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Lundström, Maria
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Publications (10 of 24) Show all publications
Olofsson, B., Persson, M., Bellelli, G., Morandi, A., Gustafson, Y. & Stenvall, M. (2018). Development of dementia in patients with femoral neck fracture who experience postoperative delirium: A three-year follow-up study. International Journal of Geriatric Psychiatry, 33(4), 623-632
Open this publication in new window or tab >>Development of dementia in patients with femoral neck fracture who experience postoperative delirium: A three-year follow-up study
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2018 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 33, no 4, p. 623-632Article in journal (Refereed) Published
Abstract [en]

Objectives It remains unclear to what extent postoperative delirium (POD) affects the incidence of dementia in hip fracture patients, and the methods used to detect delirium and dementia require validation. The aim of this study was to investigate the development of dementia within 3 years of femoral neck fracture repair surgery, with a focus on POD as a potential predictive factor.

Methods Patients were assessed for cognition, delirium, depression, psychological well-being, and nutritional status during their hospitalization as well as 4, 12, and 36 months after the operation. Logistic regression models were used to analyse factors associated with POD and factors associated with the development of dementia.

Results The study sample consisted of 135 patients without a history of dementia, of whom 20 (14.8%) were delirious preoperatively and 75 (55.5%) postoperatively. Three years after their operations, 43/135 patients (31.8%) were diagnosed with dementia. A greater portion of patients diagnosed with dementia (39/43, 90.6%) than patients with no dementia (36/92, 39.1%) were included among the 75 patients who had experienced POD (P<0.001). In a logistic regression model, after adjustment for covariates (age, sex, diabetes, delirium pre- and postoperatively, hyperactive delirium, days with delirium, urinary tract infection, and Mini Nutritional Assessment score), POD emerged an independent predictor for the development of new dementia (odds ratio, 15.6; 95% confidence interval, 2.6-91.6) within 3 years after the operation.

Conclusion Geriatric hip fracture patients who exhibit POD should be monitored closely for the development of dementia.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
cognitive impairment, femoral neck fracture, geriatrics, logistic regression, mortality
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-146141 (URN)10.1002/gps.4832 (DOI)000426505700008 ()29292537 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2019-01-08Bibliographically approved
Stenvall, M., Berggren, M., Lundström, M., Gustafson, Y. & Olofsson, B. (2012). A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia: subgroup analyses of a randomized controlled trial. Archives of gerontology and geriatrics (Print), 54(3), E284-E289
Open this publication in new window or tab >>A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia: subgroup analyses of a randomized controlled trial
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2012 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 54, no 3, p. E284-E289Article in journal (Refereed) Published
Abstract [en]

Background: People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery, about 30-50% of all those who sustain a hip fracture have dementia. Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia.

Methods: A randomized controlled trial with subgroup analyses among patients with dementia. Sixty-four patients with femoral neck fracture, aged ≥70 years at Umeå University Hospital, Sweden. The intervention consisted of staff education, individualized care planning and rehabilitation, active prevention, detection and treatment of postoperative complications, especially delirium. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation, including a follow-up at 4 months postoperatively. The control group followed conventional postoperative routines.

Results: There were fewer postoperative complications in the intervention group such as urinary tract infections, p=0.001; nutritional problems, p=0.025; postoperative delirium, p=0.002; falls, p=0.006. At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance, p=0.005. At 12 months a larger proportion in the intervention group had regained the activities of daily living (ADL) performance level they had before the fracture, p=0.027.

Conclusion: This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs.

