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.

Background: Europe has called attention to the importance of the e-inclusion of older adults. Society is indicating that the developers, websites, and devices are causing age bias in technology. This affects living independently, the values of ethical principles associated with an older person, and digital ageism: which is an age-related bias in artificial intelligence systems. Objective: This research attempts to investigate the instrument technology anxiety and enthusiasm, and assistive technology devices during the period 2019-2021. This instrument may be a way to redress misconceptions about digital ageism. The assistive technology device that we will investigate in this study is the adoption of a service that is designed for online health consultations. Method: The participants are part of the longitudinal Swedish National Study on Aging and Care. Technology anxiety and technology enthusiasm are two factors, which aim to measure technophilia (vs technophobia) in older adults. The age range is 63 -99 years of age in 2019 T1 and 66 -101 in 2021 T2. Wilcoxon rank test was conducted to investigate technology enthusiasm, technology anxiety, and how they changed with time. An Edwards Nunnally index was then calculated for both variables to observe a significant change in score from T1 to T2. Mann Whitney U test was used to investigate the variables sex and health status with technology anxiety & technology enthusiasm in T1 & T2. Age, Cognitive function MMSE, and digital social participation were investigated through a Kruskall-Wallis test. A logistic regression was conducted with the significant variable. Results: Between 2019-2021, change in technology enthusiasm was based on less digital social participation (OR: 0.608; CI 95%: 0.476-0.792). Technology anxiety was significantly higher due to age (OR: 1.086, CI 95%: 1.035-1.139) and less digital social participation (OR: 0.684; CI 95%: 0.522-0.895). The want for online healthcare consultations was popular but usage was low. Conclusion: Staying active online and participating digitally may be a way to reduce digital ageism. However, digital ageism is a complex phenomenon, which requires different solutions in order to include older people and reduce an inaccurate categorisation of this group in the digital society © 2022,Gerontechnology. All Rights Reserved.

Older adults need to participate in the digital society, as societal and personal changes and what they do with the remaining time that they have in their older years has an undeniable effect on motivation, cognition and emotion. Changes in personality traits were investigated in older adults over the period 2019–2021. Technology enthusiasm and technology anxiety are attitudes that affect the relationship to the technology used. The changes in the score of technology enthusiasm and technology anxiety were the dependent variables. They were investigated with personality traits, age, gender, education, whether someone lives alone, cognitive function, digital social participation (DSP) and health literacy as predictors of the outcome. The Edwards-Nunnally index and logistic regression were used. The results indicated that DSP, lower age, lower neuroticism and higher education were indicative of less technology anxiety. High DSP and high extraversion are indicative of technology enthusiasm. DSP and attitude towards technology seem to be key in getting older adults to stay active online. 

Older adults need to participate in the digital society, as societal and personal changes and what they do with the remaining time that they have in their older years has an undeniable effect on motivation, cognition and emotion. Changes in personality traits were investigated in older adults over the period 2019–2021. Technology enthusiasm and technology anxiety are attitudes that affect the relationship to the technology used. The changes in the score of technology enthusiasm and technology anxiety were the dependent variables. They were investigated with personality traits, age, gender, education, whether someone lives alone, cognitive function, digital social participation (DSP) and health literacy as predictors of the outcome. The Edwards-Nunnally index and logistic regression were used. The results indicated that DSP, lower age, lower neuroticism and higher education were indicative of less technology anxiety. High DSP and high extraversion are indicative of technology enthusiasm. DSP and attitude towards technology seem to be key in getting older adults to stay active online. © The Author(s) 2023.

Background: Europe has called attention to the importance of the e-inclusion of older adults. Society is indicating that the developers, websites, and devices are causing age bias in technology. This affects living independently, the values of ethical principles associated with an older person, and digital ageism: which is an age-related bias in artificial intelligence systems. Objective: This research attempts to investigate the instrument technology anxiety and enthusiasm, and assistive technology devices during the period 2019- 2021. This instrument may be a way to redress misconceptions about digital ageism. The assistive technology device that we will investigate in this study is the adoption of a service that is designed for online health consultations. Method: The participants are part of the longitudinal Swedish National Study on Aging and Care. Technology anxiety and technology enthusiasm are two factors, which aim to measure technophilia (vs technophobia) in older adults. The age range is 63 -99 years of age in 2019 T1 and 66 -101 in 2021 T2. Wilcoxon rank test was conducted to investigate technology enthusiasm, technology anxiety, and how they changed with time. An Edwards Nunnally index was then calculated for both variables to observe a significant change in score from T1 to T2. Mann Whitney U test was used to investigate the variables sex and health status with technology anxiety & technology enthusiasm in T1 & T2. Age, Cognitive function MMSE, and digital social participation were investigated through a Kruskall-Wallis test. A logistic regression was conducted with the significant variable. Results: Between 2019-2021, change in technology enthusiasm was based on less digital social participation (OR: 0.608; CI 95%: 0.476- 0.792). Technology anxiety was significantly higher due to age (OR: 1.086, CI 95%: 1.035-1.139) and less digital social participation (OR: 0.684; CI 95%: 0.522- 0.895). The want for online healthcare consultations was popular but usage was low. Conclusion: Staying active on- line and participating digitally may be a way to reduce digital ageism. However, digital ageism is a complex phenomenon, which requires different solutions in order to include older people and reduce an inaccurate categorisation of this group in the digital society.

Abstract: The increased reliance on Internet use in social functions has presumably left out a part of the population: the oldest-older adults. These are people who have not kept themselves up to date with the technological developments for various reasons. There are, however, exceptions from whom we have something to learn. This study investigates the older people in Sweden who started to use the Internet over a period of 6 years. Cognition, extraversion, openness, functional disability, household economy, sex, age and education were investigated in relation to starting to use the Internet. A chi-square test, Spearman correlation and a logistic regression analysis were conducted. It was found that higher cognition, being male and being between the ages of 60 and 80 years were determining factors in starting to use the Internet for the Swedish older adult. Our results indicate that the oldest-older adults are slow to adapt to using the Internet and more attention should be paid on how to support this group.

Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.

In-home monitoring using sensors has the potential to improve the life of elderly and chronically ill persons, assist their family and friends in supervising their status, and provide early warning signs to the person's clinicians. The Get Up and Go test is a clinical test used to assess the balance and gait of a patient. We propose a way to automatically apply an abbreviated version of this test to patients in their residence using video data without body-worn sensors or markers.

Background

People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time.

Objectives

Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project.

Materials and methods

The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario.

Results

A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system.

Conclusion

Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.

Introduction Symptoms of dementia bring about challenges to couples relationships. Relationship-focused support has been highlighted to be of significant importance for sustained relationship quality and to reduce the negative impact of dementia on the dyadic relationship. This review aimed to explore the what and why of interventions aimed at couples where one partner has a diagnosis of dementia and in which the couple jointly participate. Method Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus and Web of Science from January 2000 to August 2017. Results Six studies were included. Objectives for the person with dementia was related to cognitive function and for the care partner the objectives were related to well-being. The majority of the outcomes were mirrored by the objectives and focused on cognitive function for people with dementia and depression and relationship quality for care partners. Our findings indicate that people with dementia should be included in the assessment of the relationship in order to gain an overall picture of relationship dynamics and to increase tailored support in couple-centred interventions. Conclusions The findings of this review indicate that joint interventions for people with dementia and care partners are lacking a genuine dyadic approach where both partners views of their relationship are valued. In order to identify targets for support and to use the appropriate outcome measures, the quality of the relationship should be recognised and taken into account. Moreover, there is a lack of a salutogenic approach in couple-centred interventions in which couples strengths and resources can be identified and supported.

Bakgrund: Majoriteten av personer med demens bor i sitt eget hem och ofta tillsammans med sin partner som blir en informell vårdgivare. Relationens kvalitet och känsla av parskap hotas ofta till följd av övergången från en ömsesidig beroenderelation till en vårdgivare-vårdtagar-relation allt eftersom demenssjukdomen fortskrider. Detta kan innebära många negativa konsekvenser. Stöd för par där ena partnern har demens delas ofta upp i olika former för personen med demens och för partnern utan demens, vilket innebär att det saknas parbaserat resursorienterat stöd med inriktning på att främja parrelationen och parets vardagliga liv.

Syfte: Syftet med denna avhandling är att utforska parcentrerade interventioner inom demens och att utveckla och testa ett parbaserat, salutogent och resursorienterat stöd för par där ena partnern har en demenssjukdom och som bor tillsammans i det egna hemmet.

Metoder och fynd: Denna avhandling består av tre delar. Den första delen att utforska inkluderar två länkade litteraturöversikter, en narrativ översikt och en kartläggande översikt (studie I) som beskriver tidigare interventioner för par som lever med demens och varför de genomförts. Resultaten av översikterna visade ett kunskapsgap i, och ett behov av lättillgängligt stöd som riktar sig till parförhållanden, parens resurser och att främja det vardagliga livet. Den andra delen, att skapa (studie II) involverar utvecklingen av ett lättillgängligt resursorienterat och parbaserat stöd. Det första steget var att identifiera prioriterade ämnen för en sådan intervention tillsammans med par som lever med demens, genom en så kallad medforskarprocess. Detta inkluderade en omfattande litteraturgenomgång, intervjuer med par där ena partnern har demens, och konsultationsmöten med expertgrupper bestående av personer med demens och partners i Sverige och i Storbritannien. Medforskarprocessen och expertmötena resulterade i fyra huvudteman med motsvarande underteman vilka par med demens ansåg vara viktiga för deras relation och för välbefinnande i vardagen: (1) Hem och grannskap, (2) Meningsfulla aktiviteter och relationer, (3) Förhållningssätt och empowerment och (4) Parskap. Dessa teman vidareutvecklades och integrerades i multimedia-applikationen DemPower, som utvecklades i syfte att erbjuda interventionen till par som lever med demens.

Den tredje delen att testa och att utvärdera beskriver genomförbarhetsstudien (studie III) där applikationen DemPower testades med avseende på genomförbarhet och acceptabilitet hos par där en partner har demens i Sverige och i Storbritannien. Resultaten av studien visade att DemPower-interventionen var genomförbar och acceptabel bland par där ena partnern har demens. Denna delen av avhandlingen inkluderar även en kvalitativ studie (studie IV) som undersökte parens erfarenheter av att testa DemPower tillsammans som ett par. De samlade upplevelserna resulterade i tre teman: (1) Utveckling av parrelationen, (2) Vi är inte ensamma och (3) Positivt förhållningssätt. De övergripande resultaten från avhandlingen presenteras även i en konkluderande syntes i slutet av avhandlingen. Den konkluderande syntesen med fokus på Meningsfullhet, Empowerment, Normalisering och Parskap representerar kärnan i denna avhandling.

Avhandlingens slutsatser och kunskapsbidrag: DemPower-applikationen med fokus på parförhållanden, hälsofrämjande resurser och vardagen har bidragit med ett stöd som vilar på en genuin parbaserad grund tillämpad i det vardagliga livet för par som lever med demens. Denna avhandling bidrar även med kunskap till forskning, vård och allmänheten genom att lyfta fram ett salutogent förhållningssätt till par som lever med demens. Som forskare, vårdpersonal och allmänhet bör vi stödja par där ena partnern har demens för att de ska kunna fortsätta leva ett så normalt liv som möjligt. Detta kan bäst uppnås genom att fokusera på parens resurser, genom inkludering och genom att värdera dem som experter inom demensforskning och i deras livserfarenheter.  

