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Despite the care and support needs of migrants affected by dementia differing from the population of the country where they live now, most European countries do not provide specific strategies to address migration in their national dementia plans. The concept of intersectionality provides an innovative approach to dementia care perspectives and methodologies.The aim is to define intersectionality and to provide examples of applying the concept to dementia care research, focusing on people with a migration background.This article was conceptualized and discussed during virtual INTERDEM taskforce meetings in 2020/2021, while discussing identified literature on intersectionality, migration, and dementia care research.Using an intersectionality framework allows understanding of a person's lived experience by considering the dimensionality, co-occurrence and interlocking of factors (e.g., sex/gender, socioeconomic status, ethnicity, migration status, geographic location/place).Intersectionality can be applied as a conceptual and methodological approach to identify and address gaps in perspectives and in (dementia care) research to overcome the threat of ignorance, exclusion and discrimination.HINTERGRUND: Obwohl sich die Bedürfnisse und Bedarfe an Pflege und Unterstützung für Menschen mit Migrationshintergrund sowie deren Zugang zu Gesundheitsleistungen oft von denen anderer Menschen, die von Demenz betroffen sind, unterscheiden, adressieren die meisten europäischen Länder Migration nicht in ihren nationalen Demenzstrategien. Das Konzept der „Intersektionalität“ bietet einen innovativen methodologischen und perspektivischen Zugang zu Demenz.Ziel ist es Intersektionalität zu definieren und Anwendungsbeispiele des Konzepts im Kontext der Demenzversorgungsforschung – mit Fokus auf Menschen mit Migrationshintergrund – aufzuzeigen.Dieser Artikel wurde im Rahmen virtueller INTERDEM-Taskforce-Treffen 2020/2021 konzipiert und diskutiert, um eine auf Intersektionalität fundierte Basis für zukünftige Demenzforschung zu formulieren. Dabei wurde die identifizierte Literatur zu Intersektionalität, Migration und Demenzversorgungsforschung betrachtet.Die Anwendung von Intersektionalität als analytischem Rahmen erlaubt es, die gelebte Erfahrung einer Person zu verstehen, indem die Dimensionalität, das gleichzeitige Auftreten sowie die Verschränkung von Faktoren wie geschlechtlicher Identität, sozioökonomischem Status, Ethnie, Migrationsstatus und geografischem Ort beachtet werden.Intersektionalität und intersektionale Analysen können als konzeptioneller und methodologischer Zugang angewendet werden, um Lücken in der Demenzversorgung und -forschung zu identifizieren, zu adressieren und damit möglicher Ignoranz, Exklusion und Diskriminierung entgegenzuwirken.

Background: Healthcare workers (HCWs) are central and serve in the frontlines when epidemics threaten public health. Thus, certain communities may be hardest hit by these challenges. Interventions supporting HCWs are important, and to develop these, understanding their experiences is essential. Aim: To explore how HCWs in Norwegian public in-home services experienced work during the COVID-19 pandemic over time. Method: A longitudinal qualitative study with two data collections approximately one year apart (2021 and 2022) was performed. Individual interviews were conducted with HCWs. Results: The analysis resulted in six main themes: Changing everything, Redefining ‘necessary tasks’, Distancing and loneliness, Cooperation and coordination, More infections and fewer worries and Lessons for the future. These indicate capabilities and processes, how they are evolving over time, and outcomes. The first two themes focus on the first period of the pandemic, the next two on the ongoing intermediate period, and the final two cover the last period. Conclusion: The HCWs’ narratives have demonstrated their collective coping based on adaptive and transformative capacities. Further, they have enlisted experienced social resilience in their strategies for coping with the COVID-19 challenges.

