The study assesses exploratory the geography of the elderly fall in Sweden in relation to the ecology of the socio-demographic characteristics of the Swedes older population. Kendall Test is used to measure the association between elderly fall rates and demographic, socio-economic characteristics of the population, costs of elderly care and accessibility measures at county level. Results show a number of significant associations: high rates of the elderly fall are associated with high cost of the elderly care but also low rate of elderly fall and good accessibility to basic services (e.g., grocery store, health care and cash machines). The articles finalizes with reflections of the results and suggestions for future research.

The study assesses exploratory the geography of the elderly fall in Sweden in relation to the ecology of the socio-demographic characteristics of the Swedes older population. Kendall Test is used to measure the association between elderly fall rates and demographic, socio-economic characteristics of the population, costs of elderly care and accessibility measures at county level. Results show a number of significant associations: high rates of the elderly fall are associated with high cost of the elderly care but also low rate of elderly fall and good accessibility to basic services (e.g., grocery store, health care and cash machines). The articles finalizes with reflections of the results and suggestions for future research.

Despite the increasing complexity of nursing home care, the role of physicians caring for residents is largely unexplored. This international, exploratory study sought to learn about physicians' roles, responsibilities, and tasks as well as investigate the unique qualities of medical practice in nursing homes. We conducted interviews with 18 physicians, who reported making important contributions to the quality of resident care, including clarifying the goals of care, working to reduce unnecessary medication and hospitalization, as well as contributing to staff education. Nursing home practice involved physicians in networks of relations that were instrumental to the quality of medical care and physicians' job satisfaction. The importance of these relationships disrupts the oft-drawn boundary between the medical and the social, suggesting that good medical practice depends on good social practice. Reflecting the exploratory nature of the study, we recommend research to better understand and support the relational dimensions of nursing home medicine.

O-GlcNAcylation, a dynamic nutrient and stress sensitive post-translational modification, occurs on myriad proteins in the cell nucleus, cytoplasm and mitochondria. O-GlcNAcylation serves as a nutrient sensor to regulate signaling, transcription, translation, cell division, metabolism, and stress sensitivity in all cells. Aberrant protein O-GlcNAcylation plays a critical role both in the development, as well as in the progression of a variety of age related diseases. O-GlcNAcylation underlies the etiology of diabetes, and changes in specific protein O-GlcNAc levels and sites are responsible for insulin expression and sensitivity and glucose toxicity. Abnormal O-GlcNAcylation contributes directly to diabetes related dysfunction of the heart, kidney and eyes and affects progression of cardiomyopathy, nephropathy and retinopathy. O-GlcNAcylation is a critical modification in the brain and plays a role in both plaque and tangle formation, thus making its study important in neurodegenerative disorders. O-GlcNAcylation also affects cellular growth and metabolism during the development and metastasis of cancer. Finally, alterations in O-GlcNAcylation of transcription factors in macrophages and lymphocytes affect inflammation and cytokine production. Thus, O-GlcNAcylation plays key roles in many of the major diseases associated with aging. Elucidation of its specific functions in both normal and diseased tissues is likely to uncover totally novel avenues for therapeutic intervention.

Despite the increasing availability of gerontological training programmes, knowledge of theircontents, characteristics, methods and outcomes remains limited. However, the transitionfrom multidisciplinarity to interdisciplinary orientations is now fundamental to such training,providing participants from diverse academic orientations and professional backgrounds withopportunities to interact ‘across boundaries’. In response to recommendations of the EUFuturage Road Map for European Ageing Research (2011) concerning training and careerdevelopmentneeds of future cohorts of practitioners and scholars in aging, an InternationalSummer School on Ageing (ISSA) was developed in 2012. Its aim was to initiate the practicalimplementation of some of the capacity building goals identified by Futurage. The design andstructure of the ISSA was informed by the experience of Canada’s Summer Programme inAgeing - run by the Institute of Aging of the Canadian Institutes of Health Research – and bythe cross-border academic training activities organized by Lund University (Sweden) inScandinavian countries. As Italy has lacked a tradition of comprehensive, interdisciplinarytraining programmes in gerontology, the Italian National Institute of Health and Science onAgeing undertook to launch the inaugural ISSA. In this article, the core aims andmethodology of the ISSA are presented, together with an analysis of its main outcomes, asmeasured by participant evaluations. These are discussed in the context of internationaldebate on this topic.

Introduction: While healthy ageing represents a pre-condition for older people to enjoy a longer and disability-free life span, quality of life in older age is dependent also upon society’s ability to grant individuals social protection, as well as to promote their active participation in the community until the very end of life. These issues constitute a challenge for current and future research on ageing.

Method: A 2-year consultation process with over 70 international experts was conducted within the FUTURAGE work-stream focussedon social and economic resources in ageing research. This process allowed a comprehensive discussion on most relevant social participation and protection issues involving scientists, users’ organisations, policy makers and other stakeholders, which led to a set of specific research priorities.

Results: The main challenges identified for future ageing research concerning social participation are: ageism; migration; life-long learning; digital divide; spirituality; volunteering; mobility and accessibility; discrimination in the labour market; consumption and access to products and services; and work-life balance. As for social protection, the following core issues have been spotted: sustainability; support to informal carers (also through ICT-based services); efficiency; access to care; cost-effectiveness and quality of interventions; initiatives to improve intergenerational solidarity.

