title: Home care assistants' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity.
abstract: BACKGROUND
  Elderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs). Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients' mental health status.
  
  
  OBJECTIVE
  To describe HCAs' perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity.
  
  
  METHODS
  We applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs.
  
  
  RESULTS
  Most HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors' own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health.
  
  
  CONCLUSIONS
  The HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of loneliness, and increasing physical activity. The results indicate that the HCAs seemed dependent on supervision by district nurses and on care managers' decisions to support the needed care, to schedule assignments related to the detection of mental health problems, and to promote mental health.
authors.affiliation: Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden; Sophiahemmet University, Stockholm, Sweden.
authors.forename: Åke
authors.initials: Å
authors.lastname: Grundberg
authors.affiliation: Sophiahemmet University, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Hansson
authors.affiliation: Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Dorota
authors.initials: D
authors.lastname: Religa
authors.affiliation: Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden; Sophiahemmet University, Stockholm, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Hillerås
keywords: Sweden; home care assistants; mental health promotion; municipal care; older people