Background: Having accurate, up-to-date information on the epidemiology of mild cognitive impairment (MCI) and dementia is imperative. Objective: To determine the prevalence of MCI and dementia in Norway using data from a large population-based study. Methods: All people 70 + years of age, n = 19,403, in the fourth wave of the Trøndelag Health Study (HUNT4) were invited to participate in the study HUNT4 70 + . Trained health personnel assessed participants using cognitive tests at a field station, at homes, or at their nursing home. Interviewers also completed a structured carer questionnaire in regard to participants suspected of having dementia. Clinical experts made diagnoses according to DSM-5 criteria. We calculated prevalence weighing the data to ensure population representativeness. Results: A total of 9,930 (51.2%) of the possible 19,403 people participated, and 9,663 of these had sufficient information for analysis. Standardized prevalence of dementia and MCI was 14.6% (95% confidence interval (CI) 13.9-15.4) and 35.3% (95% CI 34.3-36.4), respectively. Dementia was more prevalent in women and MCI more prevalent in men. The most prevalent dementia subtype was Alzheimer's disease (57%). By adding data collected from a study of persons < 70 years in the same region, we estimate that there are 101,118 persons with dementia in Norway in 2020, and this is projected to increase to 236,789 and 380,134 in 2050 and 2100, respectively. Conclusion: We found a higher prevalence of dementia and MCI than most previous studies. The present prevalence and future projections are vital for preparing for future challenges to the healthcare system and the entire society. Keywords: Alzheimer’s disease; dementia; epidemiology; population study; prevalence.

Background: The gendered aspects of extraordinary demanding spousal car- ing for people with young-onset dementia have been scarcely researched. Aim: To analyze spouses’ experiences of the meaning, content, and effort of intensive caring for spouses/partners with young-onset frontotemporal dementia (YO-FTD), concentrating on a female perspective. Method: A qualitative Norwegian study using narrative interviews with 10 wives and 6 husbands were conducted in 2014 and 2015. Findings: The analysis resulted in four gendered main themes: Different caregiving periods, Distancing: experiencing a transformed spouse and relationship, Social isolation, and Needing assistance and relief. A case ana- lysis of wives’ and men’s stories was applied, especially focusing on a wife’s story, to examine the detailed interrelationships between life situ- ation, caring demands, experiences, and reactions. Spousal care is influ- enced by gendered caring norms and roles. The study finds marked differences between wives and husbands in the meaning, content and sus- tainability of care, and needs for support vary. Wives endured more stress longer than husbands, with a greater emotional impact and negative health consequences, and their needs are more easily neglected. Husbands presented their needs more efficiently and obtained public relief earlier. Conclusion: Women may need more support earlier during different stages of caring for a spouse with YO-FTD. They need gender sensitive per- son-centered support to live their own lives and preserve their selves.

Background: Persons living with aphasia have unique needs and challenges that would benefit from greater understanding among all health professionals. Aim: To explore which factors influence social dignity in persons with aphasia in their contact with healthcare professionals. Methods: A literature search was conducted in CINAHL, MEDLINE, Embase, PSYCINFO, ProQuest, Web of Science, ERIC and Epistemonikos. A total of 317 studies were read and eight were finally included. Qualitative content analysis methods were applied for data extraction and interpretation. Results: One overarching theme emerged: enabling person-centred communication among healthcare professionals. This covered two main themes – the experiences of empathy and of empowerment. The first of these is based on the subthemes of openness and awareness of feelings, and being acknowledged as a unique person. The second covers three subthemes: involvement in care and rehabilitation; capacity building to gain control and confidence in communication; and enabling communication in community aphasia groups. Conclusions: Healthcare professionals’ ability to safeguard the social dignity of persons with aphasia is contingent on enabling them to communicate in a person-centred manner. Without such communication, persons with aphasia may perceive that their feelings, uniqueness, involvement and confidence are being disregarded. Implications for practice: Outcomes for persons with aphasia are potentially better when healthcare professionals involve them empathetically and empower them in communication To promote person-oriented communication with persons with moderate or severe aphasia, healthcare professionals need to learn tailored skills from competent speech therapists Persons with aphasia and healthcare professionals require a supportive organisational environment for person-centred care. Without such support persons with aphasia are often not empowered to participate in communication

