General information on the SNAC Study
A well-functioning system of care services for the elderly that meets their needs in the best possible way within the framework of available resources, presupposes a sound knowledge of these needs and of the efforts that are being made on their part.
The purpose of the Swedish National Study on Ageing and Care – SNAC – is to augment this knowledge. The study was initiated through the initiative of the government in the 1998 action plan published for the elderly care policy, and is supported not only by the government but also to an equal extent by the local authorities and county councils taking part in the study.
The basic idea
The basic idea behind SNAC is to make an area-oriented and individual-based collection of information over a longer period of time (30 years or more), which on the one hand describes ageing, health and the emergence of care needs, from a social, medical and psychological point of view, and on the other registers the provisions received by individuals from the local authority care services for the elderly and from the county council health and medical care services. Information is also collected which sheds light on the efforts and contributions made by relatives and voluntary organisations. The information is fed into a longitudinal database.
The purpose of this is to make it possible to follow the individuals and the care efforts made in the area concerned over the course of time, and thereby enable studies to be made of how health care and medical requirements are evolving, how well they are being met and what sort of results the contributions are achieving from an overall point of view. As a rule, this is impossible in the field of traditional research on ageing, where studies are usually made on limited issues in clearly defined projects.
Four research centres are taking part in the work, each with its own constituent project:
In Blekinge, the sub-project SNAC – Blekinge is directed from Blekinge Competence Centre. There is cooperation with Blekinge Institute of Technology, Blekinge County Council, Lund University, Växjö University and Kristianstad University.
The work on the project is directed by a steering committee that represents the various scientific interests of SNAC-Blekinge, and the committee also cooperates in the planning of the national SNAC.
- Project Manager
SNAC – Blekinge is directed by Professor Johan Berglund.
SNAC – Blekinge
- SNAC – Nordanstig
The body responsible for the SNAC project in Nordanstig is Primärvårdens FoU-enhet i Nordanstig (the Nordanstig Primary Care R&D Unit). The project is being conducted in cooperation with the local authority of Nordanstig and Gävleborg County Council.
SNAC – Nordanstig is directed by Associate Professor Anders Wimo.
- SNAC- Skåne (GÅS)
In Skåne, the sub-project is entitled Gott åldrande i Skåne, Good Aging in Skåne (GÅS). GÅS is being conducted in five local authorities in Skåne - Malmö, Eslöv, Hässleholm, Osby and Ystad.
GÅS is directed by Professor Sölve Elmståhl at Institutionen för hälsa, vård och samhälle (the Faculty of Medicine), Lund University.
Gott Åldrande i Skåne
- SNAC – Kungsholmen
In Stockholm, Stiftelsen Stockhoms läns Äldrecentrum (Stockholm Gerontology Research Centre) is responsible for the study SNAC-Kungsholmen (SNAC-K). This study is being conducted in the Kungsholmen district, which comprises Kungsholmen and the Essinge islands. The work is conducted together with Ageing Research Centre (ARC).
The population part of SNAC-K is directed by Professor Laura Fratiglioni, and the care system part by Associate Professor Mårten Lagergren, Stockholm Gerontology Research Centre.
The SNAC Study consists of two components: population and care systems.
The longitudinal data collection in the population part concerns the follow-up of health, illness, functional capability, social situation and care need in a panel consisting of the elderly population through repeated medical examinations, tests, interviews, questionnaires, etc. This information is supplemented by different types of register data.
Common study design
The four areas work with a common study design. Initially, a base line survey relating to a selection of individuals living in respective areas and aged 60, 66, 72, 78, 81, 84, 87, 90, 93 and 96. These individuals are now followed regularly – the younger ones every 6 years and the older ones every third year. Every sixth year a new cohort of 60-year-olds is added to the study population.
In this way it will be possible to both follow the aging of individual persons in separate age groups and to compare cohorts – for example with respect to health improvements. As a consequence of the rich quantities of data that are gathered on each person, aging with the occurrence and development of functional impairments and care needs can be studied from a number of different aspects and against a background of a diversity of conceivable influencing factors.
