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  • 851.
    Kirsebom, Marie
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Hedström, Mariann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Wadensten, Barbro
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Pöder, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    The frequency of and reasons for acute hospital transfers of older nursing home residents2013Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, nr 1, s. 115-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. Structured reviews of the electronic healthcare records were performed. Included were residents living in a nursing home age 65+, with healthcare records including documented transfers to the ED during a 9-month period in 2010. The transfer rate to the ED was 594 among a total of 431 residents (M = 1.37 each). 63% resulted in hospitalization (M = 7.12 days). Nursing home's transfer rate differed between 0.00 and 1.03 transfers/ bed and was higher for the private for-profit providers than for public/private non-profit providers. One- fourth of the transfers were caused by falls and/or injuries, including fractures. The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored.

     

  • 852.
    Kirsebom, Marie
    et al.
    Uppsala University.
    Hedström, Mariann
    Uppsala University.
    Wadensten, Barbro
    Uppsala University.
    Pöder, Ulrika
    Uppsala University.
    The frequency of and reasons for acute hospital transfers of older nursing home residents2013Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, nr 1, s. 115-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. Structured reviews of the electronic healthcare records were performed. Included were residents living in a nursing home age 65+, with healthcare records including documented transfers to the ED during a 9-month period in 2010. The transfer rate to the ED was 594 among a total of 431 residents (M = 1.37 each). 63% resulted in hospitalization (M = 7.12 days). Nursing home's transfer rate differed between 0.00 and 1.03 transfers/ bed and was higher for the private for-profit providers than for public/private non-profit providers. One- fourth of the transfers were caused by falls and/or injuries, including fractures. The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored.

     

  • 853. Kivimaki, Mika
    et al.
    Singh-Manoux, Archana
    Pentti, Jaana
    Sabia, Severine
    Nyberg, Solja T.
    Alfredsson, Lars
    Goldberg, Marcel
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Oksanen, Tuula
    Strandberg, Timo
    Suominen, Sakari B.
    Theorell, Tores
    Vahtera, Jussi
    Vaananen, Ari
    Virtanen, Marianna
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Seshadri, Sudha
    Batty, G. David
    Sipila, Pyry N.
    Shipley, Martin J.
    Lindbohm, Joni V.
    Ferrie, Jane E.
    Jokela, Markus
    Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis2019Ingår i: The BMJ, E-ISSN 1756-1833, Vol. 365, artikel-id l1495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

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  • 854. Kivimäki, Mika
    et al.
    Singh-Manoux, Archana
    Pentti, Jaana
    Sabia, Séverine
    Nyberg, Solja T.
    Alfredsson, Lars
    Goldberg, Marcel
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Nordin, Maria
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Umeå University, Sweden.
    Oksanen, Tuula
    Strandberg, Timo
    Suominen, Sakari B.
    Theorell, Töres
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Vahtera, Jussi
    Väänänen, Ari
    Virtanen, Marianna
    Westerholm, Peter
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Zins, Marie
    Seshadri, Sudha
    Batty, G. David
    Sipilä, Pyry N.
    Shipley, Martin J.
    Lindbohm, Joni V.
    Ferrie, Jane E.
    Jokela, Markus
    Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis2019Ingår i: The BMJ, E-ISSN 1756-1833, Vol. 365, artikel-id 1495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

  • 855.
    Kivipelto, Miia
    et al.
    Karolinska Institutet ; Karolinska University Hospital ; University of Eastern Finland, Finland.
    Håkansson, Krister
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för psykologi (PSY). Karolinska Institutet.
    A Rare Success against Alzheimer's2017Ingår i: Scientific American, ISSN 0036-8733, E-ISSN 1946-7087, Vol. 316, nr 4, s. 32-37Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]
    • Two hundred experimental drugs intended to treat Alzheimer's disease have failed in the past 30 years. Without new therapies, the number of patients worldwide will increase dramatically by 2050.
    • A ray of hope has come recently from a clinical trial that showed that dementia's cognitive impairment might be prevented by paying close attention to various health factors.
    • Participants in the study who followed a regimen of health-related steps registered improvements on cognitive measures such as memory and mental-processing speed.
    • Results of this research suffice for health care professionals to begin making a series of recommendations to patients on diet, exercise and levels of social engagement that may help prevent dementia.
  • 856. Kivipelto, Miia
    et al.
    Mangialasche, Francesca
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Karolinska Institutet, Sweden.
    Ngandu, Tiia
    Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease2018Ingår i: Nature Reviews Neurology, ISSN 1759-4758, E-ISSN 1759-4766, Vol. 14, nr 11, s. 653-666Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Research into dementia prevention is of paramount importance if the dementia epidemic is to be halted. Observational studies have identified several potentially modifiable risk factors for dementia, including hypertension, dyslipidaemia and obesity at midlife, diabetes mellitus, smoking, physical inactivity, depression and low levels of education. Randomized clinical trials are needed that investigate whether interventions targeting these risk factors can reduce the risk of cognitive decline and dementia in elderly adults, but such trials are methodologically challenging. To date, most preventive interventions have been tested in small groups, have focused on a single lifestyle factor and have yielded negative or modest results. Given the multifactorial aetiology of dementia and late-onset Alzheimer disease, multidomain interventions that target several risk factors and mechanisms simultaneously might be necessary for an optimal preventive effect. In the past few years, three large multidomain trials (FINGER, MAPT and PreDIVA) have been completed. The FINGER trial showed that a multidomain lifestyle intervention can benefit cognition in elderly people with an elevated risk of dementia. The primary results from the other trials did not show a statistically significant benefit of preventive interventions, but additional analyses among participants at risk of dementia showed beneficial effects of intervention. Overall, results from these three trials suggest that targeting of preventive interventions to at-risk individuals is an effective strategy. This Review discusses the current knowledge of lifestyle-related risk factors and results from novel trials aiming to prevent cognitive decline and dementia. Global initiatives are presented, including the World Wide FINGERS network, which aims to harmonize studies on dementia prevention, generate high-quality scientific evidence and promote its implementation.

  • 857.
    Kjerstin, Larsson
    et al.
    Region Örebro län. Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center.
    Wallroth, Veronika
    Division of Social Work (SOCARB), Department of Culture and Society (IKOS), Linköping University, Linköping, Sweden.
    Schröder, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Nursing, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), 2815 Gjövik, Norway.
    Efforts of a Mobile Geriatric Team from a Next-of-Kin Perspective: A Phenomenographic Study2023Ingår i: Healthcare, E-ISSN 2227-9032, Vol. 11, nr 7, artikel-id 1038Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Many older adults with complex illnesses are today cared for by their next of kin in their own homes and are often sent between different caregivers in public healthcare. Mobile Geriatric Teams (MGTs) are a healthcare initiative for older adults with extensive care needs living at home, coordinated between hospital, primary, and municipal care. The study aims to describe how next of kin experience care efforts from an MGT for their older adult family members. The study has a descriptive qualitative design and uses a phenomenographic approach. Fourteen next of kin to older adult family members who receive efforts from an MGT were interviewed. Two descriptive categories reflecting their experiences emerged: Professional care and No longer having the main responsibility. The study shows that the participants valued that the staff was very competent, that the physician made home visits and could make quick decisions, and that treatments were given at home. They feel that they receive support and experience security and that a burden is lifted from them. Our study shows that through the MGT, next of kin become involved in the care and are relieved of the burden of responsibility of caring for their older family member.

  • 858. Kletzel, Sandra L.
    et al.
    Sood, Pallavi
    Negm, Ahmed
    Heyn, Patricia C.
    Krishnan, Shilpa
    Machtinger, Joseph
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Neurocentrum, NUS.
    Devos, Hannes
    Effectiveness of Brain Gaming in Older Adults With Cognitive Impairments: A Systematic Review and Meta-Analysis.2021Ingår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 22, nr 11, s. 2281-2288Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: This systematic review and meta-analysis evaluates the evidence from randomized clinical trials (RCTs) that designed brain gaming interventions to improve cognitive functions of older adults with cognitive impairments, including mild cognitive impairments and dementia.

    DESIGN: Systematic review and meta-analysis.

    SETTING AND PARTICIPANTS: N/A.

    MEASURES: N/A.

    METHODS: Data sources-relevant randomized control trials (RCTs) were identified by a systematic search of databases including Medline, PubMed, PsycINFO, Embase, CINAHL, Web of Science, and Cochrane. RCTs were selected first based on title and abstract review and then on full-text review by independent reviewers using predefined eligibility criteria. Risk of bias (RoB) was assessed using the Cochrane RoB tool and funnel plots. The primary outcome variable was the composite score of global cognitive function.

    RESULTS: A total of 909 participants with mild cognitive impairment or dementia from 16 RCTs were included in the systematic review. The study quality was modest, and the RoB assessment showed bias in blinding the participants and personnel. Funnel plots showed no evidence of publication bias. The meta-analysis of 14 RCTs revealed no superior effect of brain gaming compared to other interventions on global cognitive function (pooled standardized mean difference = 0.08, 95% confidence interval -0.24, 0.41, P = .61, I2 = 77%). Likewise, no superior effects were found on the cognitive domains of memory, executive function, visuospatial skills, and language.