Introduction: Although a clear relationship has been established between elevated alcohol consumption and psychiatric problems in old age, there are few descriptions of the prevalence of elevated alcohol consumption in older adults who have been referred to geriatric psychiatric treatment. Aim: To describe the prevalence of self-reported elevated alcohol consumption in men and women referred to geriatric psychiatry wards in Norway, and to explore factors associated with elevated alcohol consumption. Method: This cross-sectional study includes data from a registry of geriatric psychiatry patients aged ≥ 65 years from December 2016 until December 2018. The outcome measure was reported elevated alcohol consumption assessed with the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). The analyses used demographic data as well as a measure of cognitive function, psychiatric diagnosis and use of psychotropic drugs. Results: In total, 367 patients (131, 35.7% men) with a mean (SD) age of 74.7 (7.6) years were included. Of these patients, 27% scored above the pre-set cut-off for elevated alcohol consumption according to AUDIT-C (≥ 3 and 4 for women and men, respectively). The prevalence of elevated alcohol did not differ by gender. In adjusted logistic regression analysis, older age, living with someone and use of antidepressants were associated with reduced odds for reporting elevated alcohol consumption (OR 0.93, 95% CI 0.89–0.96; OR 0.54, 95% CI 0.31–0.97; and 0.54, 95% CI 0.32–0.92, respectively). Conclusion: A relatively high proportion of psychiatric patients aged 65 years or older reported elevated alcohol consumption, regardless of diagnosis. Older age, living with someone and use of antidepressants were associated with lower odds for elevated alcohol consumption. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Dignified care is a central issue in the nursing care of older adults. Nurses are expected to treat older adults with dignity, and older adults wish to be treated in a dignified manner. Researchers have recommended investigating the concept of dignity based on specific contexts and population groups. This meta-synthesis study aims to explore the understandings of dignity from the perspective of older adults in the Nordic countries. Synthesising findings from qualitative studies on older adults’ experiences of dignity has provided important insight into what can be essential for dignified care in a Nordic context. The importance of visibility and recognition for the experience of dignity is an overarching theme in all the studies. The participants’ descriptions mostly implicated an existence dominated by a lack of recognition. The older adults do not feel valued as people or for their contribution to society and strive to tone down their illnesses in an attempt to become more visible and acknowledged as people. Toning down their illnesses and masking their needs can protect their independence. At the same time, becoming less visible can leave them without a voice. The metaphorical phrase protected and exposed by a cloak of invisibility is used to express the authors’ overall interpretation of the findings. Lack of recognition and being socially invisible is a genuine threat to older adults’ dignity.

Background: People with younger onset dementia (YOD

Young onset dementia has become a growing challenge in national healthcare systems. Concerns about the situation have already been expressed; however, they mostly report the views of services end-users. Aimed at finding out useful further improvement, interviews documenting the working experiences of professionals addressing healthcare services to people with young onset dementia (YOD) were analysed qualitatively. The interviews resulted in four themes and twelve categories. The themes regarded services’ complexity and responsiveness, the levels of education and knowledge on YOD, the impact that serving people with YOD reflects on staff working experience and quality of life, and a series of proposals aimed at improving services by giving people with YOD and families the provision of care they deserve. Although some of the themes recapped the ones reported in the previous literature, the mixture of internally and externally driven instances represented in the themes depict the complexity of care delivery in the services. Findings are discussed in the light of a pragmatical framework capable of suggesting what changes services should implement to be timely responsive.

Kirsten Thorsen,1,2 Aud Johannessen1,3 1Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; 2Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway; 3Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern NorwayCorrespondence: Aud JohannessenNorwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, P.O. Box 2136 NO-3103, Tønsberg, NorwayTel +47 97547979Email aud.johannessen@aldringoghelse.noBackground: Spouses of people with young-onset frontotemporal dementia (YO-FTD) (age 65 years or younger) encounter special challenges. The diagnosis is scarcely known; the early onset is unexpected; and the disease is characterized by symptoms varying from those of other types of dementia. Caring implies increasing hardships, which can be difficult to communicate to others when applying for support. Metaphors create and communicate meaning and are increasingly used in health care and health interventions as ways to better understand the situation.Aim: To examine the experiences of spouses of people with YO-FTD and their needs for care and support as expressed through metaphors in narratives of their experiences during the development of the dementia.Methods: Qualitative interviews with 16 informants (ten women, six men) were conducted in 2014/2015. They were recruited from seven memory clinics, one municipality dementia team, and a nursing home. Steger’s three-step method for analyzing metaphors was applied.Findings: The core metaphors cover experiences of the dementia and the transformation of the spouse, changed roles and relationships between spouses, the transformation of the self, a radical turn of existential life, and relationships with others. Metaphors are words and phrases used to talk about complicated, contradictory, shameful, and/or normatively difficult feelings and reactions as caring spouses. The open themes and, at the same time, provide verbal shields and defences. Metaphors are especially effective for expressing the strength of the reactions in caring as emotional work and are tools for mastering emotions and challenges in life.Conclusion: Metaphors give insights into the significant experiences of spouses of partners with YO-FTD and offer personnel in health services a better understanding of their needs for tailored support and help.Keywords: communication, early-onset, narratives, spouses, frontotemporal dementia, qualitative method