Although mobility in and out of intimate relationships has become more common in later life, it has been a neglected issue in social gerontology. In this article, we ask what characterises the formation of new intimate relationships in later life, and whether there are any specific conditions that separate these from relationships in earlier stages of the lifecourse. On the basis of qualitative interviews with 28 persons aged 63-91 who have established a new intimate heterosexual relationship after the age of 60 or who are dating singles, we argue that time constitutes such a central structuring condition. We discuss and theorise two aspects of time - post-(re) productive free time and remaining time - which have an important formative power on new late-in-life relationships. We argue that together these aspects form a central existential structure of ageing in many Western societies - the paradoxical condition of having lots of available free time but little time left in life - which, besides influencing new late-in-life relationships, might also be relevant to other aspects of and choices in later life.

Welfare states differ greatly in the extent to which they provide social protection for various age-related social risks and set different priorities between needs associated with childhood, maturity, and old age. This chapter aims to explore and defend an ideal of age universalism in social insurance, according to which the degree of income replacement should be similar across age-related social risks. The argument suggests pragmatic advantages of age-balanced social insurance, showing that it tends to provide higher levels of income replacement for age-related risks throughout the life cycle and achieve more favourable social outcomes in all age groups, including poverty rates, trust, and subjective well-being.

Background and purpose Infections with human herpesvirus 6A (HHV-6A) and Epstein-Barr virus (EBV) have been linked to multiple sclerosis (MS) development. For EBV, late infection has been proposed as a risk factor, but serological support is lacking. The objective of this study was to investigate how age affects the EBV and HHV-6A associated risks of developing MS. Methods In this nested case-control study, Swedish biobanks were accessed to find pre-symptomatically collected blood samples from 670 individuals who later developed relapsing MS and 670 matched controls. A bead-based multiplex assay was used to determine serological response against EBV and HHV-6A. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals. Results Seropositivity against EBV exhibited a pattern where associations switched from a decreased risk of developing MS in the group below 20 years of age to an increased risk amongst individuals aged 20-29 and 30-39 years (p for trend 0.020). The age of transition was estimated to be 18.8 years. In contrast, HHV-6A was associated with increased MS risk in all age groups (total cohort odds ratio 2.1, 95% confidence interval 1.6-2.7). Conclusions This study suggests EBV infection after adolescence and age independent HHV-6A infection as risk factors for MS.

Background and purpose: Infections with human herpesvirus 6A (HHV-6A) and Epstein–Barr virus (EBV) have been linked to multiple sclerosis (MS) development. For EBV, late infection has been proposed as a risk factor, but serological support is lacking. The objective of this study was to investigate how age affects the EBV and HHV-6A associated risks of developing MS.

Methods: In this nested case–control study, Swedish biobanks were accessed to find pre-symptomatically collected blood samples from 670 individuals who later developed relapsing MS and 670 matched controls. A bead-based multiplex assay was used to determine serological response against EBV and HHV-6A. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals.

Results: Seropositivity against EBV exhibited a pattern where associations switched from a decreased risk of developing MS in the group below 20 years of age to an increased risk amongst individuals aged 20–29 and 30–39 years (p for trend 0.020). The age of transition was estimated to be 18.8 years. In contrast, HHV-6A was associated with increased MS risk in all age groups (total cohort odds ratio 2.1, 95% confidence interval 1.6–2.7).

Conclusions: This study suggests EBV infection after adolescence and age independent HHV-6A infection as risk factors for MS.

It has been suggested that volunteering leads to increases in well-being, particularly in older and retiring adults, and that volunteering could be used as a public health intervention to increase well-being. However, the causal relationship has been questioned. We investigated the association between voluntary work and life satisfaction in a bivariate dual-change score model, using 4 years of longitudinal data from 1,123 participants from the Health, Aging and Retirement Transitions in Sweden (HEARTS) study. Both the frequency of volunteering and the level of life satisfaction increased across the retirement transition. However, baseline life satisfaction and volunteering were only marginally associated. Further, the coupling parameters suggest that higher levels of volunteering were followed by decreases in life satisfaction and that higher levels of life satisfaction were followed by increases in volunteering. These findings suggest that increasing levels of volunteering might not be a fruitful strategy for improving life satisfaction for all older adults-if people engage too much in voluntary work, it might even be detrimental for their life satisfaction. More research is needed to better understand when and for whom increased levels of volunteering might have positive effects on life satisfaction.

Older adults have been shown to avoid negative and prefer positive information to a higher extent than younger adults. This positivity bias influences their information processing as well as decision-making. We investigate age-related positivity bias in charitable giving in two studies. In Study 1 we examine motivational factors in monetary donations, while Study 2 focuses on the emotional effect of actual monetary donations. In Study 1, participants (n = 353, age range 20-74 years) were asked to rate their affect toward a person in need and then state how much money they would be willing to donate to help this person. In Study 2, participants (n = 108, age range 19-89) were asked to rate their affect toward a donation made a few days prior. Regression analysis was used to investigate whether or not the positivity bias influences the relationship between affect and donations. In Study 1, we found that older adults felt more sympathy and compassion and were less motivated by negative affect when compared to younger adults, who were motivated by both negative and positive affect. In Study 2, we found that the level of positive emotional reactions from monetary donations was higher in older participants compared to younger participants. We find support for an age-related positivity bias in charitable giving. This is true for motivation to make a future donation, as well as affective thinking about a previous donation. We conclude that older adults draw more positive affect from both the planning and outcome of monetary donations and hence benefit more from engaging in monetary charity than their younger counterparts.