Keywords
Activities of daily living, dementia, hip fracture, rehabilitation, intervention
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-52739 (URN)10.1016/j.archger.2011.08.013 (DOI)000302959400006 ()21930310 (PubMedID)
Available from: 2012-03-01 Created: 2012-03-01 Last updated: 2018-06-08Bibliographically approved
Lundström, M., Stenvall, M. & Olofsson, B. (2012). Symptom profile of postoperative delirium in patients with and without dementia. Journal of Geriatric Psychiatry and Neurology, 25(3), 162-169
Open this publication in new window or tab >>Symptom profile of postoperative delirium in patients with and without dementia
2012 (English)In: Journal of Geriatric Psychiatry and Neurology, ISSN 0891-9887, E-ISSN 1552-5708, Vol. 25, no 3, p. 162-169Article in journal (Refereed) Published
Abstract [en]

This study compares the symptom profile of patients with postoperative delirium after femoral neck fracture surgery in those with and without dementia. In this study, 129 patients of age >= 70 years (mean age +/- SD, 86 +/- 6 yr, 72% women) with postoperative delirium, were included. Delirium and dementia were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Of the 129 patients with delirium, 54 (42%) had a dementia disorder. Patients with delirium superimposed on dementia more often had any hyperactive and pure emotional delirium. Communication difficulties and symptoms such as restlessness/agitation, aggressive behavior, and irritability were more commonly found in the dementia group. In contrast, patients with delirium but without dementia were more often diagnosed with pure hypoactive and any psychotic delirium. The symptom profile of postoperative delirium varies according to whether it occurs in patients with or without dementia. This may indicate that postoperative delirium among patients with hip fracture differs based on the presence or absence of dementia.

Place, publisher, year, edition, pages
Sage Publications, 2012
Keywords
delirium, symptom, dementia, femoral neck fracture
National Category
Gerontology, specialising in Medical and Health Sciences Neurology Psychiatry Nursing
Identifiers
urn:nbn:se:umu:diva-61986 (URN)10.1177/0891988712455221 (DOI)000310627400005 ()
Available from: 2012-12-13 Created: 2012-12-04 Last updated: 2018-06-08Bibliographically approved
Olofsson, B., Stenvall, M., Lundström, M., Gustafson, Y. & Svensson, O. (2009). Mental status and surgical methods in patients with femoral neck fracture. Orthopedic Nursing, 28(6), 305-313
Open this publication in new window or tab >>Mental status and surgical methods in patients with femoral neck fracture
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2009 (English)In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 28, no 6, p. 305-313Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: About one third of hip-fractured patients have dementia and thus may have difficulties adhering to postoperative instructions. Hip replacement is the most common treatment when a femoral neck fracture is displaced in healthy older people, whereas for those with dementia and other severe comorbidities, internal fixation (IF) is generally recommended.

PURPOSE: To evaluate complications, functional outcome, and mortality for both surgical methods, IF and hemiarthroplasty (HAP), in older patients suffering from femoral neck fracture with or without dementia. SAMPLE: One hundred eighty patients, aged 70 years or older, who were operated on using IF (n = 69) in undisplaced femoral neck fracture and HAP (n = 111) if the fractures were displaced.

DATA COLLECTION: Mental state was assessed using the Mini-Mental State Examination and Organic Brain Syndrome scale, and dementia and delirium were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Outcomes of mortality, complications, functional ability, and quality of life were measured.

FINDINGS: There was no difference in complications or mortality at 4 months and 1 year for the IF or HAP groups. Patients with and without dementia, operated on with HAP, had a better functional outcome after 1 year than those operated on with IF. The result of this study indicates that dementia per se is not a reason for disqualifying those patients from the most appropriate surgical method.