    CONCLUSION AND IMPLICATIONS: The findings of this meta-analysis suggest that brain gaming compared with the control intervention does not show significant improvement in standardized tests of cognitive function. Because of considerable heterogeneity in sample size, gaming platform, cognitive status, study design, assessment tools, and training prescription, we cannot confidently refute the premise that brain gaming is an effective cognitive training approach for older adults with cognitive impairments. Recommendations for future research are included.

  • 859.
    Kochar, Bharati
    et al.
    Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Clinical Translational Epidemiology Unit, Mongan Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Center for Aging and Serious Illness, Mongan Institute, Boston, Massachusetts..
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden..
    Söderling, Jonas
    Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts..
    Ritchie, Christine S
    Harvard Medical School, Boston, Massachusetts; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet Stockholm, Sweden; Center for Aging and Serious Illness, Mongan Institute, Boston, Massachusetts..
    Ludvigsson, Jonas F
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York..
    Khalili, Hamed
    Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Clinical Translational Epidemiology Unit, Mongan Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts..
    Olén, Ola
    Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden..
    Prevalence and Implications of Frailty in Older Adults With Incident Inflammatory Bowel Diseases: A Nationwide Cohort Study2022Ingår i: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 20, nr 10, s. 2358-2365Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: We aimed to compare the risk of frailty in older adults with incident inflammatory bowel disease (IBD) and matched non-IBD comparators and assess the association between frailty and future hospitalizations and mortality.

    Methods: In a cohort of patients with incident IBD ≥60 years of age from 2007 to 2016 in Sweden identified using nationwide registers, we defined frailty using Hospital Frailty Risk Score. We compared prevalence of frailty in patients with IBD with age, sex, place of residency- and calendar year-matched population comparators. In the IBD cohort, we used Cox proportional hazards modeling to examine the associations between frailty risk and hospitalizations or mortality.

    Results: We identified 10,590 patients with IBD, 52% female with a mean age of 71 years of age, matched to 103,398 population-based comparators. Among patients with IBD, 39% had no risk for frailty, 49% had low risk for frailty, and 12% had higher risk for frailty. Mean Hospital Frailty Risk Score was 1.9 in IBD and 0.9 in matched comparators (P &lt; .01). Older adults with IBD at higher risk for frailty had a 20% greater risk for mortality at 3 years compared with those who were not frail. Compared with nonfrail older patients with IBD, patients at higher risk for frailty had increased mortality (hazard ratio [HR], 3.22, 95% confidence interval [CI], 2.86-3.61), all-cause hospitalization (HR, 2.42; 95% CI, 2.24-2.61), and IBD-related hospitalization (HR, 1.50; 95% CI, 1.35-1.66). These associations were not attenuated after adjusting for comorbidities.

    Conclusions: Frailty is more prevalent in older adults with IBD than in matched comparators. Among older patients with IBD, frailty is associated with increased risk for hospitalizations and mortality.

  • 860.
    Koistinen, Susanne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. School of Health and Welfare, Dalarna University, Falun, Sweden.
    Ståhlnacke, Katri
    Dental Research Department, Postgraduate Dental Education Center, Örebro, Sweden.
    Olai, Lena
    School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ehrenberg, Anna
    School of Health and Welfare, Dalarna University, Falun, Sweden.
    Carlsson, Eva
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Older people’s experiences of oral health and assisted daily oral care in short-term facilities2021Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, nr 1, artikel-id 388Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Older people’s oral health has improved, and many retain their natural teeth throughout their life. However, their daily oral care can be more difficult because of compromised general health and the reduced capacity for self-care that often comes with old age. More knowledge is needed about how older people view their oral health and oral care. The aim of this study was to describe how older people in short-term care experience their oral health and daily oral care.

    Method: A descriptive, qualitative study was performed through interviews with 14 older people (74–95 years) recruited from short-term care units in two Swedish regions. Data were analysed using inductive content analysis.

    Results: The findings are described in one main category, three categories and nine sub-categories. The main category was Adapting to a changed oral condition while striving to retain independence. The first category, Wanting to manage daily oral care independently, contained three subcategories: Having always brushed my teeth without help, Being satisfied with my mouth and teeth, and Having to accept help if necessary. The second category, Acceptance of changes in oral condition, had three subcategories: Difficulty in chewing and swallowing, Difficulty with tooth brushing, and Not considering a dentist visit to be worth the cost. The third category, Barriers to receiving assistance from staff, had three subcategories: Staff lacking the time to help, Not wanting to be a burden, and Lack of confidence in staff’s knowledge.

    Conclusions: The participants were generally satisfied with their oral health despite an expressed need for dental treatment. Daily oral care was something they wanted to manage themselves, and they had a strong desire to stay independent for as long as possible. Closer collaboration between dental and health care staff is necessary in order to implement clinical practice guidelines for oral health care and increase nursing staff’s attention towards older peoples’ oral health.

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  • 861.
    Koistinen, Susanne
    et al.
    Dalarna Univ, Sch Hlth & Welf, Falun, Sweden; Umeå Univ, Dept Odontol, Dent Hygienist Educ, Umeå, Sweden.
    Ståhlnacke, Katri
    Postgrad Dent Educ Ctr, Dent Res Dept, Örebro, Sweden.
    Olai, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Dalarna Univ, Sch Hlth & Welf, Falun, Sweden.
    Ehrenberg, Anna
    Dalarna Univ, Sch Hlth & Welf, Falun, Sweden.
    Carlsson, Eva
    Örebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Örebro, Sweden.
    Older people's experiences of oral health and assisted daily oral care in short-term facilities2021Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, nr 1, artikel-id 388Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Older people’s oral health has improved, and many retain their natural teeth throughout their life. However, their daily oral care can be more difficult because of compromised general health and the reduced capacity for self-care that often comes with old age. More knowledge is needed about how older people view their oral health and oral care. The aim of this study was to describe how older people in short-term care experience their oral health and daily oral care.

    Method

    A descriptive, qualitative study was performed through interviews with 14 older people (74–95 years) recruited from short-term care units in two Swedish regions. Data were analysed using inductive content analysis.

    Results

    The findings are described in one main category, three categories and nine sub-categories. The main category was Adapting to a changed oral condition while striving to retain independence. The first category, Wanting to manage daily oral care independently, contained three subcategories: Having always brushed my teeth without help, Being satisfied with my mouth and teeth, and Having to accept help if necessary. The second category, Acceptance of changes in oral condition, had three subcategories: Difficulty in chewing and swallowing, Difficulty with tooth brushing, and Not considering a dentist visit to be worth the cost. The third category, Barriers to receiving assistance from staff, had three subcategories: Staff lacking the time to help, Not wanting to be a burden, and Lack of confidence in staff’s knowledge.

    Conclusions

    The participants were generally satisfied with their oral health despite an expressed need for dental treatment. Daily oral care was something they wanted to manage themselves, and they had a strong desire to stay independent for as long as possible. Closer collaboration between dental and health care staff is necessary in order to implement clinical practice guidelines for oral health care and increase nursing staff’s attention towards older peoples’ oral health.

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  • 862.
    Kolkowska, Ella
    et al.
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Nöu, Anneli Avatare
    SICS Swedish ICT, Kista, Sweden.
    Sjölinder, Marie
    SICS Swedish ICT, Kista, Sweden.
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Socio-Technical Challenges in Implementation of Monitoring Technologies in Elderly Care2016Ingår i: Human Aspects of IT for the Aged Population: Healthy and Active Aging, ITAP 2016, Proceedings, Part II, Springer, 2016, s. 45-56Konferensbidrag (Refereegranskat)
    Abstract [en]

    Although new monitoring technologies (MT) supporting aging in place are continuously developed and introduced on the market, attempts to implement these technologies as an integrated part of elderly care often fail. According to the literature, the reason for that may be the prevailing technical focus applied during development and implementation of monitoring technologies in real settings. The aim of this paper was to investigate the socio-technical challenges that arise during implementation of monitoring technologies in elderly care. We used a qualitative case study and semi-structured interviews to investigate socio-technical (S/T) challenges in implementation of monitoring technologies generally and social alarms especially. Based on our findings we suggest a framework for classification of S/T challenges arising during implementation of monitoring technologies in elderly care and in this way this paper contributes to a better understanding of these challenges.

  • 863.
    Kollén, Lena
    et al.
    Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hörder, Helena
    Division of Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, sweden.
    Möller, Claes
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Audiological Research Centre, Region Örebro County, Örebro, Sweden; Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Frändin, Kerstin
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Physical functioning in older persons with dizziness: a population-based study2017Ingår i: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 29, nr 2, s. 197-205Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Dizziness is one of the most prevalent symptoms in old age and tends to increase with age.

    Aims: To report physical functioning, health-related aspects and gender differences in elderly persons with and without dizziness in a population-based sample of 75-year-olds.

    Methods: A cross-sectional sample of 75-year-olds from Gothenburg, Sweden (n = 675, 398 women and 277 men) was examined by means of questionnaires and functional tests. The questions concerned dizziness/imbalance, physical activity level, walking habits, falls efficacy, number of falls, subjective health or general fatigue and medication. The tests included were self-selected and maximum gait speed, stair climbing capacity, one leg stance and grip strength.