Since individual and societal expectations regarding the possibility of an extended working life after the expected retirement age are increasing, research on sustainable working life combined with healthy ageing is needed. This study explores the incentives behind and experiences of an extended working life after the expected retirement age of 65 among Swedish people. The inductive qualitative content analyses are based on 18 individual semi-structured interviews among persons 67–90 years old with varying characteristics and varying experiences of extended working lives. The analyses revealed that working contributed to (1) sustained internal resources, i.e., cognitive function, physical ability and increased vigor; (2) sustained external resources, i.e., social enrichment, better daily routines and economic benefits; (3) added meaningfulness to life, i.e., being needed, capability and satisfaction with working tasks. Meanwhile, having flexible working conditions enabled a satisfying balance between work and leisure. Altogether, these different aspects of overall health and working life were interpreted as contributing to increased feelings of vitality, the innermost dimension of health. Conclusions: regardless of biological age, our results indicate that being able to remain active in working life can be beneficial to vitality and could make these results valuable for both health-care personnel and employers.

Socialt arbete med äldre har under lång tid behandlats synonymt med äldreomsorg. Detta trots att målgruppen är heterogen med skiftande och individuella behov precis som alla andra människor. Detta gör att äldreomsorgen inte sällan får agera sista instans även för äldre personer med sociala problem som kanske inte alltid har tydliga omsorgsbehov. Detta riskerar leda till att vissa sociala problem som äldre personer har faller mellan stolarna och därför behöver biståndshandläggarens uppgifter och arbete för äldre personer breddas. Äldreförvaltningen i Göteborgs stad har beslutat att bredda yrkesrollen till att bistå äldre personer som har behov utanför äldreomsorgen. I samverkan med forskare vid Institutionen för socialt arbete, Göteborgs universitet och Högskolan Väst delades en webbenkät ut till 205 biståndshandläggare i Göteborgs Stad inom avdelningen för myndighet äldre. Kartläggningen genomförs innan förändringen av yrkesrollen ägt rum med som en sorts temperaturtagning av utgångsläget och förutsättningar inför breddningen av yrkesrollen. Materialet från enkätundersökningen används och utgör material till aktuell magisteruppsats för att studera i vilken utsträckning som sociala problem hanteras inom äldreomsorgen inom den traditionella biståndshandläggarrollen. Syftet är att studera biståndshandläggares arbete med sociala problem inom äldreomsorgen och hur detta påverkas av utbildningsbakgrund och antal år i arbetet som biståndshandläggare. Resultaten visar att biståndshandläggare sällan möter sociala problem och att de hänvisar i låg uträckning till andra myndigheter och verksamheter. Det verkar som att antal år i arbetet har större betydelse än utbildningsbakgrund för hantering av sociala problem. Samtidigt säger studien för lite om biståndshandläggarens förutsättningar i arbetet och fler studier behövs. Biståndshandläggare vill arbeta mer förebyggande. Utifrån studiens resultat kan kunskap om relationen mellan olika sociala problem därför förstås som viktig för att de bättre ska kunna upptäcka och förebygga problemen. Breddningen av biståndshandläggarens uppdrag kan även kräva mer kunskap om hanteringen av sociala problem mellan myndigheter och verksamheter som kommer i kontakt med äldre personer och de sociala problemen.

The focus of Narrative Gerontology is placed on stories about the aging process. In the present paper, the learning of older adults in a Senior University context is captured by means of stories written by the participants themselves. The examination of older adults' stories, as they look back on life or any narrative that connected to a specific area of life, can contribute to our understanding of growth later in life. The aim of the study is to examine how growth manifests itself later in life. Participants at Senior University were asked to share their experiences of education later in life. Participation was voluntary and the identity of each participant was kept anonymous for the purpose of the research project. Fifty-three stories written by Senior University participants (n = 38 women and 15 men) were analyzed according to: (i) an inductive analysis of the stories that resulted in a description of the main topics addressed in the stories, and (ii) a deductive analysis that invoked a theoretical framework concerning the existential aspects of older adults' learning, including “corporeality,” “relationality,” “spatiality,” “temporality,” and “materiality.” The two analyses were compared, and it was noted that “relationality” and “spatiality” corresponded to the educational experiences in the stories. “Relationality” was observed to be concerned with the social dimensions of life; but in the context of Senior University, “relationality” was strongly intertwined with the learning process. “Spatiality” addressed how older adults relate to physical- and mental space. Participation at Senior University entailed an expansion of both physical- and mental space for the participants. A number of tensions were identified in the stories. One the one hand, the stories can be interpreted as illustrations of moving forward and embracing continued growth and development. On the other hand, the stories can be interpreted as illustrations of resistance toward aging and decline. Since life is complex and contradictory, multiple, and even contradictory plots, co-exist in life stories.

A prolonged working life is crucial for sustaining social welfare and fiscal stability for countries facing ageing populations. The group of older adults is not homogeneous; however, differences within the group may affect the propensity to continue working and to participate in continuing education. The aim of this paper is to explore how participation in work and education vary with gender, age, and education level in a sample of older adults. The study was performed in Sweden, a context characterized by high female labour-market-participation rates and a high average retirement age. The participants were 232 members of four of the major senior citizens? organizations. We found no differences in participation in work and education based on gender. People older than 75 years were found to be as active as people 65?75 years old in education, but the older group worked less. There were positive associations between education level and participation in both work and education. Hence, this study implies that socio-economic inequalities along these dimensions are widened later in life. This highlights the importance of engaging workers with lower education levels in educational efforts throughout life. It also emphasizes the need for true lifelong learning in society.

Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk-benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.

