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Research problems: The Swedish healthcare system has become very specialised and is often experienced as fragmented and lacking coordination between caregivers. Advanced age is associated with multi-morbidity, which usually requires care from several different caregivers. This makes older people vulnerable to fragmentated care and lack of care coordination. Health literacy (HL) is an essential component of an individual’s ability to gain access to, understand and use information to improve and maintain good health and is an important prerequisite for managing health and care needs. Therefore, knowledge on older people’s HL is vital to efficiently and equitably meet the care needs of the rapidly aging population.Specific questions: The project aim is to gain knowledge on HL in the older population. In this project we will assess to what degree the older population in Sweden is health literate, identify groups that might face challenges due to inadequate HL and explore what older people experience as prerequisites for understanding health information and managing their health and care needs as well as communicate with caregivers.Data and Methods: This project combines both qualitative and quantitative data. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), linked with register data on healthcare utilisation will allow for measuring the level of health literacy in a nationally representative sample of the Swedish population aged 77 years and over. Semi-structured interviews with older people will be performed to deepen the understanding of contextual barriers and facilitators, and individual internal and external resources to make informed decisions about their health and care needs. Plan for project realisation: The collection of SWEOLD data is in progress and preliminary analyses on a sub-sample have been performed. Information about HL, life situation, health, care utilisation, physical and cognitive ability and social support from relatives are being collected. The project group has extensive knowledge about older adults, health literacy, the health and social care system as well as relevant research methodology, both qualitative and quantitative.Relevance: Knowledge on HL among the older population can be used to tailor communication and directing support to vulnerable groups in order to achieve an efficient and equitable health and social care system, as well as supporting older people in health crisis, like the COVID-19 pandemic.

This application concerns studies of shortcomings in the structure and quality of health and social care for older people with complex care needs in Sweden, illustrated by the COVID-19 pandemic. The proportion of people aged 80 years and older is increasing rapidly in Sweden, whereas the number of beds in care homes and hospitals decreases. Hence, municipal home health care is expected to address the needs of the frailest older persons with multimorbidity and complex health and social care needs. The studies form 3 work packages:1.Mapping and analysis of home health care among older persons in municipalities of Stockholm Region Aim: to map and analyse differences in the home health care provided to older persons in different municipalities in Stockholm Region, regarding its contents, physicians’ engagement in home healthcare and how the use of home health care is related to utilization of other health and social care. Method: Statistical analyses of register data from multiple databases.2.The organization of care from the perspective of end-users (older people, their relatives) and care professionals, in two different regions of Sweden Aim: to examine the perceptions of older people, their family members, care professionals and nursing students regarding challenges related to a) the organisation of home care and care homes for older adults, and b) hesitancy to care homes and home care in the wake of the COVID-19 pandemic, in the regions of Stockholm and Dalarna. Method: Focus groups with end-users, care workers and nursing students.3.Insights from other Nordic countries on how to organize services to improve health and social care among older persons Aim: to identify features in the organization of health and social care of older people in other Nordic countries of relevance to providing good and equitable care to older people with complex health and social care needs in Sweden. Method: Policy analysis and semi-structured interviews with experts.