Planning of the study
The planning of the study was carried out in cooperation between the researchers from the constituent areas. The work was focused on developing a common so-called core protocol with identical survey variables. To this in each area a supplementary protocol has been developed consisting of questions and examinations with a focus on various specific issues that need to be deepened within respective areas.
Data collection is carried out via a questionnaire, interviews, tests and medical examinations. Special personnel – doctors, nurses, psychologists, etc. – have been employed for this purpose. The examination takes a total of four – six hours per person. All principals for the study have requested and been granted permission for the survey by the Research Ethics Committee at Karolinska Institutet (Kungsholmen and Nordanstig) as well as Lund University (Skåne and Blekinge). The surveys based on voluntary participation and all participants have given its consent to the registration of collected information.
Base line investigation
The base line survey in n the SNAC Study’s Population Part was set in operation in all areas in March 2001 and completed in 2003/04. Altogether, a total of some 8 300 individuals were investigated in the four areas. The first re-survey concerning persons aged 81, 84,…, 96 was started 2004 and completed in 2007. A new re-survey of all age group was started later the same year and completed in 2010. This survey includes a new cohort of 60-year-olds and 81-yer-olds who have not been previously examined. After that there was a new re-survey of the 81-year-olds and over, which was started in 2010. This third re-survey was completed in 2012. In 2013, the next re-survey of all age-groups was started including new cohorts of 60- and 81-year-olds (except for Kungsholmen where these age groups will not be represented until 2015). This survey will be finished early 2016, when another re-survey of old age groups will be launched.
In preparation for the re-surveys, the study protocols was revised with deletion of questions and examinations that do not need to be repeated from the base line. New cohorts, however, are subject to the unchanged initial protocol. After this repeated revisions have been made for each re-survey though with the aim of avoiding unnecessary changes. A detailed compilation of the local protocols has been made with the aim of facilitating comparisons and the collation of data from the participating areas.
Care system part
The purpose of data collection in the care system part is to follow continuously the long-term care and health care that the older population receive and to register various factors that are of importance to the allocation of the provisions.
The data collected is to be used as input for planning, resource allocation and evaluation of the care and medical services for the older adults. In addition, the data collected is used in research and development work on issues related to care and medical services. One important aspect is that the connection between the population and care system parts of the SNAC-study provides an opportunity for comparison between those who do and those who do not receive public-financed care and medical services.
Registration in the care system part concerns in principle all changes in the provision of long-term care of those persons who live within the area in question and who are 65 and older. This means registration for each new provision decision, including the discontinuation of provisions and with the exception of those that have only been provided with alarm or food distribution. The information is collected on a monthly basis.
To the data that is acquired in the registration of long-term care services, information is then added on an individual level concerning acute health care services in outpatient and inpatient care. The collation of various data sources assumes the consent of the registered persons (see below). Permits to conduct the registration have been obtained from the research ethics committee at the respective universities.
When registering in the various areas, use is made of a survey protocol, that has been worked out in cooperation between the constituent sub-projects in the SNAC-study. The protocols concur with each other in all major respects, which means that it is possible to make various comparisons between care of the older adults and the participating areas.
Apart from information on the submitter of the information and the form for collection, the protocol contains:
– personal data
(personal identity no, origins from outside the Nordic area, where relevant, civil status, living alone/in a partnership, etc. )
In those cases where people are living in partnerships, a registration is made whether even the partner receives long term care from the local authority or County Council.
– surrounding factors
– personal care dependence
– need for special care provision
– provision decided in accordance with SoL (Social Service Act)
– provision decided in accordance with LSS (Support and Service to People with Functional Impairments Act)
– ongoing efforts in accordance with the HSL (Health and Medical Care Act)
Data collection in the care system part is performed primarily by the permanent staff in the municipality or local authority and county council. In one area – Kungsholmen – some of the collection takes place with the help of specially employed personal. As can be seen from above, the collation of individual information presupposes the informed consent of the registered individuals.