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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
Brännström, J., Boström, G., Rosendahl, E., Nordström, P., Littbrand, H., Lövheim, H. & Gustafson, Y. (2017). Psychotropic drug use and mortality in old people with dementia: investigating sex differences. BMC Pharmacology & Toxicology, 18, Article ID 36.
Open this publication in new window or tab >>Psychotropic drug use and mortality in old people with dementia: investigating sex differences
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2017 (English)In: BMC Pharmacology & Toxicology, E-ISSN 2050-6511, Vol. 18, article id 36Article in journal (Refereed) Published
Abstract [en]

Background: Psychotropic drugs are common among old people with dementia, and have been associated with increased mortality. Previous studies have not investigated sex differences in this risk. This study was conducted to analyse associations between the use of antipsychotics, antidepressants, and benzodiazepines and 2-year mortality in old people with dementia, and to investigate sex differences therein.

Methods: In total, 1037 participants (74% women; mean age, 89 years) with dementia were included from four cohort studies and followed for 2 years. Data were collected through home visits and medical records. Cox proportional hazard regression models were used to analyse associations between ongoing baseline drug use and mortality. Multiple possible confounders were evaluated and adjusted for.

Results: In fully adjusted models including data from the whole population, no association between baseline psychotropic drug use and increased 2-year mortality was seen. Significant sex differences were found in mortality associated with antidepressant use, which was protective in men, but not in women (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40–0.92 and HR 1.09, 95% CI 0.87–1.38, respectively). The interaction term for sex was significant in analyses of benzodiazepine use, with a higher mortality risk among men than among women.

Conclusions: Among old people with dementia, ongoing psychotropic drug use at baseline was not associated with increased mortality in analyses adjusted for multiple confounders. Sex differences in mortality risk associated with antidepressant and benzodiazepine use were seen, highlighting the need for further investigation of the impact of sex.

Keywords
Alzheimer’s disease, antidepressants, antipsychotics, benzodiazepines, cohort study, dementia, gender, mortality, old age, psychotropic drugs, vascular dementia
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-119011 (URN)10.1186/s40360-017-0142-9 (DOI)000402184000001 ()28545507 (PubMedID)
Note

Originally published in manuscript form with title "Psychotropic drug use and mortality in old people with dementia: a gender-sensitive analysis"

Available from: 2016-04-07 Created: 2016-04-07 Last updated: 2018-06-07Bibliographically 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. (2016). Depression in older people with and without dementia: non-pharmacological interventions and associations between psychotropic drugs and mortality. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Depression in older people with and without dementia: non-pharmacological interventions and associations between psychotropic drugs and mortality
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Depression hos äldre människor med och utan demenssjukdom : icke-farmakologiska interventioner och associationer mellan psykofarmaka och död
Abstract [en]

The aim of this thesis was to investigate associations between psychotropic drug use and death, associations between functional capacity, dependency in ADL and depression, and to evaluate a non-pharmacological intervention to reduce depressive symptoms, among older people with and without dementia.

There is limited knowledge about the risk of death associated with psychotropic drug use among those aged ≥85 years, those with dementia, or those living in residential care facilities; groups that have a higher intake of psychotropic drugs and who are also more prone to adverse drug reactions. In a representative sample of people ≥85 years (n = 992), baseline antidepressant use was not associated with an increased 5-year mortality risk when adjusting for confounding factors. A significant interaction between gender and antidepressant use was found, with a higher mortality risk in women, than in men.  When analyzing men and women separately, no significant associations were found. In a sample of older people (i.e. ≥65 years) with dementia (n = 1037), there was a significant gender difference in 2-year mortality associated with the baseline use of antidepressant drugs, with a lower mortality risk in men, than in women. In men, the mortality risk was significantly reduced with antidepressant use, while there was no significant association in women. The association between baseline use of benzodiazepines and mortality had a tendency toward an increased risk during the first year of follow-up, although this became non-significant after adjustments. In this time period, the interaction term for sex was significant, with a higher mortality risk among men than women. When the sexes were analyzed separately, no significant associations were found. No significant associations were found between baseline use of antipsychotic drugs and mortality.

