environmental factors. Health factors most prominent predicted AD use after six years, but also variables within socio-demographics and the environment had an impact on the use; income for ADs for personal care and aspects in the outdoor environment for ADs for mobility. Conclusions: As ADs increases over time, it is important, to pay attention to health as well as other factors, among users and non-users of ADs, to provide important information in planning for and supporting healthy and active ageing. [Box: see text].

Purpose: To explore clients' experience of the housing adaptations (HAs) over time in relation to housing and health. Method: A multiple longitudinal case study, employing an embedded mixed-method design was used. Four participants were included and data from semi-structured interviews were combined with data from structured survey assessments. Results: HA made it possible to maintain valuable roles and activities, to continue to live in the participants' own homes and to take part in the society. The participants strived for autonomy and control, and in order to do so they needed different kinds of support, in terms of HA and mobility devices as well as support from professionals. HA also challenged the participants' routines and habits, as well as their perception about how an appealing HA aesthetically. Thus, the decision to apply for a HA was not always straightforward. Instead, the participants were constantly engaged in negotiations with themselves, concerning benefits and drawbacks of different decisions. Conclusions: HAs involve complex person-environment-activity (P-E-A) transactions, and enhance clients' activity and independence in spite of functional decline. The knowledge generated is important in order to improve individual HA, as well as improving the efficiency and effectiveness of the intervention.

The purpose of preventive home visits is to promote overall health and wellbeing in old age. The aim of this paper was to describe the process of the development of evidence-based preventive home visits, targeting independent community-living older persons. The evidence base was generated from published studies and practical experiences. The results demonstrate that preventive home visits should be directed to persons 80 years old and older and involve various professional competences. The visits should be personalized, lead to concrete interventions, and be followed up. The health areas assessed should derive from a broad perspective and include social, psychological, and medical aspects. Core components in the protocol developed in this study captured physical, medical, psychosocial, and environmental aspects. Results of a pilot study showed that the protocol validly identified health risks among older people with different levels of ADL dependence.

Purpose: The aim was to investigate outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use regarding need for assistance when moving around, frequency of mobility-related participation, easiness/difficulty in mobility during participation, and number of participation aspects performed in everyday life. Method: The study was a prospective cohort study, using an instrument focusing on mobility-related participation outcomes of mobility device interventions (NOMO 1.0), at baseline, after 4-months and 1-year use. Results: The results show that the outcomes in terms of participation frequency and easiness in mobility occur in a short time perspective, and that the effects remained stable at 1-year follow-up. The frequency of going for a walk increased most prominently (26%). Even though the majority of the participation aspects were not performed, more often they became easier to perform: 56-91% found that shopping, walking and visiting family/friends were easier. Moreover, independence outdoors and indoors increased. Conclusions: This small study provides knowledge about the outcomes of powered wheelchairs and scooters in terms of mobility and mobility-related participation in real-life situations. The study supports results from former studies, but even so, larger studies are required in order to provide evidence for the effectiveness of powered wheelchairs and scooters. [Box: see text].

Sparked by the development of a Nordic Master’s Program in Gerontology, and followed by the establishment of graduate schools integrated with national aging research centers in Sweden, a national Graduate School for Ageing and Health (SWEAH) was established. SWEAH is a partner of the International Summer School on Ageing (ISSA). Program evaluation results show that students appreciate the networking and interdisciplinary ambitions of these programs, but they also display challenges inherent in motivating students to get seriously involved in activities requiring that they leave their disciplinary comfort zones. Based on experiences and evaluation results gained from these programs over the years, we describe and problematize requirements for efficient capacity-building in a national and international context. Spin-off effects in terms of international engagement and collaboration in supervision teams and examination committees serve to strengthen the interdisciplinary competence and capacity for international collaboration of the management teams and teachers involved.