Aud Johannessen,1,2 Kjerstin Tevik,3 Knut Engedal,1 Gro Gade Haanes,2 Anne-Sofie Helvik1,3 1Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; 2University of South-Eastern Norway (USN), Department of Nursing and Health Sciences, Kongsberg, Norway; 3General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NorwayCorrespondence: Aud JohannessenNorwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, P.O. Box 2136, Tønsberg, NO-3103, NorwayTel +47 97547979Email aud.johannessen@aldringoghelse.noBackground: Alcohol consumption among older people is expected to increase in the years ahead. Health professionals’ experiences of, and reflections on, alcohol consumption and its relation to well-being are thus important to the provision of adequate and high-quality treatment and care.Aim: To investigate health professionals’ experiences and reflections about alcohol consumption among older people and how it is related to their health and well-being.Methods: A case study design approach was adopted, incorporating three qualitative studies involving Norwegian health professionals. The health professionals interviewed included workers in nursing homes, home care professionals and general practitioners.Results: The study revealed a diversity of views and reflections on alcohol consumption, its facilitation, and the impact on the health and well-being of older patients and care recipients. Six themes were revealed by the three studies: (i) the facilitation of alcohol consumption to promote and normalize life in nursing homes, (ii) the restriction of unhealthy alcohol consumption, (iii) attempts to discuss alcohol consumption with care recipients, (iv) the initiation of collaboration with informal caregivers in restricting alcohol consumption, (v) minimalizing the dialogue regarding alcohol consumption to guard patient privacy and (vi) a desire for joint action and a national political strategy.Conclusion: Health professionals working in NHs, in-home and GPs find it difficult to discuss the use and elevated use of alcohol with older people for whom they have care and treatment responsibilities. In general, they are concerned that such conversations infringe on the principles governing an individual’s autonomy. However, because they are aware that elevated alcohol intake may have a negative impact on health and well-being, they also express a need for guidelines how they in a better and open minded way can discuss the use and elevated use of alcohol with the patients they care for.Keywords: case-study, elderly, harmful use of alcohol, narrative interviews, municipality staff, older adult, older oldest

Background: Awareness of functional status may underlie specific profiles and differences related to stage severity in individuals with Alzheimer’s disease (AD). Objective: This study aimed to assess self-reported experiences of awareness of functional activity in people with mild and moderate AD. Methods: This is a mixed methods approach. The qualitative part was conducted through semi-structured interviews concerning the experiences and awareness of deficits in 38 older adults with mild or moderate AD. The quantitative approach included a comparison between groups with regard to concerns of awareness and clinic and demographic data. Results: Impairment on awareness of disease and awareness of functional deficits was observed even in the mild stages of AD. There was also a noticeable progression of impairments of both kinds of awareness from mild to moderate stage of disease. The majority of participants with mild and moderate AD were partially aware of their functional deficits. Both groups of participants reported some negative impact; however, they were not able to entirely describe their functional status. Also, deficits to recognize the need for help with hygiene and general tasks were observed. Significant differences were found in awareness of need for help with general tasks and awareness of need for help with hygiene tasks. Conclusion: People with mild and moderate AD may describe their aware of the disease better than specific functional deficits, and most of them can provide some reports concerning to the impact of the disease.