Drug treatment for depression seems to have a limited effect in older people and may have no effect in people with dementia. In order to find alternative ways of treating or preventing depression in older age, it is important to increase our knowledge about factors associated with this condition. Functional capacity and dependency in activities of daily living (ADL) are associated with depression in community-dwelling older people. However, it is uncertain whether the same associations are to be found in very old people (i.e. ≥80 years), including those with severe cognitive or physical impairments. In a heterogeneous sample (n = 392) with a high mean age, a large range of cognitive and functional capacity, a wide spectrum of dependency in ADL, and a high prevalence of comorbidities, depressive symptoms were significantly associated with functional balance capacity, but not with overall dependency in ADL. Among individual ADL tasks, dependency in transfer and dressing were associated with depressive symptoms.

Physical exercise has shown effect sizes similar to those of antidepressants in reducing depressive symptoms among older people without dementia, with moderate–high-intensity exercise being more effective than low-intensity exercise. However, these effects are unclear among older people with dementia. Care-facility residents with dementia (n = 186) were cluster-randomized to a high-intensity functional exercise program or a non-exercise control activity conducted for 45 minutes every other weekday for 4 months. No significant difference between the exercise and control activity was found in depressive symptoms at 4 or 7 months. Among participants with high levels of depressive symptoms, reductions were observed in both the exercise and control groups at 4 and 7 months.

In conclusion, ongoing treatment at baseline with any of the three psychotropic drug classes antidepressants, antipsychotics and benzodiazepines did not increase the risk of mortality in older people with dementia.  Neither did antidepressant drugs in very old people. In both samples, gender differences were found in the mortality risk due to antidepressant use. In those with dementia, the mortality risk due to benzodiazepine use also differed by gender. The potential risk from initial treatment and gender differences regarding mortality risk require further investigation in randomized controlled trials or in large cohort studies properly controlled for confounding factors. In older people, living in community and residential care facilities, functional capacity seems to be independently associated with depressive symptoms whereas overall ADL performance may not be associated. Dependency in the individual ADL tasks of transfer and dressing appear to be independently associated with depressive symptoms and may be an important focus for future interdisciplinary multifactorial intervention studies. Among older people with dementia living in residential care facilities, a 4-month high-intensity functional exercise program has no superior effect on depressive symptoms than a control activity. Both exercise and non-exercise group activities may reduce high levels of depressive symptoms. However, this finding must be confirmed in three-armed randomized controlled trials including control groups receiving standard care.

Abstract [sv]

Syftet med avhandlingen var att utreda sambandet mellan risken för död och användningen av psykofarmaka (läkemedel som används vid olika psykiatriska tillstånd) och att utforska samband mellan funktionell kapacitet, hjälpberoende i aktiviteter i det dagliga livet (ADL) och depression hos äldre personer med och utan demenssjukdom. Syftet var även att utvärdera effekten av högintensiv funktionell träning på depressiva symtom hos äldre människor med demenssjukdom som bor på särskilt boende.

