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Hörnsten, Carl
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Publications (10 of 14) Show all publications
Olofsson, H., Ulander, E. L., Gustafson, Y. & Hörnsten, C. (2018). Association between socioeconomic and health factors and edentulism in people aged 65 and older: a population-based survey. Scandinavian Journal of Public Health, 46(7), 690-698
Open this publication in new window or tab >>Association between socioeconomic and health factors and edentulism in people aged 65 and older: a population-based survey
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 7, p. 690-698Article in journal (Refereed) Published
Abstract [en]

Aims: To study edentulism and use of dental services in a population-based sample of people aged 65 years and older from northern Sweden and western Finland.

Methods: In 2010, people aged 65, 70, 75 and 80 years who were living in one of 32 municipalities in northern Sweden and western Finland were invited to answer a questionnaire as part of the Gerontological Regional Database (GERDA) study (n = 6099). The questionnaire contained items related to socioeconomic status, general health and edentulism.

Results: The prevalence of edentulism was 34.9% in Finland, compared with 20.6% in Sweden (p < 0.001), 31.9% in rural areas, compared with 20.9% in urban areas (p < 0.001), and 25% overall. The prevalence of edentulism rose from 17.8% in 65-year-olds, 23.8% in 70-year-olds, 33.5% in 75-year-olds and 37.3% in 80-year-olds (p < 0.001), and was 23.8% in women, compared with 27% in men (p < 0.001). In multivariate models, edentulism was associated with lower educational level (odds ratio (OR) 2.87, 95% confidence interval (CI) 2.31-3.58), low income level (OR 1.7, CI 1.09-1.47), residence in a rural area (OR 1.43, CI 1.23-1.66), male sex (OR 1.30, CI 1.12-1.52), dependence in instrumental activities of daily living (OR 1.48, CI 1.25-1.74), social isolation (OR 1.52, CI 1.17-1.98) and poor self-experienced health (OR 1.38, CI 1.17-1.62).

Conclusions: One-quarter of the total sample was edentulous, with a higher prevalence of edentulism in Finland than in Sweden and in rural than in urban areas. Edentulism was associated with socioeconomic, psychological and health-related factors. These findings could be used to inform preventive measures and identify people aged 65 years and older who are in need of oral care.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Epidemiology, dental health survey, dental care for older people, edentulous mouth, educational level
National Category
Public Health, Global Health, Social Medicine and Epidemiology Dentistry
Identifiers
urn:nbn:se:umu:diva-154856 (URN)10.1177/1403494817717406 (DOI)000452488900003 ()28768459 (PubMedID)2-s2.0-85042129153 (Scopus ID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-01-09Bibliographically approved
Toots, A., Littbrand, H., Boström, G., Hörnsten, C., Holmberg, H., Lundin-Olsson, L., . . . Rosendahl, E. (2017). Effects of exercise on cognitive function in older people with dementia: a randomized controlled trial. Journal of alzheimers disease, 60(1), 323-332
Open this publication in new window or tab >>Effects of exercise on cognitive function in older people with dementia: a randomized controlled trial
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2017 (English)In: Journal of alzheimers disease, ISSN 1387-2877, Vol. 60, no 1, p. 323-332Article in journal (Refereed) Published
Abstract [en]

Background: Although physical exercise has been suggested to influence cognitive function, previous exercise studies show inconsistent results in people with dementia. Objectives: To investigate effects of exercise on cognitive function in people with dementia. Method: The Umea a Dementia and Exercise (UMDEX) study, a cluster-randomized controlled trial, was set in 16 nursing homes in Umea, Sweden. One hundred-and-forty-one women and 45 men with dementia; mean age of 85 y and mean MiniMental State Examination (MMSE) score of 15, were randomized to a High-Intensity Functional Exercise program or a seated attention control activity. Blinded assessors measured global cognitive function using the MMSE and the Alzheimer's disease Assessment Scale -Cognitive subscale (ADAS-Cog), and executive function using Verbal fluency (VF) at baseline and 4 months (directly after intervention completion), and MMSE and VF at 7 months. Results: Linear mixed models showed no between-group effects in mean difference from baseline (95% confidence intervals, CI) at 4 months in MMSE (-0.27; 95% CI -1.4 to 0.87, p = 0.644), ADAS-Cog (-1.04, 95% CI -4 to 1.92, p = 0.491), or VF (-0.53, 95% CI -1.42 to 0.35, p = 0.241) or at 7 months in MMSE (-1.15, 95% CI -2.32 to 0.03, p = 0.056) or VF (-0.18, 95% CI -1.09 to 0.74, p = 0.707). Conclusion: A 4-month, high-intensity functional exercise program had no superior effects on global cognition or executive function in people with dementia living in nursing homes when compared with an attention control activity.