Background: Earlier studies in nursing homes show a high prevalence of cognitive impairment, dependency in activities of daily living (ADL), pain, and neuropsychiatric symptoms among residents. The aim of this study was to explore the prevalence of the above among residents in a nationally representative sample of Swedish nursing homes, and to investigate whether pain and neuropsychiatric symptoms differ in relation to gender, cognitive function, ADL-capacity, type of nursing-home unit and length of stay. Methods: Cross-sectional data from 188 randomly selected nursing homes were collected. A total of 4831 residents were assessed for cognitive and ADL function, pain and neuropsychiatric symptoms. Data were analysed using descriptive statistics and the chi-square test. Results: The results show the following: the prevalence of cognitive impairment was 67 %, 56 % of residents were ADL-dependent, 48 % exhibited pain and 92 % exhibited neuropsychiatric symptoms. The prevalence of pain did not differ significantly between male and female residents, but pain was more prevalent among cognitively impaired and ADL-dependent residents. Pain prevalence was not significantly different between residents in special care units for people with dementia (SCU) and general units, or between shorter-and longer-stay residents. Furthermore, the prevalence of neuropsychiatric symptoms did not differ significantly between male and female residents, between ADL capacities or in relation to length of stay. However, residents with cognitive impairment and residents in SCUs had a significantly higher prevalence of neuropsychiatric symptoms than residents without cognitive impairment and residents in general units. Conclusions: The prevalence rates ascertained in this study could contribute to a greater understanding of the needs of nursing-home residents, and may provide nursing home staff and managers with trustworthy assessment scales and benchmark values for further quality assessment purposes, clinical development work and initiating future nursing assessments.

Objectives: The purpose of this study was to explore relations among thriving, cognitive function, and neuropsychiatric symptoms (NPS) in nursing home residents.

Methods: A national, cross-sectional, randomized study of Swedish nursing home residents (N = 4831) was conducted between November 2013 and September 2014. Activities of daily life functioning, cognitive functioning, NPS, and thriving were assessed with the Katz activities of daily living, Gottfries' Cognitive Scale, Nursing Home version of the Neuropsychiatric Inventory, and Thriving of Older People Scale, respectively. Individual NPS were explored in relation to cognitive function. Simple linear and multiple regression models were used to explore thriving in relation to resident characteristics.

Results: Aggression and depressive symptoms were identified as negatively associated with thriving regardless of resident cognitive functioning. At higher levels of cognitive functioning, several factors showed associations with thriving; however, at lower levels of cognitive functioning, only the degree of cognitive impairment and the NPS was associated with thriving. Most of the individual NPS formed nonlinear relationships with cognitive functioning with higher symptom scores in the middle stages of cognitive functioning. Exceptions were elation/euphoria and apathy, which increased linearly with severity of cognitive impairment.

Conclusions: The lower the cognitive functioning was, the fewer factors were associated with thriving. Aggression and depressive symptoms may indicate lower levels of thriving; thus, targeting these symptoms should be a priority in nursing homes.

Background: Driving is a complex activity requiring highly integrated cognitive and perceptual functions that can be negatively affected following a stroke. The decision to continue or cease with driving after a stroke may not be exclusively dependent on deficits in cognitive and motor abilities. Instead, it is possible that social supports, alternative means of transportation, education level, income, self-regulation ability and the awareness of personal health problems may also influence the decision.

Aim: The aim of this research was to explore the influence of personal and socioeconomic factors, in addition to existing cognitive impairment, on the decision of post-stroke adults to return to driving.

Method: A case control design was employed to compare driving performance of 48 individuals who had experienced a stroke and 22 volunteer healthy control participants. Half of the post-stroke cohort (N=24) had continued driving and the other half had ceased driving. Socio-demographic and driving-related cognitive performance data were collected to characterise the comparison groups before driving performance was assessed in a driving simulator.

Results: Overall, the post-stroke groups did not perform as well as the control participants in the cognitive and driving assessments. The perceived ability to drive after a stroke was not significantly correlated with participants'€™ actual driving ability. Post-stroke adults were more likely to continue driving if they reported having a tertiary level education and a greater income.

Conclusion: The decision to return to driving after a stroke is a complicated, multifactorial process. This study confirms previous research, which found that cognition and driving performance are impaired poststroke. The findings also suggest that post-stroke drivers'€™ decision to return to driving was not linked to their ability to drive, but more to socio-demographic and environmental factors. Further screening tools and assessments to identify those at risk when returning to the road post-stroke are required. 

Driving is an important activity of daily living, which is increasingly relied upon as the population ages. It has been well-established that cognitive processes decline following a stroke and these processes may influence driving performance. There is much debate on the use of off-road neurological assessments and driving simulators as tools to predict driving performance; however, the majority of research uses unlicensed poststroke drivers, making the comparability of poststroke adults to that of a control group difficult. It stands to reason that in order to determine whether simulators and cognitive assessments can accurately assess driving performance, the baseline should be set by licenced drivers. Therefore, the aim of this study was to assess differences in cognitive ability and driving simulator performance in licensed community-dwelling poststroke drivers and controls. Two groups of licensed drivers (37 poststroke and 43 controls) were assessed using several cognitive tasks and using a driving simulator. The poststroke adults exhibited poorer cognitive ability; however, there were no differences in simulator performance between groups except that the poststroke drivers demonstrated less variability in driver headway. The application of these results as a prescreening toolbox for poststroke drivers is discussed.

Background: The comparison of traits in twins from opposite-sex (OS) and same-sex (SS) dizygotic twin pairs is considered a proxy measure of prenatal hormone exposure. To examine possible prenatal hormonal influences on anthropometric traits, we compared mean height, body mass index (BMI) and the prevalence of being overweight or obese between men and women from OS and SS dizygotic twin pairs.