    Results: More women than men reported dizziness/imbalance (40 vs 30 %, p < 0.001). Persons with dizziness, compared to those without dizziness, less often regularly exercised at a moderate intensity level (summer: 62 vs 74 %, p < 0.001; winter: 41 vs 51 %, p < 0.001), less often took a daily walk (p < 0.05), had lower scores on the FES(S) (p < 0.001), more often reported general fatigue (p < 0.001), more often had fallen in the previous year (40 vs 23 %, p < 0.001) and had a higher intake of medical drugs (4.6 vs 3.3, p < 0.001). They also performed worse regarding gait speed, stair climbing and one leg stance (p < 0.001), but there was no difference in grip strength.

    Conclusion: Older persons with dizziness are less physically active, have worse lower extremity function, are more often fallers and report lower self-rated health than persons without dizziness.

  • 864. Korhonen, Kaarina
    et al.
    Tarkiainen, Lasse
    Leinonen, Taina
    Einiö, Elina
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Association between a history of clinical depression and dementia, and the role of sociodemographic factors: population-based cohort study2022Ingår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 221, nr 1, s. 410-416Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Depression is associated with an increased dementia risk, but the nature of the association in the long-term remains unresolved, and the role of sociodemographic factors mainly unexplored.

    Aims

    To assess whether a history of clinical depression is associated with dementia in later life, controlling for observed sociodemographic factors and unobserved factors shared by siblings, and to test whether gender, educational level and marital status modify the association.

    Method

    We conducted a national cohort study of 1 616 321 individuals aged 65 years or older between 2001 and 2018 using administrative healthcare data. A history of depression was ascertained from the national hospital register in the period 15–30 years prior to dementia follow-up. We used conventional and sibling fixed-effects Cox regression models to analyse the association between a history of depression, sociodemographic factors and dementia.

    Results

    A history of depression was related to an adjusted hazard ratio of 1.27 (95% CI 1.23–1.31) for dementia in the conventional Cox model and of 1.55 (95% CI 1.09–2.20) in the sibling fixed-effects model. Depression was related to an elevated dementia risk similarly across all levels of education (test for interaction, P = 0.84), but the association was weaker for the widowed than for the married (P = 0.003), and stronger for men than women (P = 0.006). The excess risk among men attenuated following covariate adjustment (P = 0.10).

    Discussion

    This study shows that a history of depression is consistently associated with later-life dementia risk. The results support the hypothesis that depression is an aetiological risk factor for dementia.

  • 865. Kramberger, Milica Gregoric
    et al.
    Jelic, Vesna
    Kåreholt, Ingemar
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Enache, Daniela
    Eriksdotter Jönhagen, Maria
    Winblad, Bengt
    Aarsland, Dag
    Cerebrospinal Fluid Alzheimer Markers in Depressed Elderly Subjects with and without Alzheimer's Disease2012Ingår i: Dementia and Geriatric Cognitive Disorders Extra, E-ISSN 1664-5464, Vol. 2, nr 1, s. 48-56Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of this study was to explore the relationship between cerebrospinal fluid Alzheimer's disease (AD) markers and depression in elderly people. Method: We included subjects with AD as well as persons with subjective cognitive impairment and normal cognition. Depression was assessed with the Cornell Scale for Depression in Dementia, and a cut-off score of >6 was used to define depression. Cerebrospinal fluid was analyzed using commercially available assays for β-amyloid 1-42, total tau, and phosphorylated tau 181. Results: A total of 183 participants (66.7% female) were included (92 with AD and 9 with subjective cognitive impairment), with a mean age (±SD) of 67.6 ± 7.4 years, a Mini-Mental State Examination score of 26.0 ± 4.0, and a median Cornell Scale for Depression in Dementia score of 5 (range 0-19). Depression scores were not associated with higher phosphorylated tau 181 and total tau or reduced β-amyloid 1-42 in AD or non-demented subjects. Conclusions: These results suggest that AD pathology does not contribute to depression, indicating that other factors may be more important. Further studies of the aetiology of depression in elderly people with and without AD are warranted.

  • 866. Kramberger, Milica Gregoric
    et al.
    Kåreholt, Ingemar
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Andersson, T
    Winblad, B
    Eriksdotter, M
    Jelic, V
    Association between EEG abnormalities and CSF biomarkers in a memory clinic cohort2013Ingår i: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 36, nr 5-6, s. 319-328Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of the study was to describe distinct electroencephalogram (EEG) phenotypes defined after routine visual EEG analysis in a large memory clinic cohort and to investigate their relationship to cerebrospinal fluid (CSF) biomarkers. Methods: Patients with Alzheimer's disease (n = 131), mild cognitive impairment (n = 285), subjective cognitive impairment (n = 310), and mixed dementia (n = 29) were assessed clinically with neuroimaging, EEG and CSF investigations. EEG phenotypes were based on frequency of background activity (BA) and presence and degree of episodic abnormalities (EA). Results: BA and EA differed significantly (p < 0.001) between diagnostic groups. A lower CSF amyloid β42/phospho-tau ratio and higher total tau were associated with slower BA (p < 0.01) and a higher degree of EA (p < 0.04). Conclusions: Slowing of BA in combination with EA seems to be related to biological markers of neurodegeneration

  • 867.
    Kritz, Marlene
    et al.
    Curtin University, Perth, Australia; University of Southern Denmark, Odense, Denmark.
    Thøgersen-Ntoumani, Cecilie
    Curtin University, Perth, Australia; University Of Southern Denmark, Odense, Denmark.
    Mullan, Barbara
    Curtin University, Perth, Australia.
    Stathi, Afroditi
    University of Birmingham, Birmingham, United Kingdom.
    Ntoumanis, Nikos
    Högskolan i Halmstad, Akademin för hälsa och välfärd. Curtin University, Perth, Australia; University of Southern Denmark, Odense, Denmark.
    How can older peer leaders best support motivation for walking in physically inactive older adults? A self-determination theory perspective2023Ingår i: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 38, nr 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: We aimed to determine what older adults perceive to be need-supportive behaviours of peer walk leaders, drawing primarily from Self-Determination Theory (SDT). Design: Experienced peer leaders (n = 13; Mage = 73.23, SD = 6.55) and walkers (n = 17; Mage = 72.88, SD = 5.79) were recruited from existing walking groups. Individuals who expressed an interest in becoming a peer leader (n = 18; Mage = 72.72, SD = 4.99) or walker (n = 20; Mage = 78.90, SD = 10.45) were recruited from retirement villages. Main Outcome Measures: We conducted semi-structured interviews to identify leader behaviours that support autonomy, competence, and relatedness and analysed the data using framework analysis. Results: We identified eight main themes: eliciting walker interest, acknowledging and adapting to walkers’ requirements, ensuring walkers feel comfortable, cared for, and socially integrated, supporting walker confidence, and promoting success experiences. Inexperienced leaders differed from other sub-groups in what they perceived to be supportive behaviours. Conclusion: Future peer leaders could use the identified behaviours to help older adults feel motivated during group walks. New peer leaders can be educated about potential differences between what they describe as supportive and what walkers and experienced leaders perceive as need-supportive behaviours. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

  • 868.
    Kurien, M.
    et al.
    Univ Sheffield, England.
    Ludvigsson, J. F.
    Karolinska Inst, Sweden; Orebro Univ, Sweden.
    Sanders, D. S.
    Univ Sheffield, England.
    Zylberberg, H. M.
    Columbia Univ Coll Phys and Surg, NY 10032 USA.
    Green, P. H.
    Columbia Univ Coll Phys and Surg, NY 10032 USA.
    Sundelin, Heléne
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Lebwohl, B.
    Karolinska Inst, Sweden; Columbia Univ Coll Phys and Surg, NY 10032 USA.
    Persistent mucosal damage and risk of epilepsy in people with celiac disease2018Ingår i: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 25, nr 3, s. 592-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purposeCeliac disease (CD) is associated with an increased risk of developing epilepsy, a risk that persists after CD diagnosis. A significant proportion of patients with CD have persistent villous atrophy (VA) on follow-up biopsy. The objective of this study was to determine whether persistent VA on follow-up biopsy affected long-term epilepsy risk and epilepsy-related hospital emergency admissions. MethodsThis was a nationwide cohort study. We identified all people in Sweden with histological evidence of CD who underwent a follow-up small intestinal biopsy (1969-2008). We compared those with persistent VA with those who showed histological improvement, assessing the development of epilepsy and related emergency hospital admissions (defined according to relevant International Classification of Diseases codes in the Swedish Patient Register). Cox regression analysis was used to assess outcome measures. ResultsVillous atrophy was present in 43% of 7590 people with CD who had a follow-up biopsy. The presence of persistent VA was significantly associated with a reduced risk of developing newly-diagnosed epilepsy (hazard ratio, 0.61; 95% confidence interval, 0.38-0.98). On stratified analysis, this effect was primarily amongst males (hazard ratio, 0.35; 95% confidence interval, 0.15-0.80). Among the 58 patients with CD with a prior diagnosis of epilepsy, those with persistent VA were less likely to visit an emergency department with epilepsy (hazard ratio, 0.37; 95% confidence interval, 0.09-1.09). ConclusionsIn a population-based study of individuals with CD, persisting VA on follow-up biopsy was associated with reduced future risk of developing epilepsy but did not influence emergency epilepsy-related hospital admissions. The mechanism as to why persistent VA confers this benefit requires further exploration.