Place, publisher, year, edition, pages
IOS Press, 2017
Keywords
Cognition, dementia, exercise, residential facilities
National Category
Physiotherapy Geriatrics
Identifiers
urn:nbn:se:umu:diva-128727 (URN)10.3233/JAD-170014 (DOI)000408582800026 ()28800328 (PubMedID)
Note

Originally published in manuscript form with title [Effects of exercise on cognitive function in older people with dementia: a randomized controlled study]

Available from: 2016-12-13 Created: 2016-12-13 Last updated: 2019-05-17Bibliographically approved
Boström, G., Hörnsten, C., Brännström, J., Conradsson, M., Nordström, P., Allard, P., . . . Littbrand, H. (2016). Antidepressant use and mortality in very old people. International psychogeriatrics, 28(7), 1201-1210
Open this publication in new window or tab >>Antidepressant use and mortality in very old people
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2016 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 28, no 7, p. 1201-1210Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Antidepressant treatment may increase the risk of death. The association between antidepressants and mortality has been evaluated in community-dwelling older people, but not in representative samples of very old people, among whom dementia, multimorbidity, and disability are common.

METHODS: Umeå 85+/GERDA study participants (n = 992) aged 85, 90, and ≥95 years were followed for up to five years. Cox proportional hazard regression models were used to analyze mortality risk associated with baseline antidepressant treatment, adjusted for potential confounders.

RESULTS: Mean age was 89 years; 27% of participants had dementia, 20% had stroke histories, 29% had heart failure, and 16% used antidepressants. In age- and sex-adjusted analyses, antidepressant use was associated with a 76% increased mortality risk (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.41-2.19). Adding adjustment for Geriatric Depression Scale score, HR was 1.62 (95% CI, 1.29-2.03). The association was not significant when adjusting for additional confounding factors (HR = 1.08; 95% CI, 0.85-1.38). Interaction analyses in the fully adjusted model revealed a significant interaction between sex and antidepressant use (HR: 1.76; 95% CI, 1.05-2.94). Among male and female antidepressant users, the HRs for death were 0.76 (95% CI, 0.47-1.24) and 1.28 (95% CI, 0.97-1.70), respectively.

CONCLUSION: Among very old people, baseline antidepressant treatment does not seem to be independently associated with increased mortality risk. However, the risk may be different in men and women. This difference and the potential risk of initial treatment require further investigation in future cohort studies of very old people.

Place, publisher, year, edition, pages
Cambridge University Press, 2016
Keywords
depression, antidepressants, age 80 and over, dementia, residential facilities, frail elderly, epidemiology, mortality
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-119010 (URN)10.1017/S104161021600048X (DOI)000382387500016 ()26987958 (PubMedID)
Available from: 2016-04-07 Created: 2016-04-07 Last updated: 2018-06-07Bibliographically approved
Boström, G., Conradsson, M., Hörnsten, C., Rosendahl, E., Lindelöf, N., Holmberg, H., . . . Littbrand, H. (2016). Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial. International Journal of Geriatric Psychiatry, 31(8), 868-878
Open this publication in new window or tab >>Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial
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2016 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 31, no 8, p. 868-878Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia.

METHODS: Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini-Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45 min every other weekday for 4 months. The 15-item Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7 months.

RESULTS: No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7 months. Among participants with GDS scores ≥ 5, reductions in GDS score were observed in the exercise and control groups at 4 months (-1.58, P = 0.001 and -1.54, P = 0.004) and 7 months (-1.25, P = 0.01 and -1.45, P = 0.007). Among participants with MADRS scores ≥ 7, a reduction in MADRS score was observed at 4 months in the control group (-2.80, P = 0.009) and at 7 months in the exercise and control groups (-3.17, P = 0.003 and -3.34, P = 0.002).