Methods: The data were derived from COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) database, and included 68,494 SS and 53,808 OS dizygotic twin individuals above the age of 20 years from 31 twin cohorts representing 19 countries. Zygosity was determined by questionnaires or DNA genotyping depending on the study. Multiple regression and logistic regression models adjusted for cohort, age and birth year with the twin type as a predictor were carried out to compare height and BMI in twins from OS pairs with those from SS pairs and to calculate the adjusted odds ratios and 95% confidence intervals for being overweight or obese.

Results: OS females were, on average, 0.31 cm (95% confidence interval (CI): 0.20, 0.41) taller than SS females. OS males were also, on average, taller than SS males, but this difference was only 0.14 cm (95% CI: 0.02, 0.27). Mean BMI and the prevalence of overweight or obesity did not differ between males and females from SS and OS twin pairs. The statistically significant differences between OS and SS twins for height were small and appeared to reflect our large sample size rather than meaningful differences of public health relevance.

Conclusions: We found no evidence to support the hypothesis that prenatal hormonal exposure or postnatal socialization (i.e., having grown up with a twin of the opposite sex) has a major impact on height and BMI in adulthood.

Background: The comparison of traits in twins from opposite-sex (OS) and same-sex (SS) dizygotic twin pairs is considered a proxy measure of prenatal hormone exposure. To examine possible prenatal hormonal influences on anthropometric traits, we compared mean height, body mass index (BMI) and the prevalence of being overweight or obese between men and women from OS and SS dizygotic twin pairs.

Methods: The data were derived from COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) database, and included 68,494 SS and 53,808 OS dizygotic twin individuals above the age of 20 years from 31 twin cohorts representing 19 countries. Zygosity was determined by questionnaires or DNA genotyping depending on the study. Multiple regression and logistic regression models adjusted for cohort, age and birth year with the twin type as a predictor were carried out to compare height and BMI in twins from OS pairs with those from SS pairs and to calculate the adjusted odds ratios and 95% confidence intervals for being overweight or obese.

Results: OS females were, on average, 0.31 cm (95% confidence interval (CI): 0.20, 0.41) taller than SS females. OS males were also, on average, taller than SS males, but this difference was only 0.14 cm (95% CI: 0.02, 0.27). Mean BMI and the prevalence of overweight or obesity did not differ between males and females from SS and OS twin pairs. The statistically significant differences between OS and SS twins for height were small and appeared to reflect our large sample size rather than meaningful differences of public health relevance.

Conclusions: We found no evidence to support the hypothesis that prenatal hormonal exposure or postnatal socialization (i.e., having grown up with a twin of the opposite sex) has a major impact on height and BMI in adulthood.

This book aims to contribute to the essential and timely discussion on age, ageism, population ageing, and public policy. It attempts to demonstrate the breadth of the challenges by covering a wide range of policy areas from health care to old-age support, from democratic participation to education, from family to fiscal policy. It bridges the distance between academia and public life by putting into dialogue fresh philosophical analyses and new specific policy proposals. It approaches familiar issues such as age discrimination, justice between age groups, and democratic participation across the ages from novel perspectives. This introductory chapter provides an overview of the structure of the book and its topics. 

Background. Hearing deterioration at advanced ages is associated with environmental exposures (eg, to noise and solvents) and genetic influences may also be important. Little is known about the role of genetic influences on hearing when evaluated longitudinally. We sought to investigate longitudinal hearing loss in a cohort of adult male twins to evaluate the importance of genetic and environmental factors for hearing deterioration over time. Methods. Hearing using conventional clinical audiometry was assessed in 583 male twins (128 monozygotic twin pairs and 111 dizygotic twin pairs) aged 34-79 at baseline and again two decades later. The hearing thresholds at two time points were compared at each frequency and in two different frequency regions. Genetic analyses were based on structural equation models. Bivariate Cholesky decomposition was used for longitudinal analysis. Results. The prevalence of hearing loss increased over time in better and worse ear. The hearing threshold shift was more pronounced in the high-frequency region, especially at 8000 Hz. Genetic influences were moderate (heritability: 53%-65%) for pure-tone averages at both lower and higher frequencies, and were of equal magnitude at baseline and follow-up. In contrast, environmental influences were of substantial importance (55%-88%) for rate of change of the hearing threshold over the 18-year period. Conclusions. Genetic factors are of considerable importance for level of hearing acuity, but environmental factors are more important for rate of change over an 18-year period.

Objective: Research has suggested that greater psychophysiological reactivity to stress increases risk of dementia and that those with the Type A behavior pattern (TABP) are predisposed to elevated stress reactivity and cardiovascular disease (CVD), but no study has evaluated the associations among TABP, CVD, and dementia, prospectively. Hence, the present study aimed to investigate dementia risk in relation to TABP and CVD.

Methods: A population-based cohort of 1,069 persons with a baseline mean age of 64.81 years from the Swedish Twin Registry was followed consecutively for up to 23 years. Based on self-reported items, TABP was measured using 6 scales: Ambition, Stress, Hard-driving, Neuroticism, Cynicism, and Paranoia. CVD was self-reported and dementia was diagnosed adhering to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) or Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria.

Results: TABP was generally not associated with dementia risk. However, significant interaction effects of stress, paranoia, and cynicism with CVD on dementia risk were observed. That is, for those with CVD, high scores on stress, paranoia, and cynicism were associated with increased risk of dementia (hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 0.95-2.15; HR = 1.39, 95% CI = 0.83-2.33; HR = 1.25, 95% CI = 0.76-2.06, respectively), whereas for those who did not have CVD, high scores on these measures appeared to be protective (HR = 0.76, 95% CI = 0.50-1.14; HR = 0.55, 95% CI = 0.34-0.89; HR = 0.50, 95% CI = 0.29-0.84, respectively).