Conclusion: Societal challenges related to social participation and sustainability of social protection systems clearly urge new actions in research, practices and policy on ageing. In particular, the identification of over-arching issues, barriers and enablers contributes to strengthen scientific research in the field, as well as to support policy makers in improving social life and quality of life of older people.

BACKGROUND: The availability of family caregivers of older people is decreasing in Italy as the number of migrant care workers (MCWs) hired by families increases. There is little evidence on the influence of socioeconomic factors in the employment of MCWs.

METHOD: We analyzed baseline data from 438 older people with moderate Alzheimer's disease (AD), and their family caregivers enrolled in the Up-Tech trial. We used bivariate analysis and multilevel regressions to investigate the association between independent variables-education, social class, and the availability of a care allowance-and three outcomes-employment of a MCW, hours of care provided by the primary family caregiver, and by the family network (primary and other family caregivers).

RESULTS: The availability of a care allowance and the educational level were independently associated with employing MCWs. A significant interaction between education and care allowance was found, suggesting that more educated families are more likely to spend the care allowance to hire a MCW.

DISCUSSION: Socioeconomic inequalities negatively influenced access both to private care and to care allowance, leading disadvantaged families to directly provide more assistance to AD patients. Care allowance entitlement needs to be reformed in Italy and in countries with similar long-term care and migration systems.

Introduction: Italy is one of the most aged countries in the world, with a longstanding tradition of family care of the dependent elderly. Inrecent times, however, Italy has been witnessing in-depth social and cultural changes, which have been negatively impacting on informal care provision. In addition, the public long-term care (LTC) system highly relies on cash-for-care schemes for supporting older people, whereas “formal” care services are characterised by weak coverage and intensity. This situation has led to a remarkable increase in theprivate employment of migrant care workers (MCWs), whose number increased by four times in the last two decades.

Method: An overview of MCWs phenomenon in Italy is provided through the analysis of empirical data retrieved by available official sources at national level, as well as by results from own surveys conducted in recent years on large samples of MCWs.

Results: The following opportunities and challenges concerning MCWs’ employment in the LTC sector were identified: improve MCW’s capacity to deliver quality care; reduce therisk of elder abuse and neglect and of meeting MCWs’ own care needs; increase their social integration in destination countries and reduce “care drain” in sending countries; and how to improve stakeholders’ involvement for a better exchange of good practices and more effective policy measures.

Conclusion: In these years, privately employed MCWs have contributed to change the traditional Italian “family care model” into a new “migrant-in-the-family care model”. However, the issue concerning the sustainability of this model within the Italian LTC system in the future is still open.

Informal care is a hot topic in research and policy agendas at European and national level, since it greatly contributes to the sustainability and efficiency of national health care systems. A specific intervention – part of the wider INNOVAGE project funded by FP7 – was planned for developing and testing a new multilingual web platform for informal carers of dependent older people in the EU-27. Preliminary results of the pilot study, conducted in Italy, Germany and Sweden will be discussed. The final platform will be accessible in all official languages of the EU-27 and publicly available in spring 2015.

Informal care is a hot topic in research and policy agendas at European and national level, since it greatly contributes to the sustainability and efficiency of national health care systems. A specific intervention – part of the wider INNOVAGE project funded by FP7 – was planned for developing and testing a new multilingual web platform for informal carers of dependent older people in the EU-27. Preliminary results of the pilot study, conducted in Italy, Germany and Sweden will be discussed. The final platform will be accessible in all official languages of the EU-27 and publicly available in spring 2015.

Si la Suisse dispose d’un réseau bien organisé de structures de soins professionnelles, elle manque en revanche toujours de services d’assistance aux proches soignants. Les technologies de l’information et de la communication (TIC), connues pour leur souplesse et leur disponibilité, pourraient contribuer à combler cette lacune, puisqu’elles apportentde nouvelles réponses aux besoins des usagers. Toutefois, pour que leur potentiel et leur efficacité puissent être pleinement compris, il faut que les recherches se poursuivent, comme le montre une étude européenne récente.

Background: Family carers can be negatively influenced by their situation, in terms of stress, social isolation, economic constraints and other difficulties. Web-based services addressing carers’ needs represent an efficient support. The goal of the INNOVAGE work package 3(WP3) study was to develop and test a new multilingual web platform for supporting family carers of older people, to be implemented in 27 European countries.

Methods: A review of good practices and a consultation with stakeholders were conducted for identifying most appropriate types of services to be developed and tested. The prototype of web platform included information resources and interactive services for both peer and professional support. A convenient, overall sample of around 130 family carers was enrolled in three countries (Italy, Germany and Sweden) and could access services for 12-17 weeks. Data were collected through questionnaires and focus groups concerning impact onquality of life, social support, self-perception of carer’s role, as well as usability, usefulness and appropriateness of services.

Results: Active users were generally satisfied with support (information, advice, counselling) provided by moderators (social workers or psychologists) and peers. Usability and appropriateness were confirmed, although some refinements were suggested and users with low digital skills often needed technical support. A portion of the sample remained inactive even if stimulation strategies were adopted.