CONCLUSIONS: A 4-month high-intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non-exercise group activities may reduce high levels of depressive symptoms.

Keywords
dementia, residential facilities, depression, exercise, randomized controlled trial, frail elderly
National Category
Other Health Sciences Physiotherapy Geriatrics
Research subject
Geriatrics; Physiotherapy
Identifiers
urn:nbn:se:umu:diva-113681 (URN)10.1002/gps.4401 (DOI)000382959400004 ()26644304 (PubMedID)
Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2019-05-17Bibliographically approved
Hörnsten, C., Weidung, B., Littbrand, H., Carlberg, B., Nordström, P., Lövheim, H. & Gustafson, Y. (2016). High blood pressure as a risk factor for incident stroke among very old people: a population-based cohort study. Journal of Hypertension, 34(10), 2059-2065
Open this publication in new window or tab >>High blood pressure as a risk factor for incident stroke among very old people: a population-based cohort study
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2016 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 34, no 10, p. 2059-2065Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: High blood pressure (BP) increases the risk of stroke, but there is limited evidence from studies including very old people. The aim was to investigate risk factors for incident stroke among very old people.

METHODS: A prospective population-based cohort study was performed among participants aged at least 85 years in northern Sweden. The 955 participants were tested at their homes. BP was measured manually after 5-min supine rest. Incident stroke data were collected from medical charts guided by hospital registry, death records, and 5-year reassessments. Cox proportional hazards models were used.

RESULTS: The stroke incidence was 33.8/1000 person-years (94 stroke events) during a mean follow-up period of 2.9 years. In a comprehensive multivariate model, atrial fibrillation [hazard ratio 1.85, 95% confidence interval (CI) 1.07-3.19] and higher SBP (hazard ratio 1.19, 95% CI 1.08-1.30 per 10-mmHg increase) were associated with incident stroke overall. However, higher SBP was not associated with incident stroke in participants with SBP less than 140 mmHg (hazard ratio 0.90, 95% CI 0.53-1.53 per 10-mmHg increase). In additional multivariate models, DBP at least 90 mmHg (hazard ratio 2.45, 95% CI 1.47-4.08) and SBP at least 160 mmHg (vs. <140 mmHg; hazard ratio 2.80, 95% CI 1.53-5.14) were associated with incident stroke. The association between BP and incident stroke was not affected by interactions related to sex, dependence in activities of daily living, or cognitive impairment.

CONCLUSION: High SBP (≥160 mmHg) and DBP (≥90 mmHg) and atrial fibrillation appeared to be risk factors for incident stroke among very old people.

Keywords
80 and over, aged, atrial fibrillation, blood pressure, cerebrovascular disorders, risk factors, stroke, very old
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-128531 (URN)10.1097/HJH.0000000000001048 (DOI)000384032800017 ()27434102 (PubMedID)
Funder
Swedish Research Council, K2014-99X-22610-01-6
Available from: 2016-12-06 Created: 2016-12-06 Last updated: 2018-06-09Bibliographically approved
Niklasson, J., Hörnsten, C., Conradsson, M., Nyqvist, F., Olofsson, B., Lövheim, H. & Gustavsson, Y. (2016). High morale and survival. Journal of Psychosomatic Research, 85, 75-75
Open this publication in new window or tab >>High morale and survival
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2016 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 85, p. 75-75Article in journal, Meeting abstract (Other academic) Published
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:umu:diva-123987 (URN)10.1016/j.jpsychores.2016.03.185 (DOI)000377627200068 ()
Note

Meeting Abstract: 59

Available from: 2016-08-19 Created: 2016-07-07 Last updated: 2018-06-13Bibliographically approved
Hörnsten, C. (2016). Stroke and depression in very old age. (Doctoral dissertation). Umeå: Umeå University
Open this publication in new window or tab >>Stroke and depression in very old age
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Stroke och depression i mycket hög ålder
Abstract [en]

Background The prevalence and incidence of stroke are known to increase with age, which, combined with demographic change, means that very old patients with stroke are a growing patient group. Risk factors for incident stroke among very old people have not been widely investigated. The impact of depression on mortality in very old people who have had a stroke also remains unclear. 