Kunskapen är begränsad om risken för död vid psykofarmakaanvändning hos de som är 85 år eller äldre, har demenssjukdom eller bor på särskilt boende. Människor i dessa grupper får oftare utskrivet psykofarmaka och är mer benägna att drabbas av biverkningar än yngre och friskare människor. I ett representativt urval av personer som var 85 år eller äldre (n = 992) hade inte antidepressiv medicinering vid baslinjen (d.v.s. studiestarten) något signifikant samband med risken att dö under en uppföljning på 5 år, kontrollerat för störfaktorer. Sambandet mellan risken för död och användningen av antidepressiva läkemedel skiljde sig mellan kvinnor och män, med en relativt högre risk för död hos kvinnor jämfört med män. I separata analyser av män och kvinnor hittades dock inga signifikanta samband. I ett annat urval, där äldre personer med demenssjukdom (n = 1037) följdes i upp till 2 år, hittades också en skillnad mellan män och kvinnor i risken att dö relaterad till antidepressiv användning vid studiestarten. Risken för död var relativt lägre hos män jämfört med kvinnor. När män analyserades separat hittades ett signifikant samband mellan en lägre risk för död och användning av antidepressiva läkemedel, samtidigt som inget samband kunde ses hos kvinnor. Det fanns en tendens mot en ökad risk för död relaterad till användning av bensodiazepiner under det första årets uppföljning. Detta samband försvann dock, när analyserna justerades för störfaktorer. Under det första årets uppföljning fanns det också en könsskillnad i risken för död vid användning av bensodiazepiner. Denna risk var relativt högre hos män jämfört med kvinnor. När män och kvinnor analyserades separat fanns dock inga samband. Inga signifikanta samband hittades heller mellan användning av antipsykotiska läkemedel vid studiestarten och risken för död.

Läkemedelsbehandling vid depression verkar ha en begränsad effekt hos äldre människor och kan möjligtvis sakna effekt hos personer med demens. För att hitta alternativa sätt att behandla eller förebygga depression hos äldre är det därför viktigt att öka kunskapen om faktorer som har samband med depression. Nedsatt funktionell kapacitet och hjälpberoende i ADL är associerat med depression hos relativt friska äldre människor som bor i ordinärt boende. Det är dock osäkert om dessa samband också finns hos personer som är 80 år eller äldre, inklusive de med gravt nedsatt kognitiv eller fysisk funktion och inklusive de som bor på särskilt boende. I ett heterogent urval (n = 392) med hög medelålder, stor variation av kognitiv och fysisk funktion, mycket varierat hjälpbehov i ADL och hög förekomst av sjukdomar, var depressiva symptom signifikant associerade med nedsatt funktionell balanskapacitet, men inte med övergripande beroende i ADL. Bland enskilda ADL-uppgifter var depressiva symtom relaterade till hjälpberoende i överflyttning och påklädning.

Fysisk träning har haft effekter liknande antidepressiva läkemedel i att minska depressiva symtom hos äldre personer utan demenssjukdom, med bättre effekt av måttlig-högintensiv träning än lågintensiv träning. Hos äldre personer med demenssjukdom är det osäkert om fysisk träning kan minska depressiva symtom. Äldre personer med demenssjukdom (n = 186) som bodde på särskilt boende lottades till att delta i ett högintensivt funktionellt träningsprogram eller till en stillasittande kontrollaktivitet, under 45 minuter varannan vardag i 4 månader. Ingen signifikant skillnad hittades mellan träningen och kontrollaktiviteten i förändring av depressiva symtom vid 4 eller 7 månaders uppföljning. Bland deltagarna med höga nivåer av depressiva symtom sågs signifikanta minskningar i både tränings- och kontrollgruppen vid 4 och 7 månader.