National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-30493 (URN)10.1097/NOR.0b013e3181c015c5 (DOI)
Available from: 2010-01-04 Created: 2010-01-04 Last updated: 2018-06-08Bibliographically approved
Stenvall, M., Olofsson, B., Nyberg, L., Lundström, M. & Gustafson, Y. (2008). Bättre resultat med ett multidisciplinärt vårdprogram för äldre med höftfraktur.
Open this publication in new window or tab >>Bättre resultat med ett multidisciplinärt vårdprogram för äldre med höftfraktur
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2008 (Swedish)Report (Other academic)
Publisher
p. 10
Series
Äldrecentrum Västerbotten ; 2007:2
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-86384 (URN)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2018-06-08Bibliographically approved
Olofsson, B., Stenvall, M., Lundström, M., Carlsson, M., Englund, U., Berglund, M., . . . Gustafson, Y. (2008). Vårdprogram för patienter med höftfrakturer, andra upplagan: ortoped-geriatriskt preoperativt vårdprogram för alla patienter med höftfraktur och postoperativt vårdprogram för patienter över 80 år med cervikala och basocervikala höftfrakturer som behandlas vid Norrlands universitets sjukhus i Umeå. Umeå: Västerbottens läns landsting
Open this publication in new window or tab >>Vårdprogram för patienter med höftfrakturer, andra upplagan: ortoped-geriatriskt preoperativt vårdprogram för alla patienter med höftfraktur och postoperativt vårdprogram för patienter över 80 år med cervikala och basocervikala höftfrakturer som behandlas vid Norrlands universitets sjukhus i Umeå
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2008 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Umeå: Västerbottens läns landsting, 2008. p. 27
Series
Äldrecentrum Västerbotten ; 2007:1
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-86382 (URN)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2018-06-08Bibliographically approved
Stenvall, M., Olofsson, B., Lundström, M., Englund, U., Borssén, B., Svensson, O., . . . Gustafson, Y. (2007). A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture.. Osteoporosis International, 18(2), 167-175
Open this publication in new window or tab >>A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture.
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2007 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 18, no 2, p. 167-175Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: This study evaluates whether a postoperative multidisciplinary, intervention program, including systematic assessment and treatment of fall risk factors, active prevention, detection, and treatment of postoperative complications, could reduce inpatient falls and fall-related injuries after a femoral neck fracture.

METHODS: A randomized, controlled trial at the orthopedic and geriatric departments at Umeå University Hospital, Sweden, included 199 patients with femoral neck fracture, aged >or=70 years.

RESULTS: Twelve patients fell 18 times in the intervention group compared with 26 patients suffering 60 falls in the control group. Only one patient with dementia fell in the intervention group compared with 11 in the control group. The crude postoperative fall incidence rate was 6.29/1,000 days in the intervention group vs 16.28/1,000 days in the control group. The incidence rate ratio was 0.38 [95% confidence interval (CI): 0.20 - 0.76, p=0.006] for the total sample and 0.07 (95% CI: 0.01-0.57, p=0.013) among patients with dementia. There were no new fractures in the intervention group but four in the control group.

CONCLUSION: A team applying comprehensive geriatric assessment and rehabilitation, including prevention, detection, and treatment of fall risk factors, can successfully prevent inpatient falls and injuries, even in patients with dementia.

Keywords
Accidental Falls/*prevention & control, Aged, Aged; 80 and over, Delirium/complications, Dementia/complications, Female, Femoral Neck Fractures/complications/*surgery, Humans, Kaplan-Meiers Estimate, Male, Patient Care Team, Postoperative Care/*methods, Postoperative Complications/*prevention & control, Program Evaluation/methods, Risk Factors
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-8291 (URN)10.1007/s00198-006-0226-7 (DOI)17061151 (PubMedID)
Available from: 2008-01-16 Created: 2008-01-16 Last updated: 2018-06-09Bibliographically approved
Stenvall, M., Olofsson, B., Nyberg, L., Lundström, M. & Gustafson, Y. (2007). Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up.. Journal of Rehabilitation Medicine, 39(3), 232-238
Open this publication in new window or tab >>Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up.
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2007 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 3, p. 232-238Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the short- and long-term effects of a multidisciplinary postoperative rehabilitation programme in patients with femoral neck fracture.

DESIGN AND SUBJECTS: A randomized controlled trial in patients (n = 199) with femoral neck fracture, aged >or= 70 years.

METHODS: The primary outcomes were: living conditions, walking ability and activities of daily living performance on discharge, 4 and 12 months postoperatively. The intervention consisted of staff education, individualized care planning and rehabilitation, active prevention, detection and treatment of postoperative complications. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation. A geriatric team assessed those in the intervention group 4 months postoperatively, in order to detect and treat any complications. The control group followed conventional postoperative routines.