Conclusions: The pilot study confirmed the INNOVAGE Eurocarers web platform is a useful tool for family carers. Some challenges still exist for implementation in relation to digital skills required and users’ preferences on services at country level.

Background: Family carers can be negatively influenced by their situation, in terms of stress, social isolation, economic constraints and other difficulties. Web-based services addressing carers’ needs represent an efficient support. The goal of the INNOVAGE work package 3(WP3) study was to develop and test a new multilingual web platform for supporting family carers of older people, to be implemented in 27 European countries.

Methods: A review of good practices and a consultation with stakeholders were conducted for identifying most appropriate types of services to be developed and tested. The prototype of web platform included information resources and interactive services for both peer and professional support. A convenient, overall sample of around 130 family carers was enrolled in three countries (Italy, Germany and Sweden) and could access services for 12-17 weeks. Data were collected through questionnaires and focus groups concerning impact onquality of life, social support, self-perception of carer’s role, as well as usability, usefulness and appropriateness of services.

Results: Active users were generally satisfied with support (information, advice, counselling) provided by moderators (social workers or psychologists) and peers. Usability and appropriateness were confirmed, although some refinements were suggested and users with low digital skills often needed technical support. A portion of the sample remained inactive even if stimulation strategies were adopted.

Conclusions: The pilot study confirmed the INNOVAGE Eurocarers web platform is a useful tool for family carers. Some challenges still exist for implementation in relation to digital skills required and users’ preferences on services at country level.

Issue

The exploitation of eHealth tools in integrated care practices addressing multimorbidity might be a strong driver for facilitating access to the services provided to people with multiple chronic diseases. This is particularly true in the case of older people living in the community, since eHealth could enhance and reinforce care services at home, improving independent living and security of patients.

Description of the problem

One of the ICARE4EU project aims, was to explore whether and which kind of eHealth tools are implemented in integrated care practices for older people with multimorbidity across Europe. In fact, eHealth tools could differ widely across practices, requiring specific know-how by users and health professionals for using and maintaining technology-based solutions, adequate financial resources, compatible organisational and cultural environment with innovations.

Results

The ICARE4EU project selected 101 integrated care practices in 24 European countries, of which 85 included the provision of at least one eHealth tool. Out of 50 practices addressing needs of older people, 42 included some eHealth solution aimed at: enhancing digital communication (64%); monitoring care processes (58%); providing decision support systems (60%); supporting patients' self-management (32%). Two promising approaches exploiting eHealth are presented in detail: the ‘TeleRehabilitation project: Post ICU patient telerehabilitation services' at the Nicosia General Hospital and the ‘Strategy for chronic care' by the Regional Department of Health in Valencia.

Lessons

The use of eHealth seems to have many benefits in terms of improvement of integration and management of care, as well as quality of care. However, to realize this benefits, it is important to arrange adequate technical support, legislative frameworks and training of users and health professionals.

Background: An estimated 50 million people in the European Union live with multiple chronic diseases. In Italy, around 26.6% of the population aged 16 to 64 years, reported to have at least one long-standing illness or health problem in 2011. Moreover, around 46% of the population over 50 is suffering from multimorbidity. Some programmes addressing adult or older people with multimorbidity have been introduced.

Methods: Data for the ICARE4EU study were collected in the first half of 2014. Eligible programmes focussed on providing care for adult people with two or more medically diagnosed chronic or long lasting diseases (at least onesomatic), involved formalised cooperation between two or more services (at least one medical) and evaluation was available. For each programme an on-line questionnaire was completed and included four main subjects: Patientcentredness, Management, Use of E-health technologies, and Financing systems.

Results: In Italy, four programmes met the inclusion criteria. They address both daily patient care and policy/managerial levels. Integration of care services, improved collaboration between care providers, changes in resource utilisation and involvement of informal carers have been observed. In two programmes, older patients are addressed as specific subgroup and in two cases animprovement in the use of E-health tools has emerged.

Conclusions: In Italy, new policies and integrated care programmes addressing multimorbidity have been recently introduced in some areas, with good preliminary results.

Purpose Initiatives using information and communication technologies (ICTs) as support for carers of dependent older people are reported since the early 1990s, mainly in form of phone services, computer networks, and video respite. Although the role of ICTs in home care gained increasing relevance in the last decades – for instance in the areas of social integration, care coordination and ambient assisted living (AAL) – few attempts have been made to systematically understand the potentialities of such technologies, overcoming single technology or intervention domains. In this respect, the issues of terminology ambiguity and lack of comparability represented major barriers, so that most of evaluation studies in this area led to mixed and/or inconclusive results. Drawing on the findings of the CARICT-project, this paper discusses the development of a theoretical and conceptual framework to assess the impact ofI CT-based interventions for carers. Method Literature review and a mapping exercise of 52 ICT-based initiatives for carers in 8 countries. Results & Discussion We will provide the results of a mapping exercise of 52 case studies, showing the diversity of existing good practices across Europe and carrying out a review of available impact assessment of these initiatives from a social ecological perspective (at micro-, meso- and macro-level). Subsewquently, we will discuss a theoretical and conceptual framework that is built on the basis of available evidence, leading toa proper classification of ICT-based interventions in relation to types of interactions between actors they support: an attempt is made to group the solutions in coherent and comprehensive classes, with related implications for impact assessments and comparative analysis. Main classes include: alarms, home automation, auto-communication, meta-services, information and training, cognitive stimulations and mental exercises, support group sessions, individual care and support services, and social participation tools. Finally, recommendations for future research in the field are formulated with regard to the assessment and comparability of these services, as well as to the testing and development of new solutions.