The aim of this thesis was to investigate the risk factors for incident stroke, the epidemiology of stroke and depression, and the consequences of having had a stroke regarding the risk of depression and mortality among very old people.

Methods A randomly selected half of 85-, all 90-, and all ≥95-year-olds in certain municipalities in Västerbotten County, Sweden, and Pohjanmaa County, Finland were targeted in a population-based cohort study from 2000-2012. The 65-, 70-, 75-, and 80-year-olds in all the rural and random samples from the urban municipalities in the same counties were furthermore targeted in a survey in 2010.

In the cohort study patients were assessed in their homes, by means of the 15-item Geriatric Depression Scale (GDS-15) and other assessment scales, as well as blood pressure measurements, several physical tests, and a review of medical diagnoses appearing in the medical charts. Incident stroke data were collected from medical charts guided by hospital registry records, cause of death records, and reassessments after 5 years. Depression was defined as a GDS-15 score ≥5. A clinical definition of all depressive disorders, based on assessment scale scores and review of medical charts was also used. A specialist in geriatric medicine evaluated the diagnoses. The survey included yes/no questions about stroke and depression status, and the 4-item Geriatric Depression Scale. Associations with mortality and incident stroke were tested using Cox proportional-hazard models. 

Results In the ≥85-year-olds examined in 2005-2007 (n=601), the stroke prevalence was 21.5%, the prevalence of all depressive disorders was 37.8% and stroke was independently associated with depressive disorders (odds ratio 1.644, p=0.038). The prevalence of depression according to GDS-15 scores was 43.2% in people with stroke compared with 25.0% in people without stroke (p=0.001). However, in ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, depression was not independently associated with incident stroke. 

In ≥65-year-olds who responded to a survey in 2010 (n=6098), the stroke prevalence rose with age from 4.7% among the 65- to 11.6% among the 80-year-olds (p<0.001). The prevalence of depression rose from 11.0% among the 65- to 18.1% among the 80-year-olds (p<0.001). In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year, while in the non-stroke group, depression was independently associated with several additional demographic, social and health factors.

In ≥85-year-olds examined in 2005-2007 with valid GDS-15 tests (n=452), having had a stroke was associated with increased 5-year mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.15-2.03]. Having had a stroke and depression was associated with increased 5-year mortality compared with having only stroke (HR 1.90, 95% CI 1.15-3.13), having only depression (HR 1.59, 95% CI 1.03-2.45), and compared with having neither stroke nor depression (HR 2.50, 95% CI 1.69-3.69). Having only stroke without a depression did not increase mortality compared with having neither stroke nor depression.

In ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, the stroke incidence was 33.8/1000 person-years during a mean follow-up period of about three years. In a comprehensive multivariate model, atrial fibrillation (HR 1.85, 95% CI 1.07–3.19) and higher systolic blood pressure (SBP; HR 1.19, 95% CI 1.08–1.30 per 10-mmHg increase) were associated with incident stroke overall. In additional multivariate models, diastolic blood pressure (DBP) ≥90 mmHg (HR 2.45, 95% CI 1.47–4.08) and SBP ≥160 mmHg (v. <140 mmHg; HR 2.80, 95% CI 1.53–5.14) were associated with incident stroke.

Conclusion The prevalence of both stroke and depression increased with age, and rates were especially high among very old people. Having had a stroke was independently associated with a higher prevalence of depression among very old people, however, depression was not independently associated with a higher incidence of stroke. Having had a stroke was associated with increased all-cause mortality among very old people, but only among those who were also depressed. High SBP (≥160 mmHg), DBP (≥90 mmHg) and atrial fibrillation were the only consistent independent risk factors for incident stroke among very old people.

