Hanne Kaae Kristensen’s research while affiliated with University of Southern Denmark and other places

Malnutrition among community‐dwelling older adults (OAs) is prevalent, particularly in groups using healthcare services. Malnutrition burdens health, social, and aged‐care systems in terms of expenses for hospital admissions and care in nursing homes and home care settings. Effective management requires early identification and multimodal interventions; however, studies report a significant gap between recommended nutrition interventions and current healthcare practices. Therefore, this study aimed to identify, present, and map existing evidence on barriers and facilitators in the implementation of nutrition interventions among OAs living in noninstitutional municipal healthcare settings. A scoping review following the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) extension for Scoping Reviews checklist were conducted. The study included evidence from bibliographic databases and gray‐evidence sources that identify barriers and/or facilitators from stakeholder perspectives that influence the implementation of nutrition interventions for malnutrition prevention or treatment among OAs (≥65 years) in noninstitutional municipal healthcare settings. Stakeholders were OAs, informal caregivers, or healthcare professionals (HCPs). Thirty‐seven articles were included and 10 categories identified. Barriers were (1) lack of knowledge and awareness among HCPs, (2) lack of resources, (3) lack of collaboration and communication, (4) missing links between healthcare settings, and (5) poor insight among OAs and caregivers. Facilitators were (1) education and training of HCPs, (2) self‐care, (3) person‐centered care, (4) technology in nutrition care, and (5) social and psychological factors. Findings from this review indicate an imperative need for targeted implementation strategies for developing evidence‐based nutrition home care practice.

Reablement: meeting the challenges facing dementia services Dementia is a major cause of disability. People with dementia need good support, but health and social care services are overstretched and cannot provide all the support people need. Progress with drug treatments and preventive measures will not be enough to solve the problem. We need effective non-pharmacological approaches to reduce disability for people with dementia. Reablement, or rehabilitation, is one such approach. 1 Reablement enables people to maintain or regain abilities, stay involved with activities that are important to them, continue participating in society, and experience a meaningful life. It is a sustainable, low-cost way of managing disability and reducing its impact. 2 People with dementia can benefit from reablement at all stages of severity. Yet reablement is not widely implemented in dementia services. To make this happen, three key changes are needed: In a Dutch trial, staff trained in reablement enabled their clients to participate in daily activities to a greater extent than staff who were not trained. This effect was seen after 6 months and maintained 3 months later. i What needs to happen? • A shift in attitudes We need to think about what people can do and wish to do, with the right support, and not just about what they cannot do. This way of thinking supports autonomy, dignity and inclusion across all stages of progression and environments. People affected by dementia, practitioners and the public need to know that reablement can promote functioning and reduce disability. • A change in how services work Health and social care services often focus on disability, carrying out tasks for people or providing assistance with tasks. Reablement is different. It emphasizes people's abilities and priorities. Services are personalized and flexible and delivered by an interdisciplinary team. • A focus on building capacity To make reablement a reality, we need a workforce equipped with the right skills and the right organizational contexts. To ensure reablement is as effective as possible, we need to keep extending the evidence base through targeted research initiatives.

Dementia is a major cause of disability. People with dementia need good support, but health and social care services are overstretched and cannot provide all the support people need. Progress with drug treatments and preventive measures will not be enough to solve the problem. We need effective non-pharmacological approaches to reduce disability for people with dementia. Reablement, or rehabilitation, is one such approach. Reablement enables people to maintain or regain abilities, stay involved with activities that are important to them, continue participating in society, and experience a meaningful life. It is a sustainable, low-cost way of managing disability and reducing its impact. People with dementia can benefit from reablement at all stages of severity. Yet reablement is not widely implemented in dementia services. To make this happen, three key changes are needed: 1) a shift in attitudes; 22) a change in how services work; 3) a focus on building capacity.