  • 869.
    Käll, Lisa Folkmarson
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för kulturvetenskaper, KVA. Linköpings universitet, Filosofiska fakulteten.
    Towards a phenomenological conception of the subjectivity of dementia2017Ingår i: Living with dementia: relations, responses and agency in everyday life / [ed] Lars-Christer Hydén, Eleonor Antelius, Basingstoke: Palgrave Macmillan, 2017, Vol. Sidorna 14-28, s. 14-28Kapitel i bok, del av antologi (Refereegranskat)
  • 870.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Falun Hospital and Centre for Clinical Research Dalarna, Falun.
    Berg, Lena M
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Skogli, Sara
    Falun Hospital, Falun.
    Bjurbo, Charlotte
    Uppsala University Hospital, Uppsala.
    Muntlin, Åsa
    Uppsala University Hospital, Uppsala.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments2023Ingår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 23, nr 1, artikel-id 798Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited.

    AIM: To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs.

    METHODS: The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes.

    RESULTS: A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care.

    CONCLUSION: Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.

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  • 871.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Lundgren, Dan
    Municipal Varnamo, Varnamo, Jonkopings Lan, Sweden..
    Kabir, Zarina Nasar
    Karolinska Inst, Huddinge, Stockholms Lan, Sweden..
    Bostrom, Anne-Marie
    Karolinska Inst, Huddinge, Stockholms Lan, Sweden..
    Staffs' Psychosocial Work Environment in Relation to Recipient Satisfaction in Home Care Services2022Ingår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 6, nr Supplement 1, s. 702-702Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In accordance with ‘aging in place’ policy, older persons in Sweden are increasingly encouraged to continue living at home and if necessary be supported by home care service (HCS). Studies have examined whether the work environment of staff has an impact on the experiences and the wellbeing of the older persons in nursing homes, but few have examined such associations in HCS. The setting was 16 HCS work units. Two surveys were sent, one to staff on psychosocial working conditions, one to care recipients on care satisfaction. For each work unit, data on individual recipient satisfaction was matched to average values on psychosocial work conditions. Outcomes analyzed with linear regressions were overall recipient satisfaction, based on one question, and indexes on: assessment of implementation of services, contact with staff, and sense of security. Index on treatment by staff was analyzed with ordered logistic regressions due to skewed distribution. We used cluster correlated standard errors (clustering on work units). Results showed that good working conditions are important for recipient satisfaction, specifically overall recipient satisfaction, treatment by staff, and sense of security. Psychosocial work factors most important were work group climate, overall job strain, sense of mastery, job control, frustrated empathy, balancing competing needs, balancing emotional involvement, and lack of recognition. Having more home help hours was associated to stronger relation between working conditions and recipient satisfaction, especially with overall recipient satisfaction and treatment by staff as outcomes.

  • 872.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Mehmedi, Liberta
    Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Lung Function In Old Age And Physical Activity From Midlife To Old Age: Longitudinal Study With 24-30 Years' Follow-Up2021Ingår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 5, nr Supplement 1, s. 455-455Artikel i tidskrift (Refereegranskat)
  • 873.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Agerholm, Janne
    Karolinska Inst, Stockholm, Stockholms Län, Sweden.
    Kelfve, Susanne
    Linkoping Univ, Linköping, Östergötlands Län, Sweden.
    Wastesson, Jonas
    Karolinska Inst, Stockholm, Stockholms Län, Sweden.
    Nabe-Nielsen, Kirsten
    Univ Copenhagen, Copenhagen, Hovedstaden, Denmark..
    Meinow, Bettina
    Stockholm Gerontol Res Ctr, Stockholm, Stockholms Län, Sweden.
    History of Job Strain And Risk of Late-Life Dependency: A Nationwide Swedish Registerbased Study2022Ingår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 6, nr Supplement 1, s. 502-503Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is substantial evidence that work plays a significant role in post-retirement health. Yet little is known about its role in when late-life dependency may occur. We examined associations between job strain and the risk of entering late-life dependency. Individually linked nationwide Swedish registers were used to identify people 70+ alive in January 2014, and who did not experience the outcome (late-life dependency) during two months prior to the start of the follow-up. Late-life dependency was operationalized as use of long-term care. Information about job strain was obtained via a job exposure matrice and matched with job titles. Cox regression models with age as time-scale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios (HR) for entering late-life dependency during the 24 months of follow-up (n=993,595). Having an initial high starting point of job strain followed by an increasing trajectory throughout working life implied a 23% higher risk of entering late-life dependency at a younger age, compared with the reference group (low starting point with a decreasing trajectory). High initial starting point followed by a stable trajectory implied a 12% higher risk of entering late-life dependency at a younger age. High initial starting point followed by a decreasing trajectory implied a 10% risk reduction, and a low starting point with a stable trajectory implied a 22% risk reduction, of entering late-life dependency at a younger age. Reducing stressful jobs across working life may contribute to postponing late-life dependency.

  • 874.
    Köhncke, Ylva
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Max Planck Institute for Human Development, Germany.
    Papenberg, Goran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Jonasson, Lars
    Karalija, Nina
    Wahlin, Anders
    Salami, Alireza
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Stockholm Univ, S-11330 Stockholm, Sweden.
    Andersson, Micael
    Axelsson, Jan E.
    Nyberg, Lars
    Riklund, Katrine
    Bäckman, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Lindenberger, Ulman
    Lövden, Martin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Self-rated intensity of habitual physical activities is positively associated with dopamine D-2/3 receptor availability and cognition2018Ingår i: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 181, s. 605-616Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Between-person differences in cognitive performance in older age are associated with variations in physical activity. The neurotransmitter dopamine (DA) contributes to cognitive performance, and the DA system deteriorates with advancing age. Animal data and a patient study suggest that physical activity modulates DA receptor availability, but data from healthy humans are lacking. In a cross-sectional study with 178 adults aged 64-68 years, we investigated links among self-reported physical activity, D(2/3)DA receptor (D2/3DR) availability, and cognitive performance. D2/3DR availability was measured with [C-11]raclopride positron emission tomography at rest. We used structural equation modeling to obtain latent factors for processing speed, episodic memory, working memory, physical activity, and D2/3DR availability in caudate, putamen, and hippocampus. Physical activity intensity was positively associated with D2/3DR availability in caudate, but not putamen and hippocampus. Frequency of physical activity was not related to D2/3DR availability. Physical activity intensity was positively related to episodic memory and working memory. D2/3DR availability in caudate and hippocampus was positively related to episodic memory. Taken together, our results suggest that striatal DA availability might be a neurochemical correlate of episodic memory that is also associated with physical activity.

  • 875. Lagergren, Mårten
    et al.
    Fagerström, Cecilia
    Sjölund, Britt-Marie
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Berglund, Johan
    Fratiglioni, Laura
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Stockholm Gerontology Research Center, Sweden.
    Nordell, Eva
    von Strauss, Eva
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Red Cross Hospital, Sweden; Red Cross University College, Sweden.
    Wimo, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Karolinska Institutet, Sweden.
    Elmståhl, Sölve
    Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden2016Ingår i: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 28, nr 1, s. 147-158Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001-2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70-90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40-50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern-it was almost 100 % in all areas for IADL dependency, but only 50-60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

  • 876. Lagergren, Mårten
    et al.
    Sjölund, Britt-Marie
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Fagerström, Cecilia
    Berglund, Johan
    Fratiglioni, Laura
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Nordell, Eva
    Wimo, Anders
    Elmståhl, Sölve
    Horizontal and vertical target efficiency - a comparison between users and non-users of public long-term care in Sweden2014Ingår i: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 34, nr 4, s. 700-719Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The extent to which a system of services is in tune with the needs of the population can be expressed in terms of target efficiency, which includes horizontal target efficiency - the extent to which those deemed to need a service receive it - and vertical target efficiency - the corresponding extent to which those who receive a service actually need it. Vertical efficiency can be measured by looking only at those receiving services. To measure horizontal target efficiency in a population, one must have access to population surveys. Data were taken from the baseline survey of the Swedish National Study on Ageing and Care (SNAC study). The results show that more than 80 per cent of those dependent in personal activities of daily living in the studied geographic areas were users of public long-term care (LTC). Dependency in instrumental activities of daily living was identified as the most important predictor of using LTC. Vertical target efficiency was 83-95 per cent depending on age, gender and type of household, if need was defined as dependency in instrumental activities of daily living. It was considerably lower, 35-61 per cent when defined as dependency in personal daily activities. Overall, long-term target efficiency in Sweden must be regarded as high. Few persons who need public LTC services fail to receive them.

  • 877. Lagerin, Annica
    et al.
    Carlsson, Axel C.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Nilsson, Gunnar
    Westman, Jeanette
    Tornkvist, Lena
    District nurses' preventive home visits to 75-year-olds: An opportunity to identify factors related to unsafe medication management2014Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, nr 8, s. 786-794Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: To investigate factors related to unsafe medication management among 75-year-olds during preventive home visits, and to describe the interventions district nurses used. Methods: An explorative study. During a 9- to 12-month period, 36 DNs used the Safe Medication Assessment (SMA) tool during preventive home visits to 75-year-olds who used at least one drug (n=113). Results: One or more factors related to unsafe medication management were identified in 84% of the 75-year-olds. More than 40% used five or more drugs, and 34.5% reported symptoms potentially indicative of adverse effects of their drugs. Nearly 30% had prescribers from more than two medical units, and 7.1% of the older persons were appraised as having reduced cognitive ability. DNs intervened in more than two-thirds of the cases and used a variety of nursing care interventions to improve the safety of medication management. Conclusions: Preventive home visits seem to provide a unique opportunity to promote safe medication management. Several factors related to unsafe medication management were identified, and several different nursing care interventions were carried out to ensure safe medication management. Use of the SMA tool in preventive home visits seems to be advantageous in improving the safety of medication management among older persons.