Abstract [sv]

I västvärlden inklusive Sverige så ökar gruppen av människor som uppnår åldern 80 år eller äldre. Människorna som uppnår denna mycket höga ålder har en hög förekomst av kardiovaskulära riskfaktorer, har ofta flera samtidiga sjukdomar och ofta funktionsnedsättningar. Medicinska behandlingsåtgärder är ofta mindre effektiva och förknippade med biverkningar i åldersgruppen.

Stroke är en sjukdom som beror på skada av hjärnvävnad till följd av minskad blodtillhörsel till delar av hjärnan. Det är känt att såväl förekomsten av och insjuknandet i stroke ökar med stigande ålder. Den som drabbas av stroke löper risk att få en bestående funktionsnedsättning och att dö i förtid. En vanlig komplikation efter att ha drabbats av stroke är nedstämdhet eller depression.

Vetenskapliga studier om stroke har tidigare negligerat mycket gamla människor, vilket i takt med den pågående demografiska utvecklingen framstått som allt mer orimligt. Det är ej helt klarlagt vilka riskfaktorer som leder till att insjukna med stroke i mycket hög ålder. Överdödligheten förknippad med att drabbas av depression efter stroke är också oklar i åldersgruppen. Det är också oklart vad som skiljer depression efter stroke från depression bland den övriga befolkningen av åldrade människor.

Den populations-baserade kohortstudien GErontologisk Regional DAtabas (GERDA) inleddes år 2000 för att kartlägga faktorer förknippade med gott åldrande bland mycket gamla människor. Hälften av 85-åringarna, alla 90-åringar och alla ≥95-åringar i utvalda kommuner i Västerbotten erbjöds att delta i studien. Därefter har återbesök hos tidigare deltagare i sina nya åldersgrupper och rekrytering av nya deltagare genomförts vart femte år. Studien utvidgades med utvalda kommuner i Österbotten, Finland vid den första femårsuppföljningen. Datainsamlingen i studien bestod av demografiska frågor, skattningsskalor, blodtrycksmätning och kognitiva test genomförda vid ett hembesök i deltagarens hem, samt genomgång av journalhandlingar. År 2010 skickades även en enkät ut till 65-, 70-, 75- och 80-åringar i alla kommuner i Västerbotten och Österbotten. Enkäten innehöll frågor om demografi, hälsa, sjukdomar och intressen.

Bland deltagarna i kohortstudien bestämdes förekomsten av tidigare stroke baserat på genomgång av journaluppgifter och uppgifter från hembesöken. Förekomsten av depression bestämdes baserat på poängsättning från en validerad skattningsskala för depression, samt baserat på en sammanvägning av journaluppgifter och skattningsskalor. En specialist i geriatrik fattade det slutliga beslutet om diagnoser. Insjuknande i stroke bestämdes baserat på journalgenomgång av individer med stroke-relaterade diagnoskoder i sjukhusregistret, i dödsorsaksregistret eller uppgift om stroke vid femårsuppföljningen i studien. Bland deltagarna i enkätstudien bestämdes förekomsten av tidigare stroke baserat på självrapportering, och förekomsten av depression bestämdes baserat på en sammanvägning av självrapportering och en skattningsskala för depression. 

Förekomsten av stroke i enkätstudien steg med ålder, från 4.7% bland 65-åringar till 11.6% bland 80-åringar. Förekomsten av stroke var omkring 20% bland ≥85-åringar, med minimal variation mellan 85-, 90- och ≥95-åringar. Förekomsten av depression var högre bland dem med stroke jämfört med de övriga deltagarna, både gällande den sammavägda diagnosen och baserat endast på poängsättning. Stroke och sömnproblem var oberoende associerade med depression.

Bland ≥65-åringar i enkätstudien var funktionsnedsättning och genomgången livskris associerade med depression hos dem med en tidigare stroke. Bland deltagare utan stroke var ett antal ytterligare externa faktorer, inklusive subjektiv upplevelse av dålig ekonomi och att inte ha någon att anförtro sig till, associerade med depression.

Både stroke och depression var associerade med ökad dödlighet bland ≥85-åringar. De med stroke utan depression hade en dödlighet i linje med normalbefolkningen utan stroke eller depression. Förekomsten av samtidig stroke och depression var associerad med högre dödlighet än normalbefolkningen, jämfört med dem med enbart stroke eller enbart depression.