Introduction: Information and communication technologies (ICTs) have gained an increasing relevance for delivering innovative care and support services for dependent older people and their family caregivers. Although ICT-based interventions can vary remarkably in terms of functions, target users, operational aspects and technologies used, little knowledge is available concerning their implementationand impact in Europe, a gap that the CARICT project (http://is.jrc.es/pages/EAP/eInclusion/carers.html) has tried to fill.

Method: 54 ICT-based interventions addressing needs of older peopleor their family caregivers have been identified in 12 European countries through internet search, literature review and expert interviews. Reports have been delivered for each case studied, and cross-analysed to better understand their potential impact at micro, meso and macro level.

Results: Little evidence was found for positive outcomes at micro-level, including improvements in users’ health relatedquality of life and social inclusion. At meso-level, implementation of 1st/2nd generation telecare contributes to reduce hospitalization and institutionalization rates of older users, as well asto cost savings for local care providers. At macro-level, only one intervention shows concrete effects on a larger scale through a targeted program evaluation, while most ICT-based interventions do not useany tool to assess their impact, and can thus demonstrate only technology acceptance or users’ satisfaction.

Conclusion: The lack of relevant evidence at all levels, as well as difficulties in comparing and generalising results, strongly urge practitioners to improve impact assessment methodologies and researchers to develop a better general framework of ICT potentials at a conceptual, theoretical and methodological level in this area.

Some evidence suggests that information and communication technologies (ICT) can be an efficient mean to improve not only the quality of care provided to dependent older people but also the support for informal carers and privately employed care workers. However, there is a lack of research on ICT-based initiatives and their impact on carers in the European context. Moving from the preliminary findings of the CARICTproject, the paper discusses the first attempt that has been made in Europe to assess the impact of ICTbased initiatives for carers. First, an overview of the developed methodological framework is presented: it includes both a conceptual framework and an impact assessment methodology (IAM) for evaluating multidimensional outcome. Furthermore, an overview of ICT-based solutions in Europe is provided through the analysis of 52 operational initiatives and selected as good practices. Finally, some recommendations and guidelines for further research in the field are discussed.

ABSTRACT

 Background: During the past years the authorities and the dental care in the world have begun to realize the importance of maintaining a good oral health of the seniors. The care staff at special residences have an essential role in the daily oral care of the elderly. The oral state of health is also important for the rest of the health. Studies show that oral care is deficient in the elderly and needs to be highlighted as the elderly population is expected to increase. 

 Aim: The aim of this literature review is to evaluate the potential improvement regarding the staff's work with oral care in elderly care.

 Methods: Literature study search was performed with MeSh terms in the database PubMed and Scopus. The following keywords have searched:Dental care for aged, Education, Nursing homes, Nursing staff, Oral health, Oral care.   

Results: Several studies have found improvements that are beginning to emerge to develop the oral care of the elderly. These improvements can be achieved by a convenient oral care training that is designed for the elderly. The training programs for the care staff working with the elderly positively affects their attitudes, routines and documentation of the patient’s information, which benefits the elderly oral health.   

Conclusion:To achieve good oral care for the elderly, several improvements are needed to be done by the governments involving nursing and working staff´s routines. A little different has been done, but there is significant work still to be done to improve the elderly dental health. 

Background Digital assistive technology (DAT) may support time management in people with dementia or mild cognitive impairment (MCI), but research on DAT for time management is limited. We aimed to explore how everyday could be supported by DAT for time management in persons with dementia or MCI from informal carers' perspectives. This study focused on a DAT device for time management called MEMOplanner (MMP).Method Using a mixed-methods design, we utilized the Time-Proxy (c) questionnaire and a study-specific interview guide to investigate the perspectives of informal carers (n = 8) regarding the use of MMP by individuals with dementia or MCI.Result The MMP was helpful in keeping track of time and activity. It helped to maintain an active lifestyle and facilitated communication. However, the MMP did not reduce the need for assistance from the informal carers, and it took time to learn the different functions of the device. Further research into employing a more extensive array of DAT for time management or other areas to assist individuals with dementia will yield valuable insights into enhancing and sustaining a higher quality of life despite cognitive decline.

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 - the eligibility age for basic pension - compared to retiring earlier affects older adults' (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people.

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people.

ObjectiveThis study aimed to explore changes to resident thriving in Swedish nursing homes over a 5-year period and describe changes in associated factors.

MethodsCross-sectional data were collected from a randomised sample of Swedish nursing homes in 2013/2014 (baseline) and 2018/2019 (follow-up). Descriptive statistics, independent samples t-tests, and chi squared tests were used to statistically evaluate differences between the samples. Simple and multiple linear regression analyses were used to explore associations between thriving and the study variables.