  • 878. Lagerin, Annica
    et al.
    Törnkvist, Lena
    Nilsson, Gunnar
    Johnell, Kristina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Fastbom, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Extent and quality of drug use in community-dwelling people aged >= 75 years: A Swedish nationwide register-based study2020Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 48, nr 3, s. 308-315Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Methods: Data from 2013 on people aged >= 75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged >= 75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. Results: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. Conclusions: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses' role in continuing to promote safe medication management at higher ages.

  • 879.
    Lagerin, Annica
    et al.
    Karolinska institutet; Stockholm läns landsting.
    Törnkvist, Lena
    Karolinska institutet; Stockholm läns landsting.
    Nilsson, Gunnar
    Karolinska institutet; Stockholm läns landsting.
    Johnell, Kristina
    Karolinska institutet; Stockholm läns landsting.
    Fastbom, Johan
    Karolinska institutet; Stockholm läns landsting.
    Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study2020Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 48, nr 3, s. 308-315, artikel-id 1403494817744101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups.

    METHODS: Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare.

    RESULTS: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs.

    CONCLUSIONS: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses' role in continuing to promote safe medication management at higher ages.

  • 880. Lalic, Samanta
    et al.
    Sluggett, Janet K.
    Ilomäki, Jenni
    Wimmer, Barbara C.
    Tan, Edwin C. K.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Monash University, Australia.
    Robson, Leonie
    Emery, Tina
    Bell, J. Simon
    Polypharmacy and Medication Regimen Complexity as Risk Factors for Hospitalization Among Residents of Long-Term Care Facilities: A Prospective Cohort Study2016Ingår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, nr 11, s. 1067.e1-1067.e6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate the association between polypharmacy and medication regimen complexity with time to first hospitalization, number of hospitalizations, and number of hospital days over a 12-month period. Design: A 12-month prospective cohort study. Participants and Setting: A total of 383 residents of 6 Australian long-term care facilities (LTCFs). Measurements: The primary exposures were polypharmacy (>= 9 regular medications) and the 65-item Medication Regimen Complexity Index (MRCI). Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between polypharmacy and MRCI with time to first hospitalization. Poisson regression was used to compute incident rate ratios (IRR) and 95% CIs for the association between polypharmacy and MRCI with number of hospitalizations and number of hospital days. Models were adjusted for age, sex, length of stay in LTCF, comorbidities, activities of daily living, and dementia severity. Results: There were 0.56 (95% CI 0.49-0.65) hospitalizations per person-year and 4.52 (95% CI 4.31-4.76) hospital days per person-year. In adjusted analyses, polypharmacy was associated with time to first hospitalization (HR 1.84; 95% CI 1.21-2.79), number of hospitalizations (IRR 1.51; 95% CI 1.09-2.10), and hospital days per person-year (IRR 1.39; 95% CI 1.24-1.56). Similarly, in adjusted analyses a 10-unit increase in MRCI was associated with time to first hospitalization (HR 1.17; 95% CI 1.06-1.29), number of hospitalizations (IRR 1.15; 95% CI 1.06-1.24), and hospital days per person-year (IRR 1.19; 95% CI 1.16-1.23). Conclusions: Polypharmacy and medication regimen complexity are associated with hospitalizations from LTCFs. This highlights the importance of regular medication review for residents of LTCFs and the need for further research into the risk-to-benefit ratio of prescribing in this setting.

  • 881. Lammes, E.
    et al.
    Akner, Gunnar
    Örebro universitet, Hälsoakademin.
    Repeated assessment of energy and nutrient intake in 52 nursing home residents2006Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 10, nr 3, s. 222-230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    UNLABELLED: Studies in Swedish nursing-home patients have shown a high prevalence of protein-energy malnutrition. One potential cause for this may be low food intake.

    OBJECTIVE: To examine the intake of energy and nutrients in the residents of a nursing home; to investigate changes in dietary intake and body-weight over time and to analyze two-year-mortality.

    DESIGN: Explorative study. Five-day weighed assessment of food intake repeated three times during 1.5 years. Analysis of body composition at baseline and recording of body weight every third month. Analysis of two-year mortality.

    RESULTS: Fifty-two residents had three complete dietary assessments. Mean age 84 +/- 7 years, 79% were female. Mean body weight was stable at 61 kg. Mean energy intake at baseline was 1501 kcal/d (25 kcal/kg/d) and mean protein intake was 53 g/d (0.9 g/kg/d). Mean intake of vitamin D, vitamin E, folic acid, selenium and dietary fibre was less than 60% of recommended. At the second assessment intake of energy and many nutrients was higher than at baseline, but at the third assessment intake had decreased. There was no correlation between energy intake and body weight over time. Two-year mortality was 52%. Male gender and low body-weight constituted an increased risk of mortality. Comparing survivors and non-survivors showed that the mean body weight was 9 kg higher in the survivors throughout the study (p=0.02). This group had a relatively lower fat free mass and higher fat mass than the non-survivors. The difference in body composition was only seen in females, possibly due to the low number of males. The survivors had higher intakes of most nutrients but this reached significance only for a few of them. The non-survivors had significantly higher intakes of sucrose.

    CONCLUSION: Intake of energy and many nutrients was low in these nursing-home patients, and decreased further after one year, without any change in body weight. The significant positive relation between energy intake and body weight at group level disappeared when analyzing data at an individual level. Male gender and low body weight were associated with increased risk of mortality.

  • 882. Lammes, E.
    et al.
    Akner, Gunnar
    Örebro universitet, Hälsoakademin.
    Resting metabolic rate in elderly nursing home patients with multiple diagnoses2006Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 10, nr 4, s. 263-270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In the diseased elderly weight loss and malnutrition are common. It is unclear to what degree this is caused by an elevated resting metabolic rate (RMR), a decreased energy intake or a combination of the two.

    OBJECTIVE: To measure RMR and nutrient induced thermogenesis (NIT) in chronically diseased elderly living in a nursing home and test for a correlation with fat free mass (FFM), age, energy intake and activities of daily living (ADL).

    DESIGN: Explorative study performed in the residents' own apartments. RMR was measured by indirect calorimetry, and NIT was tested by giving the subjects an oral fluid test meal, then measuring metabolic rate again one hour later. Body composition was measured anthropometrically and FFM was calculated. Energy intake was calculated from a five-day record of weighed food. BMR was calculated using four different prediction equations and compared with measured RMR. Results: RMR was 1,174 kcal/d (29.3 kcal/kg FFM/d). The variation in RMR was significantly related to FFM (p < 0.0001). Energy intake was 1,474 kcal/d, (36.5 kcal/kg FFM/d). The energy intake/RMR ratio, was 1.27, and NIT was 15% (0-33%). NIT was not correlated to any of the parameters tested. The equation of Harris and Benedict underestimated BMR by 4%; the WHO/FAO overestimated BMR by 7%; Schofield and an estimate of 20 kcal/kg/d did not significantly differ from the measured mean.

    CONCLUSION: RMR was closely correlated to FFM. Variations in NIT could not be explained by any tested parameters. Predicted BMR differed from measured RMR by less than 8% in all methods, but individual variations were large.

  • 883. Lammes, E.
    et al.
    Törner, A.
    Akner, Gunnar
    Örebro universitet, Hälsoakademin.
    Nutrient density and variation in nutrient intake with changing energy intake in multimorbid nursing home residents2009Ingår i: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 22, nr 3, s. 210-218Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The low energy intake seen in some institutionalised elderly has led to a focus on energy dense diets. The present study aimed to investigate nutrient density in the diet of nursing home residents, and calculate how changes in energy intake affect nutrient intake.

    METHODS: The investigation comprised a longitudinal observational study analysing the relation between energy and nutrient intake in a general nursing home in Sweden. Food intake was weighed for 5 days every sixth month over 1.5 years and nutrient density was calculated. The 52 multimorbid residents [mean (range) age 84 (67-102) years] with three complete 5-day weighed food records were included in the study. A mixed linear model was used to calculate changes in nutrient intake with changing energy intake.

    RESULTS: Nutrient density was adequate for vitamins A, B(12), thiamine, riboflavin and niacin, and low for vitamins D and E, folate, potassium, magnesium and iron. The mixed linear model showed that the fat-soluble vitamins, as well as folate and vitamin B(12), increased the most with increasing energy intake, whereas sodium, potassium, thiamine and selenium had the smallest increase.

    CONCLUSIONS: Nutritional density of the food should be considered when planning diets for elderly patients with poor appetite.

  • 884.
    Lammes, Eva
    et al.
    Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Rydwik, Elisabeth
    Research Unit for the Elderly, North, Jakobsbergs Hospital, Karolinska Institutet, Järfälla, Sweden.
    Akner, Gunnar
    Department of Geriatric medicine, Örebro University Hospital, Örebro, Sweden.
    Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly: a randomised controlled pilot study2012Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 16, nr 2, s. 162-167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RmR) and body composition in the frail elderly. Design: Open, randomised, controlled pilot treatment study.

    Setting: Community-based research centre. Participants: ninety-six community-dwelling frail elderly people aged 75 and older, 40% men.