Sammanfattningsvis hittades ingen ökad risk för död hos äldre personer med demens som vid studiestarten behandlades med bensodiazepiner, antidepressiva läkemedel eller antipsykotiska läkemedel. Inte heller hos mycket gamla människor hittades något samband mellan en ökad risk för död och behandling med antidepressiva läkemedel. I båda urvalen hittades könsskillnader i risken för död vid användning av antidepressiva läkemedel. Hos de med demenssjukdom hittades också en könsskillnad i risken för död i samband med användning av bensodiazepiner. Den potentiella risken med initial behandling, samt könsskillnader i risken för död, bör utforskas vidare i randomiserade kontrollerade studier eller i stora kohortstudier med noggranna justeringar för störfaktorer. Hos äldre människor som bor i ordinärt boende eller särskilt boende verkar funktionell kapacitet vara oberoende associerat med depressiva symtom, samtidigt som övergripande ADL-beroende inte verkar vara det. Beroende i de enskilda ADL-uppgifterna överflyttning och påklädning verkar ha oberoende samband med depressiva symtom och kan vara ett viktigt fokus i framtida studier. Bland äldre personer med demenssjukdom som bor på särskilt boende har 4 månaders högintensiv funktionell träning inte bättre effekt på depressiva symtom än en stillasittande aktivitet. Både gruppträning och andra gruppaktiviteter skulle kunna minska höga nivåer av depressiva symtom, men det behöver bekräftas i interventionsstudier som även inkluderar en kontrollgrupp som får sedvanlig vård.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. p. 89
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1797
Keywords
Depression, Dementia, Exercise, Randomized controlled trial, Psychotropic drugs, Mortality, Gender, Residential facilities, Frail elderly, Epidemiology, Cohort study
National Category
Geriatrics Physiotherapy
Research subject
Geriatrics; Physiotherapy
Identifiers
urn:nbn:se:umu:diva-119016 (URN)978-91-7601-452-3 (ISBN)
Public defence
2016-05-04, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-13 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
Weidung, B., Boström, G., Toots, A., Nordström, P., Carlberg, B., Gustafson, Y. & Littbrand, H. (2015). Blood Pressure, Gait Speed, and Mortality in Very Old Individuals: A Population-Based Cohort Study. Journal of the American Medical Directors Association, 16(3), 208-214
Open this publication in new window or tab >>Blood Pressure, Gait Speed, and Mortality in Very Old Individuals: A Population-Based Cohort Study
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2015 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 16, no 3, p. 208-214Article in journal (Refereed) Published
Abstract [en]

Objectives: Clinical trials and observational studies have produced contradictory results regarding the association of blood pressure (BP) and mortality in people aged 80 years or older. Gait speed at usual pace has been shown to moderate this association in a population of noninstitutionalized people aged 65 years or older. The aims of this study were to investigate the association of BP with all-cause mortality in a representative sample of people aged 85 years or older and to assess whether gait speed moderates this association.

Design, Setting, and Participants: A total of 806 participants in the population-based prospective Umeå 85+/GERDA study aged 85, 90, and 95 years or older.

Measurements: Gait speed at usual pace was measured over 2.4 m. The main outcome was hazard ratios (HRs) for all-cause mortality according to systolic and diastolic BP categories in the total sample and in faster-walking (≥0.5 m/s, n = 312) and slower-walking (<0.5 m/s, n = 433) subcohorts; the latter also included habitually nonwalking participants. Comprehensive adjustments were made for sociodemographic and clinical characteristics associated with death.

Results: Mean age and baseline systolic and diastolic BP were 89.6 ± 4.6 years, 146.8 ± 23.9 mm Hg, and 74.8 ± 11.1 mm Hg, respectively. Most (n = 561 [69%]) participants were women, 315 (39%) were care facility residents, and 566 (70%) were prescribed BP-lowering drugs. Within 5 years, 490 (61%) participants died. In the total sample and slower-walking subcohort, systolic BP appeared to be inversely associated with mortality, although not independent of adjustments. Among faster-walking participants, mortality risk after adjustment was more than 2 times higher in those with systolic BP of 140 to 149 mm Hg (HR = 2.25, 95% confidence interval [CI] = 1.03–4.94) and 165 mm Hg or higher (HR = 2.13, 95% CI = 1.01–4.49), compared with systolic BP of 126 to 139 mm Hg. Mortality risk was also independently higher in faster-walking participants with diastolic BP higher than 80 mm Hg, compared with diastolic BP of 75 to 80 mm Hg (HR = 1.76, 95% CI = 1.07–2.90).

Conclusion: The gait speed threshold of 0.5 m/s may be clinically useful for the distinction of very old people with and without increased all-cause mortality risk due to elevated systolic and diastolic BP.