The World Health Organization (WHO) recognizes the right of individuals with dementia and their family caregivers to access interventions that enhance their participation in society. Reablement is an approach that enables older people to participate in meaningful daily and social activities. Over the past decade, a growing body of evidence has underscored reablement as a promising approach within dementia care, including positive outcomes for people with dementia and their family caregivers, and cost-effectiveness. However, the dissemination of knowledge about and practical implementation of reablement remain slow. This position paper, authored by the ReableDEM research network, aims to address key issues related to implementing reablement in dementia care. To expedite the adoption of reablement within dementia care, we propose five critical areas of focus: 1) Changing the attitudes and expectations of stakeholders (eg health and social care staff, policy makers, funders) – encouraging people to think about dementia as a disability from a biopsychosocial perspective; 2) Disrupting health and social care - A radical change is needed in the way services are organized so that they are more holistic, personalized and resource-oriented; 3) Investing in capacity-building and creating a supportive environment – the workforce needs to be trained and supported to implement reablement in dementia care; 4) Involving, educating and supporting family caregivers - services and staff that are equipped to provide reablement will be better able to involve family caregivers and the person’s social network; 5) Providing robust evidence about reablement in dementia care by conducting high-quality research with long-term follow-up.

Background Acquired Brain injury (ABI) causes ripples throughout the occupational and social fabric. It enters people’s lives at a significant personal cost, encroaching on people’s sense of self. Vocational rehabilitation is a viable venue to regain control of their life and support them in forming a new sense of self. From an occupational perspective, little is known about how vocational rehabilitation can support people through transforming their sense of self. Aim This study aims to explore how vocational rehabilitation may influence the relationship between sense of self and occupational engagement for persons with ABI. Material and Methods: Six persons with ABI were purposely sampled. Data were collected using semi-structured individual interviews and analysed using a hermeneutic approach. Results The analysis resulted in three themes: a new sense of my former self, engaging in occupations as transformation, and the significance of support. Conclusions Participating in vocational rehabilitation can enable persons with ABI to form a new sense of self. Engaging in occupations and professional support is significant in the transformation process. Significance From an occupational perspective, the knowledge gained in this study stresses the essential role occupational engagement and proper targeted support have for people struggling to return to work after ABI.

Worldwide, 50 million people are living with dementia. As more individuals develop dementia while still working, dementia will increasingly become a workplace issue and a societal concern. Interventions targeted at work retainment, can reduce, and postpone the loss of cognitive functioning following dementia. However, there is a small body of research focused on recommendations for work interventions for people with dementia. The aim of this mixed-methods review was to investigate experiences of work following a dementia diagnosis from the perspective of people with dementia, their relatives, employers, co-workers and HR-professionals, with the objective of formulating recommendations for work interventions for people with dementia. A mixed-method approach guided the review. 16 original studies published between 1989 to 2023 were included, with a collective sample of 684 participants. The review shows that it is possible to live and work well with dementia, if collaborative solutions are continuously negotiated to meet the needs of the person with dementia and the workplace, and with attention to possible contextual enablers and barriers. The review highlights four key elements for successful work interventions for people with dementia: 1) Person-centered Approach, 2) Contextual Relevance, 3) Knowledge-based and 4) Dynamic Approach.

Introduction Living with dementia can be challenging, even more so for people diagnosed before age 65. Loss of identity is one of the main subjective consequences dementia poses at this stage in life due to the loss of social relations and daily activities. While a growing body of research is reporting the experienced impact of early-onset dementia on identity for this group, studies synthesizing this knowledge are very limited. Therefore, we have conducted a meta-ethnographic review to explain how people with early-onset dementia form their sense of identity. Method A systematic review of literature from five databases was conducted. Ten original studies published between 2004 and 2020 were included and analyzed using an interpretive approach. Findings A conceptual interpretation emerged from the analysis, showing that social arenas and activities of daily life, as well as assumptions about dementia and natural aging made by the participants and society, influenced the participants’ sense of identity. Conclusion Being in nonjudgmental environments can support people with early-onset dementia in creating continuity and positive connections in their personal history. Providing such environments can be a viable venue for healthcare professionals to support people with early-onset dementia in maintaining a positive sense of identity.

Aim To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation. Setting The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings. Methods, participants and analysis A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50–84) with moderate stroke and seven significant others (five women and two men, aged 50–78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed. Results Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on ‘return-to-work’ and ‘re-gaining driver’s license/permission to drive’ needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting. Conclusion Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.