    Intervention: Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 x 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group. 

    Measurements: The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months’ intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals).

    Results: The training group showed a significantly increased RmR at 3 months. Otherwise, there were no observed differences within or between the four groups.There was no correlation over time between energy intake, RmR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study (‘responders’) had a statistically significantly lower Bmi (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the ‘non-responders.’The ‘non-responders’ showed a small but statistically significant decrease in body fat percentage at F1, and inbody weight, Bmi and FFm at 9 months (F3).

    Conclusion: individual nutrition counselling and physical exercise had no effect on energy intake, RmR or fat free mass in community-dwelling frail elderly people aged 75 and older. interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.

  • 885.
    Lammes, Eva
    et al.
    Karolinska University Hospital.
    Rydwik, Elisabeth
    Karolinska Institutet.
    Akner, Gunnar
    Örebro University Hospital.
    Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly: a randomised controlled pilot study2012Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 16, nr 2, s. 162-167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RmR) and body composition in the frail elderly.

    Design: Open, randomised, controlled pilot treatment study.

    Setting: Community-based research centre. Participants: ninety-six community-dwelling frail elderly people aged 75 and older, 40% men.

    Intervention: Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 x 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group. 

    Measurements: The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months’ intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals).

    Results: The training group showed a significantly increased RmR at 3 months. Otherwise, there were no observed differences within or between the four groups.There was no correlation over time between energy intake, RmR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study (‘responders’) had a statistically significantly lower Bmi (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the ‘non-responders.’The ‘non-responders’ showed a small but statistically significant decrease in body fat percentage at F1, and inbody weight, Bmi and FFm at 9 months (F3).

    Conclusion: individual nutrition counselling and physical exercise had no effect on energy intake, RmR or fat free mass in community-dwelling frail elderly people aged 75 and older. interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.

  • 886.
    Langenskiöld, Sophie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälsoekonomi.
    Evidensbaserad vård även för de allra äldsta, tack!2015Ingår i: Svensk Geriatrik, nr 1, s. 16-20Artikel, forskningsöversikt (Övrigt vetenskapligt)
  • 887.
    Lannering, Christina
    et al.
    Futurum, Sweden.
    Ernsth Bravell, Marie
    Jonköping University, Sweden.
    Midlov, Patrik
    Lund University, Sweden.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Molstad, Sigvard
    Lund University, Sweden.
    Factors related to falls, weight-loss and pressure ulcers - more insight in risk assessment among nursing home residents2016Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, nr 7-8, s. 940-950Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectivesTo describe how the included items in three different scales, Downton Fall Risk Index, the short form of Mini Nutritional Assessment and the Modified Norton Scale are associated to severe outcomes as falls, weight loss and pressure ulcers. BackgroundFalls, malnutrition and pressure ulcers are common adverse events among nursing home residents and risk scoring are common preventive activities, mainly focusing on single risks. In Sweden the three scales are routinely used together with the purpose to improve the quality of prevention. DesignLongitudinal quantitative study. MethodsDescriptive analyses and Cox regression analyses. ResultsOnly 4% scored no risk for any of these serious events. Longitudinal risk scoring showed significant impaired mean scores indicating increased risks. This confirms the complexity of this populations status of general condition. There were no statistical significant differences between residents categorised at risk or not regarding events. Physical activity increased falls, but decreased pressure ulcers. For weight loss, cognitive decline and the status of general health were most important. ConclusionsRisk tendencies for falls, malnutrition and pressure ulcers are high in nursing homes, and when measure them at the same time the majority will have several of these risks. Items assessing mobility or items affecting mobility were of most importance. Care processes can always be improved and this study can add to the topic. Relevance to clinical practiceA more comprehensive view is needed and prevention can not only be based on total scores. Mobility is an important factor for falls and pressure ulcers, both as a risk factor and a protective factor. This involves a challenge for care - to keep the inmates physical active and at the same time prevent falls.

  • 888.
    Lannfelt, Lars
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Moller, Christer
    Basun, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Osswald, Gunilla
    Sehlin, Dag
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Satlin, Andrew
    Logovinsky, Veronika
    Gellerfors, Par
    Perspectives on future Alzheimer therapies: amyloid-beta protofibrils - a new target for immunotherapy with BAN2401 in Alzheimer's disease2014Ingår i: ALZHEIMERS RES THER, ISSN 1758-9193, Vol. 6, nr 2, s. 16-Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The symptomatic drugs currently on the market for Alzheimer's disease (AD) have no effect on disease progression, and this creates a large unmet medical need. The type of drug that has developed most rapidly in the last decade is immunotherapy: vaccines and, especially, passive vaccination with monoclonal antibodies. Antibodies are attractive drugs as they can be made highly specific for their target and often with few side effects. Data from recent clinical AD trials indicate that a treatment effect by immunotherapy is possible, providing hope for a new generation of drugs. The first anti-amyloid-beta (anti-A beta) vaccine developed by Elan, AN1792, was halted in phase 2 because of aseptic meningoencephalitis. However, in a follow-up study, patients with antibody response to the vaccine demonstrated reduced cognitive decline, supporting the hypothesis that A beta immunotherapy may have clinically relevant effects. Bapineuzumab (Elan/Pfizer Inc./Johnson & Johnson), a monoclonal antibody targeting fibrillar A beta, was stopped because the desired clinical effect was not seen. Solanezumab (Eli Lilly and Company) was developed to target soluble, monomeric A beta. In two phase 3 studies, Solanezumab did not meet primary endpoints. When data from the two studies were pooled, a positive pattern emerged, revealing a significant slowing of cognitive decline in the subgroup of mild AD. The Arctic mutation has been shown to specifically increase the formation of soluble A beta protofibrils, an A beta species shown to be toxic to neurons and likely to be present in all cases of AD. A monoclonal antibody, mAb158, was developed to target A beta protofibrils with high selectivity. It has at least a 1,000-fold higher selectivity for protofibrils as compared with monomers of A beta, thus targeting the toxic species of the peptide. A humanized version of mAb158, BAN2401, has now entered a clinical phase 2b trial in a collaboration between BioArctic Neuroscience and Eisai without the safety concerns seen in previous phase 1 and 2a trials. Experiences from the field indicate the importance of initiating treatment early in the course of the disease and of enriching the trial population by improving the diagnostic accuracy. BAN2401 is a promising candidate for A beta immunotherapy in early AD. Other encouraging efforts in immunotherapy as well as in the small-molecule field offer hope for new innovative therapies for AD in the future.

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  • 889.
    Lannfelt, Lars
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Relkin, N. R.
    Siemers, E. R.
    Amyloid-beta-directed immunotherapy for Alzheimer's disease2014Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 275, nr 3, s. 284-295Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Current treatment options for Alzheimer's disease (AD) are limited to medications that reduce dementia symptoms. Given the rapidly ageing populations in most areas of the world, new therapeutic interventions for AD are urgently needed. In recent years, a number of drug candidates targeting the amyloid-ss (A ss) peptide have advanced into clinical trials; however, most have failed because of safety issues or lack of efficacy. The A ss peptide is central to the pathogenesis, and immunotherapy against A ss has attracted considerable interest. It offers the possibility to reach the target with highly specific drugs. Active immunization and passive immunization have been the most widely studied approaches to immunotherapy of AD. A favourable aspect of active immunization is the capacity for a small number of vaccinations to generate a prolonged antibody response. A potential disadvantage is the variability in the antibody response across patients. The potential advantages of passive immunotherapy include the reproducible delivery of a known amount of therapeutic antibodies to the patient and rapid clearance of those antibodies if side effects develop. A disadvantage is the requirement for repeated infusions of antibodies over time. After more than a decade of research, anti-amyloid immunotherapy remains one of the most promising emerging strategies for developing disease-modifying treatments for AD. In this review, we examine the presently ongoing A ss-directed immunotherapies that have passed clinical development Phase IIa.

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  • 890.
    Lantz, Kristina
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Marcusson, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Wressle, Ewa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Perceived participation and health-related quality of life in 85-year olds in Sweden2012Ingår i: OTJR (Thorofare, N.J.), ISSN 1539-4492, E-ISSN 1938-2383, Vol. 32, nr 4, s. 117-125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study explores how 85-year-olds in Sweden perceive participation and autonomy in their life situations in relation to health-related quality of life and gender. A postal questionnaire included questions on socio-demographics, social network, assistive technology, community assistance, and the EQ-5D. During a home visit, an occupational therapist evaluated perceived participation and autonomy using the Impact on Participation and Autonomy Questionnaire. The majority perceived their participation as sufficient. Women had greater limitations than men in indoor and outdoor autonomy.  Only a few individuals reported many or severe problems with participation, mainly in mobility and leisure. Not having friends nearby, no close contact with neighbors, and living in community housing increased the risk of perceived problems. Sufficient participation was positively associated with higher HRQoL and facilitating participation is an area of interest for occupational therapists.

  • 891.
    Larsson, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
    Israelsson Larsen, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Eklund, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Malm, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
    Falls and Fear of Falling in Shunted Idiopathic Normal Pressure Hydrocephalus: The Idiopathic Normal Pressure Hydrocephalus Comorbidity and Risk Factors Associated With Hydrocephalus Study2021Ingår i: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 89, nr 1, s. 122-128Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Gait and balance impairment are typical symptoms of idiopathic normal pressure hydrocephalus (INPH), implicating that falls may afflict these patients.