Responsive identity support in conversations with people with dementia: A study of interviews in a five-years narrative longitudinal study A narrative longitudinal study depends on trust and a positive relationship between the interviewer and the participant to encourage the participant’s continued participation. In reported studies, the methodological part is usually too short to present the complexities in dialogues over time. We therefore have analyzed the interview processes with younger people with dementia, relating the interactions to central concepts associated with identity. The aim was to explore the methodological interview approach used in a longitudinal study, focusing on supporting identity and self-esteem. We used the concept of responsive identity to illuminate our findings. In addition, we demonstrate how the interview dialogues can support identity and self-esteem of the participants. The core of this approach is that the interviewee, living with dementia, should be seen, confirmed and supported to preserve the person`s self and dignity. Dialogue with responsive identity support is a fruitful research method in dementia research. This approach can be generalized to person-centred communication in health and caring relationships.

Objective: To compare the quality of life, burden, and depressive symptoms of caregivers of individuals with young-onset dementia (YOD) and late-onset dementia (LOD). Methods: Using a cross-sectional design, a convenience sample of 110 dyads of individuals with dementia and their caregivers, all living in the community, was included. The care recipients completed assessments about cognition, quality of life, and awareness of disease. Caregivers’ quality of life, resilience, depressive and anxiety symptoms, hopelessness, and burden of care were assessed. Results: A significant difference was found in caregivers’ burden and depressive symptoms according to the age of onset. However, there was no difference in caregivers’ quality of life between YOD and LOD groups. In both groups, a linear regression analysis indicated that caregivers’ perspective of quality of life of care recipient and caregivers’ hopelessness were associated with their quality of life. In addition, in the LOD group, caregivers’ burden was associated with their perspective of the quality of life of care recipient, type of kinship, and presence of emotional problems. In the YOD group, caregivers’ burden was associated with duration of caregiving role, cohabitating with care recipient, and their anxiety symptoms. Caregivers’ depressive symptoms were associated with anxiety symptoms in the YOD group, whereas hopelessness was associated with caregivers’ depressive symptoms in both the groups. Conclusion: Our findings suggest that the factors that affect quality of life, burden, and depressive symptoms of caregivers of individuals with LOD differ from those that affect the caregivers of individuals with YOD.

Young-onset Alzheimer disease (YOAD) causes psychological and emotional difficulties for carers. However, even in the face of considerable caregiving demands and burden, some carers are resistant to stress, which may be a sign of resilience. This study investigated whether the clinical symptoms of the person with YOAD might be associated with resilience in their carers. A consecutive series of 43 persons with YOAD and their 43 family caregivers were assessed. The carers showed moderate to high level of resilience, low level of anxiety and depressive symptoms, and moderate level of burden. No relationship was found between resilience and sociodemographic characteristics of both carers and care recipient and with clinical characteristics of persons with YOAD. A linear regression analysis showed that resilience was inversely associated with carers’ depressive symptoms. The findings suggest that resilience may mainly be related to carers’ mental health.

Kariann Krohne,1,2 Betty Døble,1,2 Aud Johannessen,1,3 Kirsten Thorsen1,2,4 1Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; 2Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; 3Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Vestfold, Norway; 4Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway Background: In Norwegian elder care, an increasing percentage of the health care staff has a migrant background. “The aging and nursing care ABC” educational program offers multicomponent training for municipal care staff to systematically improve their competence in elder care. The program consists of written material organized into booklets, regular multidisciplinary reflection group meetings, and a full-day workshop in each semester. In 2017, a Norwegian municipality included migrant health care personnel in an educational Minority ABC-model (Min. ABC), systematically focusing on processes relevant for interaction between majority and minority health care staff.Aim: To investigate the experiences of the participants in the Min. ABC-model, focusing on the processes and relationships between native participants with Norwegian language and migrants with other lingual backgrounds.Method: The study has a qualitative design, and draws on four focus group interviews, one group interview, and four individual interviews with a total of 23 female Min. ABC-model participants. Data were analyzed using an approach outlined by Corbin and Strauss.Results: Our analysis resulted in six main themes: 1) reaching equality, 2) sharing experiences, 3) communication and language, 4) relations to the elderly, 5) differences and discrimination, and 6) lessons learnt.Conclusion: Our findings indicate that the Min. ABC-model of the ABC program contributes to better the competence and interaction among personnel with migrant and native lingual backgrounds. The participants describe increased inclusion at work, as well as integration into a more holistic form of teamwork in elder care. Keywords: educational program, elder care, health care professionals, integration, migrant and native personnel, staff training&nbsp

