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Safeness and Treatment Mitigate the Effect of Loneliness on Satisfaction with Elderly Care
University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Psychology, University of Gothenburg, Sweden. (Socialpsykologi)ORCID iD: 0000-0003-0629-353X
University of Skövde, School of Health and Education. University of Skövde, Health and Education. (Avdelningen för Socialpsykologi)ORCID iD: 0000-0001-7164-0433
2016 (English)In: The gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 56, no 5, 928-936 p.Article in journal (Refereed) Published
Abstract [en]

Maximizing satisfaction among the older persons is the goal of modern individualized elderly care and how to best achieve this is of relevance for anyone planning and providing for elderly care services. Purpose of the study: What predicts satisfaction with care among older persons can be conceived as a function of process (how care is performed), and the older person. Inspired by the long-standing person versus situation debate, the present research investigated the interplay between person- and process aspects in predicting satisfaction with elderly care. Design and method: A representative nationwide sample was analyzed, based on a questionnaire sent out to 95,000 individuals using elderly care services. Results: The results showed that person-related factors (i.e., anxiety, health, and loneliness) were significant predictors of satisfaction with care, although less strongly than process-related factors (i.e., treatment, safeness, and perceived staff- and time availability). Among the person-related factors, loneliness was the strongest predictor of satisfaction among older persons in nursing homes. Interestingly, a path analysis revealed that safeness and treatment function as mediators in linking loneliness to satisfaction. Implications: The results based on a large national sample demonstrate that the individual aging condition to a significant degree can be countered by a well-functioning care process, resulting in higher satisfaction with care among older persons. 

Place, publisher, year, edition, pages
Oxford University Press, 2016. Vol. 56, no 5, 928-936 p.
National Category
Applied Psychology
Research subject
Humanities and Social sciences
Identifiers
URN: urn:nbn:se:his:diva-10508DOI: 10.1093/geront/gnu170ISI: 000386081600016PubMedID: 25628300Scopus ID: 2-s2.0-84994519936OAI: oai:DiVA.org:his-10508DiVA: diva2:778991
Projects
Organisering för verksamhetskvalitet inom svensk äldreomsorg: Ett skifte i fokus från vad till hur
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012–1200
Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2016-11-23Bibliographically approved
In thesis
1. The Impact of Care Process on Satisfaction with Elderly Care
Open this publication in new window or tab >>The Impact of Care Process on Satisfaction with Elderly Care
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

This licentiate thesis is based on the growing interest in Swedish elderly care. The aim of this thesis is to investigate what generates satisfaction with elderly care among older persons. The dominant ideology in both privately and publically run elderly care is individualized care, also called person-centered care, which holds the older person’s satisfaction as one of the main quality indicators. The proportion of older people is increasing and to maintain high levels of satisfaction with elderly care will require more knowledge. Data from the National Board of Health and Welfare’s (2012) nationwide survey on seniors’ experiences with elderly care was collected. Statistical analyses of this sample formed the basis for the results of the thesis and were reported in two papers. Study I used Donabedian’s (1988) model of quality of care in terms of structure, process, and outcome, and all municipal units in Sweden were included (N = 324). The results showed that structural variables (i.e. budget, staff, and training level) have minimal or no relationships with older persons’ satisfaction with care, while process variables (i.e. experiences of respect, information, and influence) have strong relationships with satisfaction with care. Study II made use of the long-standing person versus situation- model in social psychology, and was analyzed on an individual level (N = 95,000). The results showed that care process factors (i.e. experiences of treatment, safeness, staff- and time-availability) had a stronger relationship, than individual factors (i.e. health, anxiety, and loneliness) with satisfaction with care. The results also showed that older persons with home care generally felt better treated than older persons in nursing homes, but also felt less safe. Mediational analyses, based on this comprehensive elderly data, suggest that the individual aging condition of loneliness can be countered by providing safeness and treatment, resulting in high satisfaction with care. In conclusion, satisfaction with elderly care in Sweden today can largely be explained from a psychological perspective by the older persons’ perception of the care process, not by the amount of structural resources or the conditions of the aging persons. These findings could help facilitate the future quality development in municipalities and care organizations.

Place, publisher, year, edition, pages
Department of Psychology, Göteborgs Universitet, 2014
Series
Avhandling/Göteborgs universitet, Psykologiska institutionen, ISSN 1101-718X
Keyword
elderly care, quality, satisfaction, individualized care, äldreomsorg, äldreboende, nöjdhet
National Category
Applied Psychology
Research subject
Humanities and Social sciences
Identifiers
urn:nbn:se:his:diva-10509 (URN)
Presentation
2014-12-05, 11:32
Opponent
Supervisors
Available from: 2015-03-04 Created: 2015-01-12 Last updated: 2016-12-15Bibliographically approved
2. An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
Open this publication in new window or tab >>An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The foundation for this thesis is an ongoing discussion about quality in Swedish elderly care: Which are the most important factors that contribute to elderly care in terms of satisfaction among older persons, and what are the primary reasons for their differences?

Aims. The principal aim was to examine what determines satisfaction with elderly care in home care and nursing homes, using the perspective of older persons (Studies I and II). The secondary aim was to analyze why these determinants differ, using the perspective of care workers, managers, and observers (Studies III and IV).

Methods. Study I analyzed aggregated statistical data from the level of municipalities and districts (N = 324) based on the Swedish elderly care quality reports “Open Comparisons”, while Study II analyzed individual data based on the original ratings in the annual, nationwide elderly surveys (N = 95,000). Study III describes field observations and interviews with care workers and managers in two municipalities, one with a high rating for user satisfaction and one with an average rating. Study IV describes investigations in these two municipalities concerning their organizing principles and departmental‑level management climate.

Results. The results relating to the principal aim showed that process factors (such as respect, information, and influence) are related considerably more closely than structural factors (such as budget, staffing levels, and training levels) to satisfaction with care. Other process factors (such as treatment, safeness, staff and time availability) were also able to alleviate person factors (such as health, anxiety, and loneliness). Moreover, the results relating to the secondary aim showed that differences in user-oriented elderly care are mainly due to interpersonal factors between the caregiver and the older person. Care workers, however, reported that other factors (such as organizing principles and leadership support) influence the quality of the care process. Overall, older persons who receive home care generally report higher satisfaction with care than those in nursing homes, and feeling less safe. It may be that differences in the process of aging explain this.

Value. This thesis shows that satisfaction with elderly care can be largely explained by psychological quality at the individual level. The sizes of structural resources and organizing principles at the municipal level have minimal effect (< 5%). The thesis also presents a theoretical multiple-level Quality Agents Model to explain the sources of differences in satisfaction with care, and it presents recommendations for elderly care practices. A renewed focus on the psychology of satisfaction may contribute to the development of quality in elderly care.  

Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2015. 77 p.
Series
Doktorsavhandlingar vid Göteborgs universitet, ISSN 1101-718X
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:his:diva-11684 (URN)978-91-982353-9-5 (ISBN)
Public defence
2015-12-11, F1, Haraldsgatan 1, Göteborg, 18:21
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-1200
Available from: 2015-11-23 Created: 2015-11-12 Last updated: 2016-12-15Bibliographically approved

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