Keywords
Gait speed, blood pressure, aged, 80 and older, mortality, residential facilities, prospective studies
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-101393 (URN)10.1016/j.jamda.2014.09.004 (DOI)000350176900009 ()25441098 (PubMedID)
Available from: 2015-07-03 Created: 2015-03-30 Last updated: 2018-06-07Bibliographically approved
Boström, G., Conradsson, M., Rosendahl, E., Nordström, P., Gustafson, Y. & Littbrand, H. (2014). Functional capacity and dependency in transfer and dressing are associated with depressive symptoms in older people. Clinical Interventions in Aging, 9, 249-257
Open this publication in new window or tab >>Functional capacity and dependency in transfer and dressing are associated with depressive symptoms in older people
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2014 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 9, p. 249-257Article in journal (Refereed) Published
Abstract [en]

Background: This study examined associations between depressive symptoms and functional capacity, overall dependency in personal activities of daily living (ADLs), and dependency in individual ADL tasks, respectively, in people with a high mean age, large range of functional capacity, and wide spectrum of dependency in ADLs. Methods: Cross-sectional data from three studies were used. A total of 392 individuals living in community and residential care facilities were included. Mean age was 86.2 years, 72% were women, 75% were dependent in ADLs, 42% had depression, and 39% had dementia. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15), functional capacity with the Berg Balance Scale (BBS), and ADLs with the Barthel ADL Index. Multiple linear regression analyses with comprehensive adjustments were performed between GDS-15 and BBS, GDS-15 and Barthel ADL Index, and GDS-15 and each individual ADL task, separately. Results: GDS-15 score was associated with BBS score (unstandardized b=-0.03, P=0.008), but not with Barthel ADL Index score (unstandardized b=-0.07, P=0.068). No significant interaction effects of sex, dementia, or living conditions were found in these associations. Among individual ADL tasks, dependency in transfer (unstandardized b=-1.03, P=0.007) and dressing (unstandardized b=-0.70, P=0.035) were associated with depressive symptoms. Conclusion: Functional capacity seems to be independently associated with depressive symptoms in older people living in community and residential care facilities, whereas overall ADL performance may not be associated. Dependency in the individual ADL tasks of transfer and dressing appear to be independently associated with depressive symptoms and may be an important focus of future interdisciplinary multifactorial intervention studies.

Place, publisher, year, edition, pages
Dove Medical Press Ltd., 2014
Keywords
aged 80 and over, residential facilities, independent living, depression, activities of daily living
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-86336 (URN)10.2147/CIA.S57535 (DOI)000330634700001 ()
Funder
Swedish Research Council, K2009-69P-21298-01-4, K2009-69X-21299-01-1, K2009-69P-21298-04-4
Available from: 2014-02-24 Created: 2014-02-24 Last updated: 2018-06-08Bibliographically approved
Conradsson, M., Littbrand, H., Boström, G., Lindelöf, N., Gustafson, Y. & Rosendahl, E. (2013). Is a change in functional capacity or dependency in activities of daily living associated with a change in mental health among older people living in residential care facilities?. Clinical Interventions in Aging, 8, 1561-1568
Open this publication in new window or tab >>Is a change in functional capacity or dependency in activities of daily living associated with a change in mental health among older people living in residential care facilities?
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2013 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 8, p. 1561-1568Article in journal (Refereed) Published
Abstract [en]

Aim: Functional capacity and dependency in activities of daily living (ADL) could be important mediators for an association between physical exercise and mental health. The aim of this study was to investigate whether a change in functional capacity or dependency in ADL is associated with a change in depressive symptoms and psychological well-being among older people living in residential care facilities, and whether dementia can be a moderating factor for this association.

Methods: A prospective cohort study was undertaken. Participants were 206 older people, dependent in ADL, living in residential care facilities, 115 (56%) of whom had diagnosed dementia. Multivariate linear regression, with comprehensive adjustment for potential confounders, was used to investigate associations between differences over 3 months in Berg Balance Scale (BBS) and Geriatric Depression Scale (GDS-15) scores, and in BBS and Philadelphia Geriatric Center Morale Scale (PGCMS) scores. Associations were also investigated between differences in Barthel ADL Index and GDS-15 scores, and in Barthel ADL Index and PGCMS scores.