    OBJECTIVE: To investigate falls, related injuries, and associated psychological features, before and after shunt surgery for INPH and compared to the general population.

    METHODS: The study included 176 patients shunted for INPH and 368 age- and sex-matched controls. Falls, fear of falling (FOF), fall-related injuries (mild-severe), confidence in avoiding falls (Swedish Falls Efficacy Scale (FES(S)), quality of life (QoL; EuroQoL 5-dimension 5 level instrument), and symptoms of depression (Geriatric Depression Scale 15) were investigated. Pre- and postoperative observational times were 12 mo before surgery and 21 mo after (mean). Recurrent fallers fell ≥2 times.

    RESULTS: More INPH patients than controls were recurrent fallers (67% vs 11%; P < .001). They feared falling more often (FOF, mean ± standard deviation: 3.3 ± 1.1 vs 1.6 ± 0.9; P < .001) and had lower confidence in avoiding falls (FES(S) 78 ± 40 vs 126 ± 14; P < .001). After surgery, INPH patients improved in all parameters but they did not reach the levels of the controls. Among fallers there was no difference between patients and controls in the severity of injuries suffered. Low QoL and symptoms of depression were more common among recurrent fallers than one-time or nonfallers in both shunted patients and controls (P ≤ .001).

    CONCLUSION: Falls, FOF, and low confidence in avoiding falls are considerable problems in INPH that may be reduced by shunt surgery. We suggest that remaining risk of falling and preventative measures are routinely considered in postoperative follow-ups and rehabilitation planning.

  • 892.
    Larsson, Liss Elin
    et al.
    Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden.;Swedish Sch Sport & Hlth Sci, GIH, Stockholm, Sweden..
    Wang, Rui
    Swedish Sch Sport & Hlth Sci, GIH, Stockholm, Sweden.;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol, Care Sci & Soc, Stockholm, Sweden.;Univ Wisconsin, Sch Med & Publ Hlth, Wisconsin Alzheimers Dis Res Ctr, Madison, WI USA..
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism. Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden..
    Wiggenraad, Fleur
    Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden.;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol, Care Sci & Soc, Stockholm, Sweden..
    Ryden, Marie
    Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden..
    Hagman, Göran
    Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden.;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol, Care Sci & Soc, Stockholm, Sweden..
    Hellenius, Mai-Lis
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Kivipelto, Miia
    Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden.;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol, Care Sci & Soc, Stockholm, Sweden.;Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland.;Imperial Coll London, Ageing Epidemiol Res Unit, Sch Publ Hlth, London, England..
    Thunborg, Charlotta
    Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden.;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol, Care Sci & Soc, Stockholm, Sweden.;Mälardalen Univ, Dept Hlth & Welf, Västerås, Sweden.;Univ Gävle, Fac Hlth & Occupat Studies, Dept Caring Sci, Gävle, Sweden..
    Association of Sarcopenia and Its Defining Components with the Degree of Cognitive Impairment in a Memory Clinic Population2023Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 96, nr 2, s. 777-788Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Sarcopenia and cognitive impairment are two leading causes of disabilities. Objective: The objective was to examine the prevalence of sarcopenia and investigate the association between sarcopenia diagnostic components (muscle strength, muscle mass, and physical performance) and cognitive impairment in memory clinic patients.

    Methods: 368 patients were included (age 59.0 +/- 7.25 years, women: 58.7%), displaying three clinical phenotypes of cognitive impairments, i.e., subjective cognitive impairment (SCI, 57%), mild cognitive impairment (MCI, 26%), and Alzheimer's disease (AD, 17%). Sarcopenia was defined according to diagnostic algorithm recommended by the European Working Group on Sarcopenia in Older People. Components of sarcopenia were grip strength, bioelectrical impedance analysis, and gait speed. They were further aggregated into a score (0-3 points) by counting the numbers of limited components. Multi-nominal logistic regression was applied.

    Results: Probable sarcopenia (i.e., reduced grip strength) was observed in 9.6% of the patients, and 3.5% were diagnosed with sarcopenia. Patients with faster gait speed showed less likelihood of MCI (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.06-0.90) and AD (OR: 0.12, 95% CI: 0.03-0.60). One or more limited sarcopenia components was associated with worse cognitive function. After adjusting for potential confounders, the association remained significant only for AD (OR 4.29, 95% CI 1.45-11.92).

    Conclusions: The results indicate a connection between the sarcopenia components and cognitive impairments. Limitations in the sarcopenia measures, especially slow walking speed, were related to poorer cognitive outcomes. More investigations are required to further verify the causal relationship between sarcopenia and cognitive outcomes.

  • 893.
    Larsson, Liss Elin
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
    Wang, Rui
    Gymnastik- och idrottshögskolan, GIH, Institutionen för fysisk aktivitet och hälsa. Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA..
    Cederholm, Tommy
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.; Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden..
    Wiggenraad, Fleur
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.; Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden..
    Rydén, Marie
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden..
    Hagman, Göran
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.; Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden..
    Hellénius, Mai-Lis
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden..
    Kivipelto, Miia
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.; Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.: The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom..
    Thunborg, Charlotta
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.; Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.; Mälardalen University Department of Health and Welfare, Sweden.; Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Sweden..
    Association of Sarcopenia and Its Defining Components with the Degree of Cognitive Impairment in a Memory Clinic Population.2023Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 96, nr 2, s. 777-788Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sarcopenia and cognitive impairment are two leading causes of disabilities.

    OBJECTIVE: The objective was to examine the prevalence of sarcopenia and investigate the association between sarcopenia diagnostic components (muscle strength, muscle mass, and physical performance) and cognitive impairment in memory clinic patients.

    METHODS: 368 patients were included (age 59.0±7.25 years, women: 58.7%), displaying three clinical phenotypes of cognitive impairments, i.e., subjective cognitive impairment (SCI, 57%), mild cognitive impairment (MCI, 26%), and Alzheimer's disease (AD, 17%). Sarcopenia was defined according to diagnostic algorithm recommended by the European Working Group on Sarcopenia in Older People. Components of sarcopenia were grip strength, bioelectrical impedance analysis, and gait speed. They were further aggregated into a score (0-3 points) by counting the numbers of limited components. Multi-nominal logistic regression was applied.

    RESULTS: Probable sarcopenia (i.e., reduced grip strength) was observed in 9.6% of the patients, and 3.5% were diagnosed with sarcopenia. Patients with faster gait speed showed less likelihood of MCI (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.06-0.90) and AD (OR: 0.12, 95% CI: 0.03-0.60). One or more limited sarcopenia components was associated with worse cognitive function. After adjusting for potential confounders, the association remained significant only for AD (OR 4.29, 95% CI 1.45-11.92).

    CONCLUSION: The results indicate a connection between the sarcopenia components and cognitive impairments. Limitations in the sarcopenia measures, especially slow walking speed, were related to poorer cognitive outcomes. More investigationsare required to further verify the causal relationship between sarcopenia and cognitive outcomes.

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  • 894.
    Larsson, Maria
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Perception och psykofysik.
    Hedner, Margareta
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Papenberg, Goran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Seubert, Janina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Bäckman, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Laukka, Erika J.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Olfactory memory in the old and very old: relations to episodic and semantic memory and APOE genotype2016Ingår i: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 38, s. 118-126Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The neuroanatomical organization that underlies olfactory memory is different from that of other memory types. The present work examines olfactory memory in an elderly population-based sample (Swedish National Study on Aging and Care in Kungsholmen) aged 60-100 years (n = 2280). We used structural equation modeling to investigate whether olfactory memory in old age is best conceptualized as a distinct category, differentiated from episodic and semantic memory. Further, potential olfactory dedifferentiation and genetic associations (APOE) to olfactory function in late senescence were investigated. Results are in support of a 3-factor solution where olfactory memory, as indexed by episodic odor recognition and odor identification, is modeled separately from episodic and semantic memory for visual and verbal information. Increasing age was associated with poorer olfactory memory performance, and observed age-related deficits were further exacerbated for carriers of the APOE epsilon 4 allele; these effects tended to be larger for olfactory memory compared to episodic and semantic memory pertaining to other sensory systems (vision, auditory). Finally, stronger correlations between olfactory and episodic memory, indicating dedifferentiation, were observed in the older age groups.

  • 895.
    Larsson, Susanna C.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Markus, Hugh S
    Does Treating Vascular Risk Factors Prevent Dementia and Alzheimer's Disease? A Systematic Review and Meta-Analysis.2018Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 64, nr 2, s. 657-668Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Epidemiological evidence has associated Alzheimer's disease (AD) with vascular risk factors (VRFs), but whether treatment of VRFs reduces the incidence of dementia and AD is uncertain.

    OBJECTIVE: To conduct a systematic review and meta-analysis to summarize available data on the impact of treatment of VRFs on dementia and AD incidence.

    METHODS: Pertinent studies published until 1 January 2018 were identified from PubMed. Both randomized controlled trials (RCT) and prospective studies that investigated the impact of treatment of VRFs on dementia or AD incidence were included.