ResultsResident characteristics were relatively consistent between the full baseline (N = 4831) and follow-up (N = 3894) samples. Within a sub-sample of nursing homes that participated in both data collections mean thriving scores were found to have increased from 152.9 to 155.2 (p ≤ 0.003; d =0.09) and overall neuropsychiatric index scores had decreased from 16.0 to 14.3 (p ≤ 0.004; d =0.09), as had the prevalence of several neuropsychiatric symptoms. Thriving was found to have a positive association with the neuropsychiatric symptom of elation/euphoria, and negative associations with the symptoms of aggression/agitation, depression/dysphoria, apathy, and irritability.

ConclusionsThe results show an increase in overall thriving scores and a decrease in overall neuropsychiatric scores between baseline and follow-up. This study confirmed associations between thriving and certain neuropsychiatric symptoms and established comparative knowledge regarding changes in resident thriving, characteristics, and symptom prevalence. These findings could inform future care and organisational policies to support thriving in nursing homes, particularly among residents at risk of lower thriving due to cognitive impairment or neuropsychiatric symptoms.

BACKGROUND: Epidemiological research on dementia is hampered by differences across studies in how dementia is classified, especially where clinical diagnoses of dementia may not be available. OBJECTIVE: We apply structural equation modeling to estimate dementia likelihood across heterogeneous samples within a multi-study consortium and use the twin design of the sample to validate the results. METHODS: Using 10 twin studies, we implement a latent variable approach that aligns different tests available in each study to assess cognitive, memory, and functional ability. The model separates general cognitive ability from components indicative of dementia. We examine the validity of this continuous latent dementia index (LDI). We then identify cut-off points along the LDI distributions in each study and align them across studies to distinguish individuals with and without probable dementia. Finally, we validate the LDI by determining its heritability and estimating genetic and environmental correlations between the LDI and clinically diagnosed dementia where available. RESULTS: Results indicate that coordinated estimation of LDI across 10 studies has validity against clinically diagnosed dementia. The LDI can be fit to heterogeneous sets of memory, other cognitive, and functional ability variables to extract a score reflective of likelihood of dementia that can be interpreted similarly across studies despite diverse study designs and sampling characteristics. Finally, the same genetic sources of variance strongly contribute to both the LDI and clinical diagnosis. CONCLUSION: This latent dementia indicator approach may serve as a model for other research consortia confronted with similar data integration challenges.

The Louisville Twin Study (LTS) began in 1958 and became a premier longitudinal twin study of cognitive development. The LTS continuously collected data from twins through 2000 after which the study closed indefinitely due to lack of funding. Now that the majority of the sample is age 40 or older (61.36%, N = 1770), the LTS childhood data can be linked to midlife cognitive functioning, among other physical, biological, social, and psychiatric outcomes. We report results from two pilot studies in anticipation of beginning the midlife phase of the LTS. The first pilot study was a participant tracking study, in which we showed that approximately 90% of the Louisville families randomly sampled (N = 203) for the study could be found. The second pilot study consisted of 40 in-person interviews in which twins completed cognitive, memory, biometric, and functional ability measures. The main purpose of the second study was to correlate midlife measures of cognitive functioning to a measure of biological age, which is an alternative index to chronological age that quantifies age as a function of the breakdown of structural and functional physiological systems, and then to relate both of these measures to twins’ cognitive developmental trajectories. Midlife IQ was uncorrelated with biological age (−.01) while better scores on episodic memory more strongly correlated with lower biological age (−.19 to −.31). As expected, midlife IQ positively correlated with IQ measures collected throughout childhood and adolescence. Additionally, positive linear rates of change in FSIQ scores in childhood significantly correlated with biological age (−.68), physical functioning (.71), and functional ability (−.55), suggesting that cognitive development predicts lower biological age, better physical functioning, and better functional ability. In sum, the Louisville twins can be relocated to investigate whether and how early and midlife cognitive and physical health factors contribute to cognitive aging. 

Associative memory involves binding two or more items into a coherent memory episode. Relative to memory for single items, associative memory declines greatly in aging. However, older individuals vary substantially in their ability to memorize associative information. Although functional studies link associative memory to the medial temporal lobe (MTL) and prefrontal cortex (PFC), little is known about how volumetric differences in MTL and PFC might contribute to individual differences in associative memory. We investigated regional gray-matter volumes related to individual differences in associative memory in a sample of healthy older adults (n = 54; age = 60 years). To differentiate item from associative memory, participants intentionally learned face-scene picture pairs before performing a recognition task that included single faces, scenes, and face-scene pairs. Gray-matter volumes were analyzed using voxel-based morphometry region-of-interest (ROI) analyses. To examine volumetric differences specifically for associative memory, item memory was controlled for in the analyses. Behavioral results revealed large variability in associative memory that mainly originated from differences in false-alarm rates. Moreover, associative memory was independent of individuals' ability to remember single items. Older adults with better associative memory showed larger gray-matter volumes primarily in regions of the left and right lateral PFC. These findings provide evidence for the importance of PFC in intentional learning of associations, likely because of its involvement in organizational and strategic processes that distinguish older adults with good from those with poor associative memory.