Objective: We aim to assess different objects of awareness of disease of people with Alzheimer's disease (AD) in mild and moderate stages Method: Semi-structured interviews were conducted with 34 participants with AD and qualitative analyses were used to analyze the participants' reports. Results: Cognitive impairment was the most peserved area of awareness. The participants' explanations were mainly categorized as biological/genetic and psychosocial causes. Also, awareness of social/emotional functioning and interpersonal relationships were generally well-preserved in this group. Among those who noticed some alterations in social life, there were reports of the feeling of being exposed and how some cognitive symptoms interfere with their functioning. In the emotional state domains, most of the participants reported more sadness than before the onset of dementia. Although most participants noticed a change in routine and the impact on daily life, many did not notice the need of help for general tasks. Conclusion: Our results underpin that most people with AD were able to provide their own subjective report of their experience of living with a disease. Participants' self-reports demonstrated the differences across domains, and this information may contribute to a better understanding of awareness of disease in AD.

BackgroundCognition and the ability to take care of daily activities and oneself gradually declines among people with dementia. Studies are scarce, especially regarding how people with young-onset dementia (YOD) (AimTo examine the experience of the quality of life with YOD as a single person.MethodThe study presents a longitudinal case study with in-depth interviews exploring the experiences of a person with YOD. Individual interviews were conducted seven times over a period of three years from 2014 to 2017.FindingsWe examined if and how seven themes concerning the quality of life and well-being were fruitful for understanding the experiences of dementia in the everyday life of a single individual. The study explored needs and challenges during the development of dementia, and how the person reacted over time, set in context. The themes significant for well-being are: identity, connectedness, security, autonomy, meaning, growth and joy.ConclusionThe study shows how treatment, support, and services must be individualized when dementia develops in order to support identity, resources and mastering capacity, and promote well-being.

Objectives Although dementia typically occurs in older people, it can also emerge in people aged younger than 65 years in the form of young-onset dementia, the most common type of which is Alzheimer's disease (AD). However, few studies have examined the needs of persons with young-onset AD (YO-AD) and their families, and cross-cultural research on the topic is even scarcer. In response, we investigated the situations, experiences and needs for assistance of carers of persons with YO-AD in Brazil and Norway. Methods As part of our qualitative study, we formed a convenience sample of Brazilian (n = 9; 7 women) and Norwegian carers (n = 11; 6 women) in 2014 and 2015, respectively, and analysed data in light of a modified version of grounded theory. Results Carers' narratives from both countries revealed five common themes in terms of how YO-AD affected carers' psychological and emotional well-being, physical well-being, professional and financial well-being, social lives and need for support services. Conclusions The infrequent differences between carers of persons with YO-AD in Brazil and Norway indicate that carers' problems are highly similar regardless of cultural differences and public services provided. Copyright © 2017 John Wiley & Sons, Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Demographic changes and the growing elderly population in Scandinavia provide an incentive to study Health Ageing in the Nordic Countries. The chosen Nordic perspective takes into account commonalities and differences in socio-economic status, welfare systems, gender, history and culture. It also involves focusing on the health of individuals and populations. The Nordic perspective and the authors’ understanding of health and health promotion provide a backdrop for the essay. The authors are part of the Nordic Health Promotion Network (NHPRN), which is grounded in an ethics of health and well-being. This understanding highlights key values such as participation, justice and equality (freedom from discrimination), autonomy (independence). The authors focus mainly on the importance of participation and on the older person’s sense of security in this paper. We seek answers to what prevents and in which way Healthy Ageing can be promoted in the Northern countries. Concepts such as discrimination, retirement, dementia, nursing home residents’ access to nature and the elements, and the importance of relationships are illuminated.