Högt systoliskt blodtryck (≥160 mmHg), högt diastoliskt blodtryck (≥90 mmHg) och förmaksflimmer var oberoende riskfaktorer för att insjukna i stroke bland ≥85-åringarna. Sambandet mellan blodtryck och strokerisk försvagades ej hos människor med kognitiv eller funktionell nedsättning. Tidigare stroke, hjärtsvikt, kognitiv nedsättning, näringsbrist, depressiva symtom och låg gånghastighet var också associerade med att insjukna i stroke, men ej oberoende av varandra.

Sammanfattningsvis så stiger förekomsten av stroke med åldern och är särskilt hög bland mycket gamla människor. Depression är betydligt vanligare hos mycket gamla människor med stroke, även justerat för störningsfaktorer. Depression är främst associerat med funktions-nedsättning hos människor med stroke, men med ett större antal externa faktorer hos människor utan stroke. Mycket gamla människor med stroke har särskilt hög dödlighet om de samtidigt är deprimerade, men en dödlighet i linje med normalbefolkningen om de inte är deprimerade. Högt systoliskt och diastoliskt blodtryck samt förmaksflimmer är viktiga och behandlingsbara orsaker till att drabbas av stroke i mycket hög ålder.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2016. p. 56
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1800
Keywords
stroke, depression, very old, oldest old, epidemiology, mortality, risk factors, systolic blood pressure, diastolic blood pressure, atrial fibrillation, geriatric depression scale
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-120388 (URN)978-91-7601-460-8 (ISBN)
Public defence
2016-06-10, Vårdvetarhusets Aula, Lasarettsbacken 7, 907 46 Umeå, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-05-19 Created: 2016-05-16 Last updated: 2018-06-07Bibliographically approved
Hörnsten, C., Lövheim, H., Nordström, P. & Gustafson, Y. (2016). The prevalence of stroke and depression and factors associated with depression in elderly people with and without stroke. BMC Geriatrics, 16, Article ID 174.
Open this publication in new window or tab >>The prevalence of stroke and depression and factors associated with depression in elderly people with and without stroke
2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 174Article in journal (Other academic) Published
Abstract [en]

Background: Few studies have investigated factors associated with depression among elderly people with and without stroke concurrently, using identical settings, procedures and study variables. The aim was to investigate the prevalence of stroke and depression and to compare the factors associated with depression in people with and without stroke. Methods: A postal mail survey was sent to 65-, 70-, 75- and 80-year-olds in northern Sweden and Finland in 2010 (n = 6098). Stroke was defined as answering "yes" to the question "Have you had a stroke?" Depression was defined as answering "yes" to the question "Are you depressed?" or having a Geriatric Depression Scale-4 score >= 2. Dependence in personal activities of daily living was defined as not showering without human assistance. Associations were tested with log-binomial regression. Results: The overall stroke prevalence was 7.0 +/- 0.3 % and increased from 4.7 +/- 0.4 % among 65-year-olds to 11.6 +/- 1.0 % among 80-year-olds (p < 0.001). The overall depression prevalence was 12.8 +/- 0.4 % and increased from 11.0 +/- 0.6 % among 65-year-olds to 18.1 +/- 1.2 % among 80-year-olds (p < 0.001). Depression was more common among people with stroke (Prevalence Ratio 1.77, 95 % Confidence Interval 1.48-2.12). In the non-stroke group, depression was independently associated with diabetes, dependence in instrumental activities of daily living, living alone, not having someone to talk to, poor finances, pain problems and having a life crisis in the preceding year. In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year. Conclusions: Depression in people without stroke appeared to be independently associated with a broader range of external factors than depression in people with stroke.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Stroke, Depression, Epidemiology
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-120387 (URN)10.1186/s12877-016-0347-6 (DOI)000385302100002 ()27717324 (PubMedID)
Note

Originally published in thesis in manuscript form.