Conclusion: Some features of TABP confer an increased risk for dementia in those with CVD, whereas those without CVD are protected. When evaluating the risk of dementia, CVD and personality traits should be taken into consideration.

Background: While research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

Methods: Screening Across the Lifespan Twin Study (SALT) participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios (HR) for dementia.

Results: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤ 6 hours) and extended (> 9 hours) time-in-bed (TIB) compared to the middle reference group (HR=1.40, 95% CI=1.06-1.85, HR=1.11, 95% CI=1.00-1.24, respectively) and rising at 8:00AM or later compared to earlier rising (HR=1.12, 95% CI=1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

Conclusions: Short and extended TIB as well as delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

BACKGROUND: Although research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

METHODS: Screening Across the Lifespan Twin (SALT) study participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios for dementia.

RESULTS: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤6 hours) and extended (>9 hours) time in bed (TIB) compared to the middle reference group (hazard ratio = 1.40, 95% confidence interval = 1.06-1.85; hazard ratio = 1.11, 95% confidence interval = 1.00-1.24, respectively) and rising at 8:00 AM or later compared to earlier rising (hazard ratio = 1.12, 95% confidence interval = 1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

CONCLUSIONS: Short and extended TIB and delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

Background: While research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

Methods: Screening Across the Lifespan Twin Study (SALT) participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios (HR) for dementia.

Results: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤ 6 hours) and extended (> 9 hours) time-in-bed (TIB) compared to the middle reference group (HR=1.40, 95% CI=1.06-1.85, HR=1.11, 95% CI=1.00-1.24, respectively) and rising at 8:00AM or later compared to earlier rising (HR=1.12, 95% CI=1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

Conclusions: Short and extended TIB as well as delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

Objectives The few studies of shift work and late life cognitive functioning have yielded mixed findings. The aim of the present study is to estimate the association between shift-work experience and change in cognitive performance before and after retirement age among older adults who were gainfully employed.

Methods Five hundred and ninety five participants with no dementia were followed up for a mean of 17.6 standard deviation (SD) 8.8 years from a Swedish population-based sample. Participants had self-reported information on any type of shift-work experience (ever/never) in 1984 and measures of cognitive performance (verbal, spatial, memory, processing speed, and general cognitive ability) from up to 9 waves of cognitive assessments during 1986–2012. Night work history (ever/never) from 1998–2002 was available from a subsample (N=320). Early adult cognitive test scores were available for 77 men.

Results In latent growth curve modeling, there were no main effects of "any-type" or night shift work on the mean scores or rate of change in any of the cognitive domains. An interaction effect between any-type shift work and education on cognitive performance at retirement was noted. Lower-educated shift workers performed better on cognitive tests than lower-educated day workers at retirement. Sensitivity analyses, however, indicated that the interactions appeared to be driven by selection effects. Lower-educated day workers demonstrated poorer cognitive ability in early adulthood than lower-educated shift workers, who may have selected jobs entailing higher cognitive demand.

Conclusion There was no difference in late-life cognitive aging between individuals with a history of working shifts compared to those who had typical day work schedules during midlife.

Objectives The few studies of shift work and late life cognitive functioning have yielded mixed findings. The aim of the present study is to estimate the association between shift-work experience and change in cognitive performance before and after retirement age among older adults who were gainfully employed.

Methods Five hundred and ninety five participants with no dementia were followed up for a mean of 17.6 standard deviation (SD) 8.8 years from a Swedish population-based sample. Participants had self-reported information on any type of shift-work experience (ever/never) in 1984 and measures of cognitive performance (verbal, spatial, memory, processing speed, and general cognitive ability) from up to 9 waves of cognitive assessments during 1986–2012. Night work history (ever/never) from 1998–2002 was available from a subsample (N=320). Early adult cognitive test scores were available for 77 men.

Results In latent growth curve modeling, there were no main effects of "any-type" or night shift work on the mean scores or rate of change in any of the cognitive domains. An interaction effect between any-type shift work and education on cognitive performance at retirement was noted. Lower-educated shift workers performed better on cognitive tests than lower-educated day workers at retirement. Sensitivity analyses, however, indicated that the interactions appeared to be driven by selection effects. Lower-educated day workers demonstrated poorer cognitive ability in early adulthood than lower-educated shift workers, who may have selected jobs entailing higher cognitive demand.

Conclusion There was no difference in late-life cognitive aging between individuals with a history of working shifts compared to those who had typical day work schedules during midlife.

BackgroundNew technologies such as mobile/smartphones have the potential to help senior people perform everyday activities. However, senior people may find it difficult using mobile/smartphones, especially the digital calendar and short text message features. Therefore, senior people might need user-friendly, flexible, and interactive digital calendars that provide them with active reminders about their everyday activities. This study focuses on community dwelling seniors experiences learning and using RemindMe, an interactive digital calendar with active reminders, as part of customizing an intervention appropriate for senior people with cognitive impairments.MethodsFour focus groups were conducted with 20 community dwelling seniors (11 men and 9 women) who all had used RemindMe for six weeks. The focus groups were tape recorded, transcribed verbatim, and analysed using content analysis.ResultsFor participants in this study, using a calendar was an essential part of their everyday lives, but only a few had experiences using a digital calendar. Although the participants described RemindMe as easy to use, they had a difficult time incorporating RemindMe into their daily routines. In part, these difficulties were the result of the participants needing to change their mobile/smartphone routines. Some participants felt that using an interactive digital calendar was a sign of modernity allowing them to take part in the society at large, but others felt that their inability to use the technology was due to their age, dependence, and loss of function. Participants found that receiving active reminders through short text messages followed by actively acknowledging the reminder helped them perform more everyday life activities. This feature gave them a higher sense of independence and control.ConclusionsCommunity dwelling seniors found that RemindMe was easy to learn and to use, although they also found it challenging to integrate into their everyday lives. For senior people to make the effort to develop new routines for mobile/smartphone use, a prerequisite for using a digital calendar, they need to be motivated and believe that the technology will make their lives better.

