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Research problem and specific questions Loneliness is associated with poor health and mortality, but the causal relationships between loneliness, mental health and care use are not well understood, and there is a lack of evidence-based methods for care professionals to recognise and respond to loneliness. This programme takes a holistic perspective on loneliness in older adults, how loneliness is understood and experienced, and its relationship with mental health. Our work packages (WPs) will address research gaps to support evidence-based approaches to identify, assess and address to loneliness in practice by: examining inequalities in risk factors and consequences of loneliness, and causal associations between loneliness, mental health and care exploring subjective experiences of loneliness and mental health from a life-course perspective developing an instrument to assess loneliness in practice creating a loneliness literacy training programme for care professionals enhancing care professionals’ response to loneliness Data and method In WP1, panel studies will be combined with register data to examine inequalities in loneliness and its causal associations with mental health and care use. In WP2, older adults’ experiences of loneliness and mental health will be explored in interviews, which will also support the development of an instrument to assess loneliness. In WP3, researchers and care professionals will co-design a loneliness literacy training programme to improve care professionals’ competencies to address loneliness. WP4 integrates research across WPs, embeds it in practice and promotes dissemination of findings. Workshops with stakeholders will explore how to enhance care professionals’ response to loneliness. Relevance and utilisation Our research will advance the understanding of risk factors and avoidable consequences of loneliness, produce the first instrument for assessing loneliness validated for use with older adults in Swedish care practice, and develop a unique loneliness literacy programme for care professionals. Close collaboration with stakeholders will ensure our findings can support social care and civil society in addressing loneliness and mitigate its negative outcomes. Plan for project realisation The programme will be realised by an experienced multidisciplinary team with expertise in loneliness, mental health, gender and socioeconomic inequality, health literacy and care in old age. Collaboration with pensioner and mental health organisations and authorities ensures representation of older adults and the programme’s relevance and feasibility for practice. Scientific quality is supported by an international academic reference group. There will be thorough dissemination to academic, policy and practice communities.

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.