Person-Centred Care in Rural and Urban regions in Sweden Karin Sjögren, RN, MSc, PhD-student David Edvardsson RN, Associate professor Marie Lindkvist PhD, Lecturer in Statistics Per-Olof Sandman RN, Professor Karin Zingmark RN, PhD

Sweden

Person-Centred Care Focus on the person and not the disease Create a positive psychosocial environment Life story work Individualization Include the family in care Shared decision making

Research Well-being, sence of pride and confidence (McKeown, 2010) Decreased agitation (Chenoweth et al,2009) Improved bowel elimination pattern and lower prevalence of constipation (Palese et al., 2010)

The aim Investigate degree of person-centred care in age care facilities in urban and rural Sweden and the relationship to degree of quality of life, pain, depression, agitation and activity of daily living

Design and sample Cross-sectional descriptive study National sample Questionnaires Staff Resident proxy Rural Urban Total Care facilities 41 112 153 Residents 325 1141 1466 Staff 322 899 1221

Instruments Person-centredness Person-Centred Care Assessment Tool (P-CAT, Edvardsson et al., 2010) Resident health Quality of Life in Late Stage Dementia (QUALID, Weiner et al., 2000) Pain Assessment in Advanced Dementia (PAINAD, Warden et al., 2003) Cornell Scale for Depression in Dementia (Alexopoulos et al., 1988) Cohen-Mansfield Agitation Inventory (CMAI, Cohen-Mansfield et al., 1989) Multi-Dimensional Dementia Assessment Scale (MDDAS, Sandman et al., 1988)

(Independent samples t-test) Resident health Urban Rural P-value Men 340 121 Women 787 (79%) 199 (62%) Mean age 85 84 0,01 QoL (1-5) 1,93 1,90 0,5 Pain (0-2) 0,40 0,39 0,7 Depression (0-3) 1,24 1,20 0,33 Agitation (1-7) 1,62 1,60 0,72 ADL (1-5) 2,51 2,66 0,02 (Independent samples t-test)

Differences in Person-centredness Urban Rural P-value Total P-CAT (1-5) 3.83 3.68 0.032 Subscale 1 Personalizing care 4.12 3.90 0.001 Subscale 2 Organizational and environmental support 3.37 3.36 0.850 (Independent samples t-test)

Person-centredness and activity of daily living Proportion of residents with high performance in ADL High PCC Low PCC P-value Rural 61 % 53% 0.25 Urban 55 % 46 % 0.008 (Chi square test)

Person-centredness and prevalence of depression Proportion of residents with depression High PCC Low PCC P-value Rural 72 % 60 % 0.06 Urban 66 % 0.08 (Chi square test)

Person-centredness and quality of life Proportion of residents with high QoL High PCC Low PCC P-value Rural 77,4 % 63,1 % 0.03 Urban 63,5 % 62,1 % 0.68 (Chi square test)

Factors associated with high degree of Person-centred care Age 1.00 ADL 1.01 Pain 0,98 Depression 1.04* Agitation 1,01 Urban/rural 2,06 ** Sex 0,92 QoL high/low 1,47 * (* p< 0,05, **p<0,001)

Conclusions There are differences in person-centredness between rural and urban aged care facilities in Sweden. Urban facilities have a higher degree of person-centredness than rural facilities Person-centredness is associated with higher levels of quality of life, higher proportion of depressive symptoms and high performance in activities of daily living Person-centredness has an impact on resident health/well-being

Thank you for listening Rural regions < Datum Sidfot

Conflict of Interest Disclosure Karin Sjögren, RN PhD student Has no real or apparent conflicts of interest to report.