RESULTS: Despite shorter hospitalization, significantly more people from the intervention group had regained independence in personal activities of daily living performance at the 4- and 12-month follow-ups; odds ratios (95% confidence interval (CI) ) 2.51 (1.00-6.30) and 3.49 (1.31-9.23), respectively. More patients in the intervention group had also regained the ability to walk independently indoors without walking aids by the end of the study period, odds ratio (95% confidence interval) 3.01 (1.18-7.61).

CONCLUSION: A multidisciplinary postoperative intervention programme enhances activities of daily living performance and mobility after hip fracture, from both a short-term and long-term perspective.

Keywords
Activities of Daily Living, Aged, Aged; 80 and over, Female, Femoral Neck Fractures/physiopathology/*rehabilitation/surgery, Follow-Up Studies, Geriatric Assessment, Humans, Male, Motor Activity, Patient Care Team, Postoperative Complications/physiopathology/rehabilitation, Recovery of Function, Time Factors, Walking/physiology
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-8288 (URN)10.2340/16501977-0045 (DOI)17468792 (PubMedID)
Available from: 2008-01-16 Created: 2008-01-16 Last updated: 2018-06-09Bibliographically approved
Olofsson, B., Stenvall, M., Lundström, M., Svensson, O. & Gustafson, Y. (2007). Malnutrition in hip fracture patients: an intervention study.. Journal of Clinical Nursing, 16(11), 2027-2038
Open this publication in new window or tab >>Malnutrition in hip fracture patients: an intervention study.
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2007 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 11, p. 2027-2038Article in journal (Refereed) Published
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-8289 (URN)10.1111/j.1365-2702.2006.01864.x (DOI)17419798 (PubMedID)
Available from: 2008-01-16 Created: 2008-01-16 Last updated: 2018-06-09Bibliographically approved
Lundström, M., Olofsson, B., Stenvall, M., Karlsson, S., Nyberg, L., Englund, U., . . . Gustafson, Y. (2007). Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study.. Aging Clinical and Experimental Research, 19(3), 178-186
Open this publication in new window or tab >>Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study.
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2007 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 19, no 3, p. 178-186Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Delirium is a common postoperative complication in elderly patients which has a serious impact on outcome in terms of morbidity and costs. We examined whether a postoperative multi-factorial intervention program can reduce delirium and improve outcome in patients with femoral neck fractures.

METHODS: One hundred and ninety-nine patients, aged 70 years and over (mean age+/-SD, 82+/-6, 74% women), were randomly assigned to postoperative care in a specialized geriatric ward or a conventional orthopedic ward. The intervention consisted of staff education focusing on the assessment, prevention and treatment of delirium and associated complications. The staff worked as a team, applying comprehensive geriatric assessment, management and rehabilitation. Patients were assessed using the Mini Mental State Examination and the Organic Brain Syndrome Scale, and delirium was diagnosed according to DSM-IV criteria.

RESULTS: The number of days of postoperative delirium among intervention patients was fewer (5.0+/-7.1 days vs 10.2+/-13.3 days, p=0.009) compared with controls. A lower proportion of intervention patients were delirious postoperatively than controls (56/102, 54.9% vs 73/97, 75.3%, p=0.003). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from fewer complications, such as decubitus ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0+/-17.9 days vs 38.0+/-40.6 days, p=0.028).

CONCLUSIONS: Patients with postoperative delirium can be successfully treated, resulting in fewer days of delirium, fewer other complications, and shorter length of hospitalization.

Keywords
Aged, Aged; 80 and over, Delirium/etiology/*therapy, Female, Femoral Neck Fractures/*surgery, Humans, Male, Postoperative Complications/etiology/*therapy, Time Factors
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-8279 (URN)10.1007/BF03324687 (DOI)17607084 (PubMedID)
Available from: 2008-01-17 Created: 2008-01-17 Last updated: 2018-06-09Bibliographically approved
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