    RESULTS: Eight RCTs and 52 prospective studies were identified. Antihypertensive treatment was associated with a non-significant reduced risk of dementia in RCTs (n = 5; relative risk [RR], 0.84; 95% confidence interval [CI], 0.69-1.02) and prospective studies (n = 3; RR, 0.77; 95% CI, 0.58-1.01) and with reduced AD risk in prospective studies (n = 5; RR = 0.78; 95% CI, 0.66-0.91). In prospective studies, treatment of hyperlipidemia with statins, but not nonstatin lipid-lowering agents, was associated with reduced risk of dementia (n = 17; RR, 0.77; 95% CI, 0.63-0.95) and AD (n = 13; RR, 0.86; 95% CI, 0.80-0.92). The single RCT on statins and dementia incidence showed no association. Data from one RCT and six prospective studies did not support a beneficial impact of antidiabetic drugs or insulin therapy on dementia risk.

    CONCLUSION: Current evidence indicates that antihypertensives and statins might reduce the incidence of dementia and AD. Further trials to determine the effect of VRF on AD are needed.

  • 896.
    Larsson, Susanna C.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Orsini, Nicola
    Coffee Consumption and Risk of Dementia and Alzheimer's Disease: A Dose-Response Meta-Analysis of Prospective Studies.2018Ingår i: Nutrients, E-ISSN 2072-6643, Vol. 10, nr 10, artikel-id E1501Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Coffee consumption is associated with a reduced risk of several diseases but uncertainty remains about the influence of coffee consumption on the risk of dementia. We performed a dose-response meta-analysis to summarize the prospective data on coffee consumption and associated risk of dementia and Alzheimer's disease. We identified studies by searching PubMed (from January 1966) and Web of Science (from January 1945) through 4 October 2018 and by scrutinizing the reference lists of pertinent publications. Two researchers independently reviewed the literature. Results were combined using a restricted cubic spline random-effects dose-response meta-analysis based on a one-stage approach. Eight relevant prospective studies were identified. These studies included 7486 dementia cases diagnosed among 328,885 individuals during an average follow-up of 4.9⁻25 years. Meta-analysis of all eight studies indicated no statistically significant association between coffee consumption and the risk of dementia and no deviations from a linear trend (p = 0.08). The relative risk of dementia per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval (CI) 0.98⁻1.05; p = 0.37). Meta-analysis of five studies that focused on Alzheimer's disease revealed no association between coffee consumption and Alzheimer's disease and no deviations from a linear trend (p = 0.79). The relative risk of Alzheimer's disease per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval 0.95⁻1.07; p = 0.80). These results do not support an association between coffee consumption and an increased risk of overall dementia or Alzheimer's disease specifically, but further research on the association of coffee consumption with dementia risk is needed.

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  • 897.
    Larsson, Susanna C.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol, Stockholm, Sweden.
    Wolk, Alicja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol, Stockholm, Sweden.
    Sedentary leisure-time in relation to mortality and survival time2019Ingår i: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 22, nr 5, s. 562-567Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To examine the association between sedentary leisure-time and all-cause mortality and differences in survival time.

    Design: Prospective cohort study.

    Methods: Information on sedentary leisure-time, defined as TV viewing and/or sitting reading, was collected from 72 003 Swedish adults who were 45-83 (median 60) years of age and completed a self-administered questionnaire at baseline and were followed up for 17 years through linkage with the Swedish Death Register.

    Results: The association between sedentary leisure-time and all-cause mortality was modified by age with a more pronounced association in middle-aged (<60 years of age) than in older adults (>= 60 years of age) (p-interaction <0.001). During follow-up, 3358 and 15 217 deaths occurred in the middle-aged and older age group, respectively. The multivariable-adjusted hazard ratios for the highest (>6 h/day) versus lowest category (<1 h/day) of sedentary leisure-time were 1.72 (95% confidence interval [CI] 1.29-2.30) in middle-aged adults and 1.19 (95% CI 1.05-1.36) in older adults. This corresponded to a difference in survival time of respectively 2.4 (95% CI -4.1 to -0.8) years and 1.5 (95% CI -2.2 to -0.7) years.

    Conclusions: Prolonged sedentary leisure-time was associated with a significantly decreased survival time up to 2.4 years in middle-aged adults. 

  • 898. Laudisio, Alice
    et al.
    Lo Monaco, Maria Rita
    Vetrano, Davide L.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Catholic University of Medicine, Italy.
    Pisciotta, Maria Stella
    Brandi, Vincenzo
    Gemma, Antonella
    Fusco, Domenico
    Bernabei, Roberto
    Incalzi, Raffaele Antonelli
    Zuccala, Giuseppe
    Association of Pisa Syndrome With Mortality in Patients With Parkinson's Disease2019Ingår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, nr 8, s. 1037-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: In Parkinson's disease, Pisa syndrom (PS) has been associated with disease stage and severity, combined treatment with levodopa and dopamine agonists, gait disorders, and comorbidities. Some forms of PS are potentially reversible; nevertheless, little is known about the impact of this syndrome on survival. Design: Prospective study with a median follow-up of 2 years. Setting and participants: Patients with Parkinson's disease, age 65 years and older (N = 189), attending a geriatric day hospital. Measurements: According to established criteria, PS was diagnosed in the presence of at least 10 degrees lateral flexion of the trunk reducible by passive mobilization or supine positioning. Cox regression was adopted to assess the association of PS with all-cause mortality. Results: PS was diagnosed in 40 patients (21%); over the follow-up, 21 (11%) subjects died. In Cox regression, PS was associated with higher mortality [hazard ratio (HR) 4.10; 95% confidence interval (CI) = 1.36-12.38], after adjusting; other variables associated with mortality were age (HR = 1.19, 95% CI = 1.08-1.32), beta blockers (HR = 4.35, 95% CI = 1.23-15.39), and albumin levels (HR = 0.05, 95% CI = 0.01-0.33). The association of PS with mortality remained significant also after adjusting for variables associated with this syndrome (HR = 4.04, 95% CI = 1.33-12.25). Conclusions/Implications: PS represents a risk factor for earlier mortality in Parkinson's disease; further studies are needed to ascertain the underlying causes and whether treatment of this condition might improve survival. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

  • 899.
    Laukka, Erika J.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Lövdén, Martin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Kalpouzos, Gregoria
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Li, Tie-Qiang
    Jonsson, Tomas
    Wahlund, Lars-Olof
    Fratiglioni, Laura
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Bäckman, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Associations between White Matter Microstructure and Cognitive Performance in Old and Very Old Age2013Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 8, nr 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Increasing age is associated with deficits in a wide range of cognitive domains as well as with structural brain changes. Recent studies using diffusion tensor imaging (DTI) have shown that microstructural integrity of white matter is associated with cognitive performance in elderly persons, especially on tests that rely on perceptual speed. We used structural equation modeling to investigate associations between white matter microstructure and cognitive functions in a population-based sample of elderly persons (age >= 60 years), free of dementia, stroke, and neurological disorders (n = 253). Participants underwent a magnetic resonance imaging scan, from which mean fractional anisotropy (FA) and mean diffusivity (MD) of seven white matter tracts were quantified. Cognitive functioning was analyzed according to performance in five task domains (perceptual speed, episodic memory, semantic memory, letter fluency, and category fluency). After controlling for age, FA and MD were exclusively related to perceptual speed. When further stratifying the sample into two age groups, the associations were reliable in the old-old (>= 78 years) only. This relationship between white matter microstructure and perceptual speed remained significant after excluding persons in a preclinical dementia phase. The observed pattern of results suggests that microstructural white matter integrity may be especially important to perceptual speed among very old adults.

  • 900. Lehtisalo, J.
    et al.
    Lindström, J.
    Ngandu, T.
    Kivipelto, Miia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). National Institute for Health and Welfare, Finland; University of Helsinki, Finland.
    Ahtiluoto, S.
    Ilanne-Parikka, P.
    Keinanen-Kiukaanniemi, S.
    Eriksson, J. G.
    Uusitupa, M.
    Tuomilehto, J.
    Luchsinger, J.
    Association of long-term dietary fat intake, exercise, and weight with later cognitive function in the Finnish Diabetes Prevention Study2016Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 20, nr 2, s. 146-154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate associations of long-term nutrient intake, physical activity and obesity with later cognitive function among the participants in the Finnish Diabetes Prevention Study, in which a lifestyle intervention was successful in diabetes prevention. Design: An active lifestyle intervention phase during middle age (mean duration 4 years) and extended follow-up (additional 9 years) with annual lifestyle measurements, followed by an ancillary cognition assessment. Setting: 5 research centers in Finland. Participants: Of the 522 middle-aged, overweight participants with impaired glucose tolerance recruited to the study, 364 (70%) participated in the cognition assessment (mean age 68 years). Measurements: A cognitive assessment was executed with the CERAD test battery and the Trail Making Test A on average 13 years after baseline. Lifestyle measurements included annual clinical measurements, food records, and exercise questionnaires during both the intervention and follow-up phase. Results: Lower intake of total fat (p=0.021) and saturated fatty acids (p=0.010), and frequent physical activity (p=0.040) during the whole study period were associated with better cognitive performance. Higher BMI (p= 0.012) and waist circumference (p= 0.012) were also associated with worse performance, but weight reduction prior to the cognition assessment predicted worse performance as well (decrease vs. increase, p= 0.008 for BMI and p= 0.002 for waist). Conclusions: Long-term dietary fat intake, BMI, and waist circumference have an inverse association with cognitive function in later life among people with IGT. However, decreases in BMI and waist prior to cognitive assessment are associated with worse cognitive performance, which could be explained by reverse causality.

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