The association between nightmare frequency (NMF) and suicidal ideation (SI) is well known, yet the impact of the COVID-19 pandemic on this relation is inconsistent. This study aimed to investigate changes in NMF, SI, and their association during the COVID-19 pandemic. Data were collected in 16 countries using a harmonised questionnaire. The sample included 9328 individuals (4848 women; age M[SD] = 46.85 [17.75] years), and 17.60% reported previous COVID-19. Overall, SI was significantly 2% lower during the pandemic vs. before, and this was consistent across genders and ages. Most countries/regions demonstrated decreases in SI during this pandemic, with Austria (-9.57%), Sweden (-6.18%), and Bulgaria (-5.14%) exhibiting significant declines in SI, but Italy (1.45%) and Portugal (2.45%) demonstrated non-significant increases. Suicidal ideation was more common in participants with long-COVID (21.10%) vs. short-COVID (12.40%), though SI did not vary by COVID-19 history. Nightmare frequency increased by 4.50% during the pandemic and was significantly higher in those with previous COVID-19 (14.50% vs. 10.70%), during infection (23.00% vs. 8.10%), and in those with long-COVID (18.00% vs. 8.50%). The relation between NMF and SI was not significantly stronger during the pandemic than prior (rs = 0.18 vs. 0.14; z = 2.80). Frequent nightmares during the pandemic increased the likelihood of reporting SI (OR = 1.57, 95% CI 1.20-2.05), while frequent dream recall during the pandemic served a protective effect (OR = 0.74, 95% CI 0.59-0.94). These findings have important implications for identifying those at risk of suicide and may offer a potential pathway for suicide prevention.

PURPOSE: To identify, based on the literature, people with dementia's potentials to manage an easy-to-use videophone, and to develop a videophone requirement specification for people with dementia.

METHOD: The study is based on the Inclusive Design method, utilising the first two of four phases. Content analyses of literature reviews were used to identify users' potentials for managing a videophone and to gather recommendations regarding communication technology design for the target group. Existing videophones in Sweden were examined regarding potential fit to users with dementia.

FINDINGS: This led to detailed identification of cognitive, physical and psychosocial challenges that people with dementia will probably have when using an ordinary telephone or videophone. A requirement specification for videophone design to fit users with dementia was formulated, with the seven principles of Universal Design as a framework.

CONCLUSIONS: The requirement specification presented here is aimed at designing a videophone but might also facilitate design of other products for people with dementia, particularly in the field of communication technology. Based on this, further work will focus on developing a design concept and a prototype to be empirically tested by people with dementia and their significant others, i.e. the final two design process phases.

Purpose: To develop a design concept for an easy-to-use videophone for people with dementia and to evaluate the design and need of such a product.

Method: In this project, we have used an inclusive design approach that includes the target users in the design process. In an earlier study, the need of a videophone was examined and a requirement specification was developed. In this study, a preliminary design concept was developed. Five focus groups of people with dementia, significant others and occupational therapists working with people with dementia were formed to capture their experiences, expectations and thoughts concerning the videophone and the design concept. Data were analysed using a grounded theory approach.

Findings: The participants pointed out that the design of the videophone should be flexible in order to meet the needs of people with dementia, be easy-to-use and not look like assistive technology. In order to facilitate learning, the videophone should be introduced in an early stage of the disease.

Conclusions: A videophone has potentials to enable videophone calls without assistance, add quality in communication and provide possibilities for monitoring. Further work will focus on developing a prototype to be empirically tested by people with dementia and significant others.

Implications for Rehabilitation

• An easy-to-use videophone was viewed as an important device that could support people with dementia in making videophone calls without assistance. It was also viewed as a product that significant others could use for monitoring the person with dementia, for example to judge the well-being of the person. But monitoring should be used with caution and not without the consent of the person with dementia.
• It was viewed as important that the videophone be introduced in an early stage of the disease in order to facilitate learning, so that the person can get used to the new way of making telephone calls and incorporate the new habit in his/her routines.
• In order to motivate people with dementia to start using a videophone, it was recommended that the videophone should be introduced as a product which is a pleasure to use, and not as a compensation for impairment or to solve a problem.

Objectives To study the value of combining individual- and neighborhood-level sociodemographic data to predict study participation and assess the effects of baseline selection on the distribution of metabolic risk factors and lifestyle factors in the Swedish CardioPulmonary bioImage Study (SCAPIS). Methods We linked sociodemographic register data to SCAPIS participants (n = 30,154, ages: 50-64 years) and a random sample of the studys target population (n = 59,909). We assessed the classification ability of participation models based on individual-level data, neighborhood-level data, and combinations of both. Standardized mean differences (SMD) were used to examine how reweighting the sample to match the population affected the averages of 32 cardiopulmonary risk factors at baseline. Absolute SMDs > 0.10 were considered meaningful. Results Combining both individual-level and neighborhood-level data gave rise to a model with better classification ability (AUC: 71.3%) than models with only individual-level (AUC: 66.9%) or neighborhood-level data (AUC: 65.5%). We observed a greater change in the distribution of risk factors when we reweighted the participants using both individual and area data. The only meaningful change was related to the (self-reported) frequency of alcohol consumption, which appears to be higher in the SCAPIS sample than in the population. The remaining risk factors did not change meaningfully. Conclusions Both individual- and neighborhood-level characteristics are informative in assessing study selection effects. Future analyses of cardiopulmonary outcomes in the SCAPIS cohort can benefit from our study, though the average impact of selection on risk factor distributions at baseline appears small.