Background: Poor sleep is a potential modifiable risk factor for later life development cognitive impairment. The aim of this study is to examine if subjective measures of sleep duration and sleep disturbance predict future cognitive decline in a population-based cohort of 60, 66, 72 and 78-year-olds with a maximal follow up time of 18 years. Methods: This study included participants from the Swedish National Study on Ageing and Care – Blekinge, with assessments 2001–2021. A cohort of 60 (n = 478), 66 (n = 623), 72 (n = 662) and 78 (n = 548) year-olds, were assessed at baseline and every 6 years until 78 years of age. Longitudinal associations between sleep disturbance (sleep scale), self-reported sleep duration and cognitive tests (Mini Mental State Examination and the Clock drawing test) were examined together with typical confounders (sex, education level, hypertension, hyperlipidemia, smoking status, physical inactivity and depression). Results: There was an association between sleep disturbance at age 60 and worse cognitive function at ages 60, 66 and 72 years in fully adjusted models. The association was attenuated after bootstrap-analysis for the 72-year-olds. The items of the sleep scale most predictive of later life cognition regarded nightly awakenings, pain and itching and daytime naps. Long sleep was predictive of future worse cognitive function. Conclusion: Sleep disturbance was associated with worse future cognitive performance for the 60-year-olds, which suggests poor sleep being a risk factor for later life cognitive decline. Questions regarding long sleep, waking during the night, pain and itching and daytime naps should be further explored in future research and may be targets for intervention. © 2022

OBJECTIVE: To describe health issues and living conditions in a cohort of adults living with Spina bifida.

MATERIAL AND METHODS: A cross-sectional study was conducted by a multidisciplinary team. Adults with spina bifida (n = 219) were invited to participate. One-hundred-and-ninety-six persons (104 women and 92 men; 18-73 years, median age 33 years) were included. Structured interviews, questionnaires, and clinical assessments for medical, social, physical, and cognitive functions were used.

RESULTS: There was large variation among participants as regards the consequences of their spina bifida. Individuals < 46 years seemed to have more secondary conditions such as hydrocephalus, Chiari II malformation, tethered cord symptoms, and latex allergy. A higher proportion of the individuals >46 years and older was able to walk, and they had performed better in primary school and on tests of psychomotor speed and executive function.

CONCLUSIONS: This study demonstrates that adults with spina bifida have a complex set of physical, cognitive, and social needs that need to be addressed in order to improve their health issues and living conditions. The high prevalence of urinary and fecal incontinence, pain, and overweight underline that these issues need much attention during follow-up. The future generations of older adults may need more attention in many ways, since they at a younger age do have more complex medical conditions, lower physical and cognitive functions, and lower prerequisites for independent living and participation in society than those > 46 years today. This elucidates that adults with spina bifida need systematic follow-up services and social support throughout life.

OBJECTIVE: To describe health issues and living conditions in a cohort of adults living with Spina bifida.

MATERIAL AND METHODS: A cross-sectional study was conducted by a multidisciplinary team. Adults with spina bifida (n = 219) were invited to participate. One-hundred-and-ninety-six persons (104 women and 92 men; 18-73 years, median age 33 years) were included. Structured interviews, questionnaires, and clinical assessments for medical, social, physical, and cognitive functions were used.

RESULTS: There was large variation among participants as regards the consequences of their spina bifida. Individuals < 46 years seemed to have more secondary conditions such as hydrocephalus, Chiari II malformation, tethered cord symptoms, and latex allergy. A higher proportion of the individuals >46 years and older was able to walk, and they had performed better in primary school and on tests of psychomotor speed and executive function.

CONCLUSIONS: This study demonstrates that adults with spina bifida have a complex set of physical, cognitive, and social needs that need to be addressed in order to improve their health issues and living conditions. The high prevalence of urinary and fecal incontinence, pain, and overweight underline that these issues need much attention during follow-up. The future generations of older adults may need more attention in many ways, since they at a younger age do have more complex medical conditions, lower physical and cognitive functions, and lower prerequisites for independent living and participation in society than those > 46 years today. This elucidates that adults with spina bifida need systematic follow-up services and social support throughout life.

Cytomegalovirus (CMV) infection induces profound changes in different subsets of the cellular immune system. We have previously identified an immune risk profile (IRP) where CMV-associated changes in the T cell compartment, defined as a CD4/CD8 ratio < 1, are associated with increased mortality in elderly people. Since natural killer (NK) cells have an important role in the defense against viral infections, we examined whether the expansion of CD8 + T cells seen in individuals with CD4/CD8 ratio < 1 is coupled to a parallel skewing of the NK cell compartment. A number of 151 subjects were examined with CMV serology and a flow cytometry panel for assessment of T cell and NK cell subsets. CMV-seropositive individuals had higher frequencies of CD57 + and NKG2C + NK cells and lower frequencies of NKG2A + NK cells, in line with a more differentiated NK cell compartment. Intriguingly, however, there was no correlation between CD4/CD8 ratio and NK cell repertoires among CMV-seropositive donors, despite the profound skewing of the T cell compartment in the group with CD4/CD8 ratio < 1. Conversely, donors with profound expansion of NK cells, defined as NKG2C + NK cells with high expression of CD57 and ILT-2, did not display more common changes in their T cell repertoire, suggesting that NK cell expansion is independent of the T cell-defined IRP. Altogether, these results indicate that the effect of CMV on CD8 T cells and NK cells is largely nonoverlapping and independent.