Background:Nursing home (NH) residents are in most cases in older ages and use prescriptiondrugs. As alcohol interacts with many commonly prescribed drugs, NH residents may be morevulnerable to the effects of alcohol.Aim:To investigate the experiences of health professionals inNorwegian NHs when it comes to residents’ alcohol consumption and use of psychotropic drugs,and the facilitation of such use in the NH.Method:Focus-groups and individual interviews withNH health professionals were performed in 2017 and 2018. The data were analysed using contentanalysis.Findings:Two main themes emerged: (1) the balancing of alcohol consumption, and (2)the use of psychotropic drugs. Each of these themes involved reasoning, which revealed that theinformants in general had little attention regarding alcohol consumption among residents, and fewinstitutions had policies regarding serving and consumption of alcohol. The informants reported anincreased attention regarding use of psychotropic drugs and a tendency towards less use ofpsychotropic drugs among the residents than before, but few informants reported use of stan-dardised observations tools of symptoms related to prescribing and discontinuation of drugs.Conclusion:Alcohol policies or procedures related to alcohol consumption were uncommon atthe NH that the interviewees of this study represented, and the professionals regarded infrequentserving and consumption of alcohol among the residents as a part of everyday life. In cases whenresidents frequently consumed alcohol, the professionals used dialogue to underpin the adherentrisks and they also tried to control the consumption of the resident in different ways. Theinterviewees were aware of various side-effects of psychotropic drugs; they were also aware oftheir effects in combination with alcohol. https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Background: People with younger onset dementia (YOD

Background : It is estimated that one in four persons with young-onset dementia (YOD) (

Background:Awareness of dementia is examined in different scientific fields as significant for assessment of diagnosis, and for treatment and adaptation to the disease. There are very few longitudinal studies of individual experiences of awareness among people with dementia, related to quality of life.Aim:To examine how younger people (< 65 years) with dementia (YOD) express awareness of the dementia and how, over time, they seem to handle awareness as a strategy to preserve quality of life.Method:A longitudinal qualitative study with individuals with YOD was performed with interviews every six months over five years for a maximum of ten interviews. The interviews were analysed by modified grounded theory.Findings:Awareness is a complex, multidimensional concept. Awareness of dementia is predisposed by personality, life history and established coping styles. The main coping styles – live in the moment, ignore the dementia, and make the best of it – seem to be rather consistent throughout the progression of the disease. Transitions in life situation, such as moving to a nursing home, may change the individual’s awareness of dementia.Conclusion:Unawareness of dementia may have an important adaptive function to preserve quality of life. To increase awareness must be approached with reflexivity and the utmost sensitivity.

Background In Norwegian elder care, an increasing percentage of the health care staff has a migrant background. “The aging and nursing care ABC” educational program offers multi-component training for municipal care staff to systematically improve their competence in elder care. The program consists of written material organized into booklets, regular multidisciplinary reflection group meetings, and a full-day workshop in each semester. In 2017, a Norwegian municipality included migrant health care personnel in an educational Minority ABC-model (Min. ABC), systematically focusing on processes relevant for interaction between majority and minority health care staff. Aim To investigate the experiences of the participants in the Min. ABC-model, focusing on the processes and relationships between native participants with Norwegian language and migrants with other lingual backgrounds. Method The study has a qualitative design, and draws on four focus group interviews, one group interview, and four individual interviews with a total of 23 female Min. ABC-model participants. Data were analyzed using an approach outlined by Corbin and Strauss. Results Our analysis resulted in six main themes: 1) reaching equality, 2) sharing experiences, 3) communication and language, 4) relations to the elderly, 5) differences and discrimination, and 6) lessons learnt. Conclusion Our findings indicate that the Min. ABC-model of the ABC program contributes to better the competence and interaction among personnel with migrant and native lingual backgrounds. The participants describe increased inclusion at work, as well as integration into a more holistic form of teamwork in elder care.