Results: There were no significant associations between changes in scores over 3 months; the unstandardized beta for associations between BBS and GDS-15 was 0.026 (P=0.31), BBS and PGCMS 0.045 (P=0.14), Barthel ADL Index and GDS-15 0.123 (P=0.06), and Barthel ADL Index and PGCMS -0.013 (P=0.86). There were no interaction effects for dementia.

Conclusion: A change in functional capacity or dependency in ADL does not appear to be associated with a change in depressive symptoms or psychological well-being among older people living in residential care facilities. These results may offer one possible explanation as to why studies of physical exercise to influence these aspects of mental health have not shown effects in this group of older people.

Place, publisher, year, edition, pages
Dove Medical Press, 2013
Keywords
aged, residential facilities, dementia, frail elderly, activities of daily living, physical fitness, mental health, depression, quality of life
National Category
Geriatrics Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-84143 (URN)10.2147/CIA.S53270 (DOI)000327319200001 ()
Available from: 2013-12-17 Created: 2013-12-16 Last updated: 2018-06-08Bibliographically approved
Wallin, K., Boström, G., Kivipelto, M. & Gustafson, Y. (2013). Risk factors for incident dementia in the very old. International psychogeriatrics, 25(7), 1135-1143
Open this publication in new window or tab >>Risk factors for incident dementia in the very old
2013 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 25, no 7, p. 1135-1143Article in journal (Refereed) Published
Abstract [en]

Background: Several risk factors for dementia, Alzheimer's disease, and cognitive impairment have been established; however, knowledge about risk factors in the very old population (>= 85 years) is limited. This study describes the association of several baseline factors with dementia in participants aged >= 85 years, and investigates factors associated with a higher risk of incident dementia over five years.

Methods: The participants in this population-based cohort study were aged 85, 90, and >= 95 years at baseline (2000-2002). Data were collected during home visits for interviews and testing, from a review of medical records, and/or interviewing the caregiver or next of kin. After five years 212 participants could be followed up concerning incident dementia. Multivariate logistic regression was used.

Results: At baseline, 100/353 (28%) of participants had a dementia diagnosis. Over five years, 71/212 (33.5%) participants developed dementia. Few participants with dementia at baseline remained alive after five years (12%). Depression at the baseline and follow-up time were associated with a higher risk of dementia, odds ratio (OR) (95% CI, p-value) 2.91 (1.37-6.16, 0.005) and 1.61 (1.26-2.05, <0.001) respectively. More social contact and a higher Mini-Mental State Examination score at baseline were associated with lower risk of incident dementia, OR (95% CI, p-value) 0.87 (0.78-0.97, 0.009) and 0.83 (0.74-0.93, 0.001) respectively.

Conclusions: Prevalence and incidence of dementia are high in very old people and dementia appears to be a fatal disorder. Depression is associated with higher risk of incident dementia over five years whereas more frequent social contacts and a higher MMSE score are associated with lower risk.

Keywords
aged, 80 and over, longitudinal, population-based, depression, social isolation, prevalence, incidence
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-79261 (URN)10.1017/S1041610213000409 (DOI)000321262200011 ()
Available from: 2013-09-05 Created: 2013-08-13 Last updated: 2018-06-08Bibliographically approved
Conradsson, M., Littbrand, H., Boström, G., Lindelöf, N., Gustafson, Y. & Rosendahl, E.Is a change in physical capacity or dependence in ADL associated with a change in mental health among older people living in residential care facilities?.
Open this publication in new window or tab >>Is a change in physical capacity or dependence in ADL associated with a change in mental health among older people living in residential care facilities?
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(English)Manuscript (preprint) (Other academic)
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-61451 (URN)
Available from: 2012-11-14 Created: 2012-11-14 Last updated: 2018-06-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6480-8349

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