Background Several measures of medication exposure are associated with adverse outcomes in older people. Exposure to and the clinical outcomes of these measures in robust versus frail older inpatients are not known. Objective In older robust and frail patients admitted to hospital after a fall, we investigated the prevalence and clinical impact of fall-risk-increasing drugs (FRIDs), total number of medications, and drug-drug interactions (DDIs). Methods Patients >= 60 years of age admitted with a fall to a tertiary referral teaching hospital in Sydney were recruited and frailty was assessed. Data were collected at admission, discharge, and 2 months after admission. Results A total of 204 patients were recruited (mean age 80.5 +/- 8.3 years), with 101 robust and 103 frail. On admission, compared with the robust, frail participants had significantly higher mean +/- SD number of FRIDs (frail 3.4 +/- 2.2 vs. robust 1.6 +/- 1.5, P < 0.0001), total number of medications (9.8 +/- 4.3 vs. 4.4 +/- 3.3, P < 0.0001), and DDI exposure (35 vs. 5 %, P = 0.001). Number of FRIDs on discharge was significantly associated with recurrent falls [odds ratio (OR) 1.7 (95 % confidence interval [CI] 1.3-2.1)], which were most likely to occur with 1.5 FRIDs in the frail and 2.5 FRIDs in the robust. Number of medications on discharge was also associated with recurrent falls [OR 1.2 (1.0-1.3)], but DDIs were not. Conclusion Exposure to FRIDs and other measures of high-risk medication exposures is common in older people admitted with falls, especially the frail. Number of FRIDs and to a lesser extent total number of medicines at discharge were associated with recurrent falls.

AIM: To examine the association between a healthy diet, assessed by the Healthy Diet Indicator (HDI), and cognitive decline in older adults. METHODS: Data from 21,837 participants aged ≥55 years from 3 cohorts (Survey in Europe on Nutrition and the Elderly, a Concerted Action [SENECA], Rotterdam Study [RS], Nurses' Health Study [NHS]) were analyzed. HDI scores were based on intakes of saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, fruits and vegetables, and fiber. The Telephone Interview for Cognitive Status in NHS and Mini-Mental State Examination in RS and SENECA were used to assess cognitive function from multiple repeated measures. Using multivariable-adjusted, mixed linear regression, mean differences in annual rates of cognitive decline by HDI quintiles were estimated. RESULTS: Multivariable-adjusted differences in rates in the highest versus the lowest HDI quintile were 0.01 (95% CI -0.01, 0.02) in NHS, 0.00 (95% CI -0.02, 0.01) in RS, and 0.00 (95% CI -0.05, 0.05) in SENECA with a pooled estimate of 0.00 (95% CI -0.01, 0.01), I2 = 0%. CONCLUSIONS: A higher HDI score was not related to reduced rates of cognitive decline in European and American older adults.

This study aimed to investigate the prevalence of having plans for the future among very old people and the factors associated with having such plans. A longitudinal population-based study with home visits for 85-, 90-, and ≥95-year-old participants in Sweden and Finland was used. Multivariate logistic regression and Cox proportional-hazards regression models with a maximum 5-year follow-up period were used. The prevalence of having plans for the future was 18.6% (174/936). More men than women and more people living in Sweden than in Finland had plans for the future. In multivariate models, having plans for the future was associated with speaking Swedish, being dentate, and living in the community in the total sample; speaking Swedish and being dentate among women; and speaking Swedish, having a lower Geriatric Depression Scale score, and urban residence among men. Having plans for the future was associated univariately, but not multivariately, with increased survival.

Bakgrund: Den äldre befolkningen ökar ständigt och antalet äldre personer överstiger redan två miljoner i Sverige, vilket innebär ökat vårdbehov. Att flytta till särskilt boende kan vara svår att acceptera för den äldre personen, även för anhöriga som oftast känner osäkerhet för vem som bär ansvaret för deras närstående. Sjuksköterskor upplever att det kan göras mer för att förbättra omvårdnaden av den äldre personen. På grund av tidsbrist är det svårare att skapa en vårdande relation. Problem: Det finns ett bristande engagemang från sjuksköterskor till att utföra en personcentrerad omvårdnad samt en tidsbrist för att beakta den äldre personens unika behov. Syfte: Beskriva äldre personers erfarenheter i samband med flytt till särskilt boende. Metod: En systematisk litteraturstudie med beskrivande syntes. Resultat: Anpassning till ny boendemiljö kunde vara svårt för den äldre personen. Vad som underlättade för trivsel var när de fick ta beslutet att flytta själva. Trots det fanns det omkringgivande aspekter som försvårade för den äldre personens trivsel på boendet, bland annat ökat vårdbehov. Slutsats: För att förbättra äldre personernas erfarenheter kan resurser sättas in före flytten för att säkra att deras synpunkter och behov tas hänsyn till.

The present study investigated the extent to which the effect of age on cognitive ability is predicted by individual differences in physical health. The sample consisted of 118 volunteer subjects who were healthy and ranging in age from 26 to 91. The examinations included a clinical investigation, magnetic resonance imaging (MRI) brain neuroimaging, and a comprehensive neuropsychological assessment. The effect of age on fluid IQ with and without visual spatial praxis and on crystallized IQ was tested whether being fully-, partially-or non-mediated by physical health. Structural equation analyses showed that the best and most parsimonious fit to the data was provided by models that were fully mediated for fluid IQ without praxis, non-mediated for crystallized IQ and partially mediated for fluid IQ with praxis. The diseases of the circulatory and nervous systems were the major mediators. It was concluded from the pattern of findings that the effect of age on fluid intelligence is fully mediated by physical health, while crystallized intelligence is non-mediated and visual spatial praxis is partially mediated, influenced mainly by direct effects of age. Our findings imply that improving health by acting against the common age-related circulatory-and nervous system diseases and risk factors will oppose the decline in fluid intelligence with age.