The number of people with dementia is increasing rapidly and will result in a growing demand for varied health and social services. Support contact is a potential service with positive implications, but it has yet to be explored fully. The aim of this study was therefore, to explore these questions: 1) Will the support contact service be a favorable service for people with dementia? 2) How is the service experienced by patients with dementia, their carers, the support contacts, and the municipality’s administration of the service? 3) What experiences do those involved have of the service, and what do they regard as essential for a good service? A case-study design with qualitative studies of the involved illustrates the concept. The study concludes that support contact can be a highly appropriate service for people with dementia and their carers, and eventually can be coordinated with other services. Personsentrert omsorg i praksis: Fire perspektiver på støttekontakttjenesten i demensomsorgen - en case studie

Background Studies revealed that misuse of drugs and alcohol is an increasing phenomenon among older people (aged 65 years and above), and we know that such misuse is a risk factor for mortality and morbidity. Furthermore, we do not know to what extent older people have experiences, understanding and knowledge about the use and misuse of alcohol and psychotropic drugs. Aim To investigate older peoples' experiences with and reflections on the use and misuse of alcohol and psychotropic drugs among older people. Method Qualitative interviews with 16 older people were performed during 2013 and 2014. The sample included informants aged from 65 to 92 years from 11 municipalities. The data were analysed by using the phenomenological hermeneutic method. Findings The first theme that arose from the informants' narratives was to be a part of a culture in change that details the informants' experiences with and reflections on the cultural changes regarding the use and misuse of alcohol and psychotropic drugs. This theme is divided into three subthemes: to use and attitudes toward use, to trivialise use and risks of use, and to disclaim responsibility for use and misuse. The second theme, to explain use and misuse involved reasons for the use and misuse of alcohol and psychotropic drugs. It included the subthemes: to be afraid, to be lonely, and to be informed. Conclusion The study revealed that most informants had experiences with the use of alcohol and psychotropic drugs, but disclaimed any challenges with their use. The use was trivialised and seen as something older people just do. They disclaimed responsibility for their own psychotropic use as their general practitioners were defined as the responsible persons. Moreover, the study showed that the informants had poor knowledge about the risk of use and misuse of alcohol and psychotropic drugs.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Having dementia before the age of 65 (YOD) represents a radical break from an age-normative and expected life course. The disease afflicts the person’s identity, threatens the self-image and self-confidence, and erodes the person’s plans. The aim of the study was toexamine how people living alone with YOD perceive the course of dementia, their needs, and coping strategies, with a focus on narrating everyday life experiences. A longitudinal study using a qualitative approach was used. Five interviews, each with 10 informants, took place every 6 months from 2014 to 2017. The main theme is the person’s experiences of changes of identity over time. The most significant aspects of their experiences of the dementia affecting them and their reactions are these: the initial signs, coping efforts, concealing the diagnosis, social retraction, existential anxiety, revival of the self, worse and worse, and health personnel as background. The study concluded thatpeople with dementia are able to describe their experiences and needs for a long time during the progression of dementia. Their voices should be listened to for planning of services. Personalized care should be used to support them in order to preserve their identity in a normalized everyday life as far as possible.

Background To investigate health personnel's perceptions and experiences of alcohol and psychotropic drug use among older people (65 years and above) and to what extent this is an issue when services are planned for and implemented. Method Qualitative interviews with 16 health professionals who work with older patients, 13 registered district nurses, two occupational therapists and one physiotherapist, were performed during 2013. The sample included informants aged 34–62 years from 14 municipalities, four were male. Findings Two main categories emerged: state of practice and a desire to improve services. The first category details the informants' perceptions of legitimacy and attention to substance use and misuse among older people in need of healthcare, and their competence and knowledge on the topic. The topic was experienced as demanding to bring up. Health personnel described a lack of attention and competence how to handle use and misuse of alcohol and psychotropic drugs. The category is described in the subcategories legitimacy and attention to substance use and misuse and competence and knowledge in practice. The second category demonstrates the informants' desire to improve services so it better can contribute to detect misuse among older people and contribute to treatment. The variation is contained in the subcategories improving collaboration and changing routines. Conclusion Use and misuse of alcohol and psychoactive drugs among older people had little attention when the community health service is planned for and implemented. The participating health professionals had a desire to improve routines and collaboration in the healthcare services, but were also in need of improved competence about use and misuse of alcohol and psychoactive drugs.