Available from: 2016-05-16 Created: 2016-05-16 Last updated: 2018-06-07Bibliographically approved
Burman, M., Säätelä, S., Carlsson, M., Olofsson, B., Gustafson, Y. & Hörnsten, C. (2015). Body Mass Index, Mini Nutritional Assessment, and their Association with Five-Year Mortality in Very Old People. The Journal of Nutrition, Health & Aging, 19(4), 461-467
Open this publication in new window or tab >>Body Mass Index, Mini Nutritional Assessment, and their Association with Five-Year Mortality in Very Old People
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2015 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 4, p. 461-467Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: to investigate the prevalence of malnutrition and the association between Body Mass Index (BMI), Mini Nutritional Assessment (MNA) and five-year mortality in a representative population of very old (>85 years) people.

DESIGN: A prospective cohort study.

SETTING: A population-based study of very old people in northern Sweden and western Finland, living in institutional care or in the community.

PARTICIPANTS: Out of 1195 potential participants, 832 were included (mean age 90.2±4.6 years).

MEASUREMENTS: Nutritional status was assessed using BMI and MNA and the association of those two variables with five-year mortality was analyzed.

RESULTS: The mean BMI value for the whole population was 25.1±4.5 kg/m2, with no difference between genders (P=0.938). The mean MNA score was 22.5±4.6 for the whole sample, and it was lower for women than for men (P<0.001). Thirteen percent were malnourished (MNA<17) and 40.3% at risk of malnutrition (MNA 17-23.5) according to MNA. Also, 34.8% of those with a MNA score <17 still had a BMI value ≥22.2 kg/m2. A BMI value <22.2 kg/m2 and a MNA score<17 were associated with lower survival. The association with mortality seemed to be J-shaped for BMI, and linear for MNA.

CONCLUSIONS: Malnutrition according to MNA was common, but a substantial portion of those with a low MNA score still had a high BMI value, and vice versa. The association with mortality appeared to be J-shaped for BMI, and linear for MNA. The MNA seems to be a good measurement of malnutrition in very old people, and BMI might be misleading and could underestimate the prevalence of malnutrition, especially in women.

Place, publisher, year, edition, pages
Paris: Springer, 2015
Keywords
MNA, BMI, very old, five-year mortality
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-101459 (URN)10.1007/s12603-015-0443-x (DOI)000352705800012 ()25809811 (PubMedID)
Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2018-06-07Bibliographically approved
Niklasson, J., Hörnsten, C., Conradsson, M., Nyqvist, F., Olofsson, B., Lövheim, H. & Gustafson, Y. (2015). High morale is associated with increased survival in the very old. Age and Ageing, 44(4), 630-636
Open this publication in new window or tab >>High morale is associated with increased survival in the very old
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2015 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 4, p. 630-636Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: high morale is defined as future-oriented optimism. Previous research suggests that a high morale independently predicts increased survival among old people, though very old people have not been specifically studied.

OBJECTIVE: to investigate whether high morale is associated with increased survival among very old people.

SUBJECTS: the Umeå 85+/GErontological Regional DAtabase-study (GERDA) recruited participants aged 85 years and older in northern Sweden and western Finland during 2000-02 and 2005-07, of whom 646 were included in this study.

METHODS: demographic, functional- and health-related data were collected in this population-based study through structured interviews and assessments carried out during home visits and from reviews of medical records. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale.

RESULTS: the 5-year survival rate was 31.9% for participants with low morale, 39.4% for moderate and 55.6% for those with high morale. In an unadjusted Cox model, the relative risk (RR) of mortality was higher among participants with low morale (RR = 1.86, P < 0.001) and moderate morale (RR = 1.59, P < 0.001) compared with participants with high morale. Similar results were found after adjustment for age and gender. In a Cox model adjusted for several demographic, health- and function-related confounders, including age and gender, mortality was higher among participants with low morale (RR = 1.36, P = 0.032) than those with high morale. There was a similar but non-significant pattern towards increased mortality in participants with moderate morale (RR = 1.21, P value = 0.136).

CONCLUSION: high morale is independently associated with increased survival among very old people.

Keywords
aged, 80 and older, longevity, morale, mortality, older people, survival
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-101437 (URN)10.1093/ageing/afv021 (DOI)000357420400018 ()25779630 (PubMedID)
Available from: 2015-03-30 Created: 2015-03-30 Last updated: 2018-06-07Bibliographically approved
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