Background: Age-related decline in the senses is well-known, with a decline in the sensitivity of all senses having been observed. Decline in the senses can be connected to different neurological disorders and cognitive function and may even be a possible predictor of death. 

Aim: The aim of this narrative review was to find and explore recent literature on the covariation between age-related decline in the different senses and co-existing effects on cognitive ability and quality of life. 

Results and Discussion: Six themes could be identified, these were: “Decline due to normal ageing?”, “Technical aids and solutions”, “Wellbeing”, “Memory training”, “Verbal exercises” and “Sensory training”. Large differences between the different senses were obtained. However, the senses showed similar patterns in the different themes. 

Conclusion: It could be concluded that there are many similarities concerning the connections between the decline in individual senses and cognition and memory. Measurements of wellbeing and quality of life are common in the evaluation of the senses, and all types of decline have an impact on activities in daily life.  

The objectives were to investigate the associations between social and financial living conditions in childhood, education and morbidity in old age. The study population (N = 591; 76+ years old) was assembled from two nationally representative Swedish surveys, in 1968 and 2011, that together made longitudinal analysis possible. Morbidity in old age comprised self-reported measures of musculoskeletal disorders, cardiovascular disease, self-rated health and impaired mobility. There were no independent associations between adverse childhood living conditions and morbidity. However, adverse childhood living conditions were associated with an increased likelihood of low education. Moreover, low education was associated with a higher probability of health problems in old age. The results did not show any associations between adverse childhood conditions and late-life morbidity. However, adverse childhood conditions were associated with lower levels of education which, in turn, was associated with health problems and attrition from the study. These results suggest that adverse childhood conditions may indeed be associated with health and survival in old age, but mainly through mechanisms acting earlier in the lifecourse.

Background The Internet and information communication technology is today considered as a means to sustain active and healthy aging, and to provide better care for the aging population. There is an increase in prevalence in older adults using the Internet, however many are still not using the Internet. This study therefore, investigated predictors in starting and stopping Internet use by older adults between 2001-2013 in Sweden and the Netherlands. These represent currently two of the highest older adult Internet users in Europe. The aim of this study was to examine, first, if there was a different starting and stopping rate in Sweden and the Netherlands; second, if the predictors age, gender, education, rural/urban living, living alone/not, cognition and functional limitations have different effects in either country. Methods A cross-national and longitudinal design was chosen. Data was used from the Longitudinal Aging study Amsterdam (LASA) and the Swedish National Study on Aging and Care (SNAC). Cox regression analyses were done to test the predictors over time with starting or stopping Internet use. An interaction term ‘variable*country’ was then considered for each variable, if significant, leading to a stratification into a multivariate model per country. Results More older adults started use in the Netherlands (19%); lower in age, normal cognitive functioning, living alone, fewer functional limitations and lower education were predictive of starting. In Sweden fewer started (10.3%), where being female was the only significant predictor of starting use. Both countries did not have many people stopping use; in the Netherlands (3%) they were younger in age and living urban, whereas in Sweden (1.7%), they had lower cognitive functioning. Conclusion Results indicate that there are differences between countries in starting use. These differences can possibly be explained by the early adoption of the Internet in Sweden. The new findings that the older adults living alone and lower educated are now going online, are positive regarding the theme of active aging. For those stopping use, the differences are more country-specific. More research is needed in order to understand better what an older adult was using the Internet for and why they stop. © 2016. Gerontechnology. All Rights Reserved.

Objectives: Maintaining good cognitive function with aging may be aided by technology such as computers, tablets, and their applications. Little research so far has investigated whether internet use helps to maintain cognitive function over time.

Design: Two population-based studies with a longitudinal design from 2001/2003 (T1) to 2007/2010 (T2).

Setting: Sweden and the Netherlands.

Participants: Older adults aged 66 years and above from the Swedish National Study on Ageing and Care (N = 2,564) and from the Longitudinal Aging Study Amsterdam (N = 683).

Measurements: Internet use was self-reported. Using the scores from the Mini-Mental State Examination (MMSE) from T1 and T2, both a difference score and a significant change index was calculated. Linear and logistic regression analysis were performed with difference score and significant change index, respectively, as the dependent variable and internet use as the independent variable, and adjusted for sex, education, age, living situation, and functional limitations. Using a meta-analytic approach, summary coefficients were calculated across both studies.

Results: Internet use at baseline was 26.4% in Sweden and 13.3% in the Netherlands. Significant cognitive decline over six years amounted to 9.2% in Sweden and 17.0% in the Netherlands. Considering the difference score, the summary linear regression coefficient for internet use was -0.32 (95% CI: -0.62, -0.02). Considering the significant change index, the summary odds ratio for internet use was 0.54 (95% CI: 0.37, 0.78).

Conclusions: The results suggest that internet use might play a role in maintaining cognitive functioning. Further research into the specific activities that older adults are doing on the internet may shine light on this issue.