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Health, physical ability, falls and morale in very old people: the Umeå 85+ Study
Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The very old, aged 80 years and over, is the fastest growing age group today, and the demands for healthcare and services will be even higher in the future. It is, therefore, of great importance to advance our knowledge about this group. The main purpose of this thesis was to describe living conditions and health, with a special focus on physical ability, falls and morale, in women and men in three different age groups of very old people in northern Sweden.

Half the population aged 85, and the total population aged 90 and ≥95 (-103) in the municipality of Umeå were selected for participation (n=348) in this population-based cross-sectional study, entitled the Umeå 85+ Study. Structured interviews and assessments were performed with the participants in their homes, and data were also collected from next-of-kins, caregivers and medical charts. Cognition was screened for using the Mini-Mental State Examination (MMSE), depressive symptoms using the Geriatric Depression Scale-15 (GDS-15), and nutritional status using the Mini Nutritional Assessment (MNA). Activities of Daily Living (ADL) were assessed using the Staircase of ADL (including the Katz Index of ADL) and morale using the Philadelphia Geriatric Center Morale Scale (PGCMS). Participants also rated their own health and answered a questionnaire about symptoms. Physical ability was assessed using a gait speed test over 2.4 meters (8 feet), three consecutive chair stands, and the Berg Balance Scale (BBS). A follow-up study for falls was performed during a period of six months with fall calendars and telephone calls.

The very old people in this northern population have more depression, hypertension and hip fractures, as well as a higher consumption of drugs than comparable, more southern populations. In general, younger participants had lower rates of diagnoses and prescribed drugs, were less dependent in ADL and other functional variables than older participants, and men had lower rates of diagnoses and reported symptoms than women. However, there were no age or sex differences in self-rated health or morale, which were both rated as good by the majority of the participants.

There was a wide range of physical ability among these very old people, especially in women, where an age-related decline was seen. The results also demonstrate that men had greater physical ability than women. The BBS had no floor or ceiling effects in the present sample. In contrast, a large proportion was unable to perform the gait speed and chair stands test, resulting in a floor effect for the timed performances, especially in women.

Falling is a major public health problem in very old people. From the results of the present study, it could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture over a period of one year. The independent explanatory risk factors for time to first fall in this sample of very old people were dependency in personal (P-) ADL but not bedridden, thyroid disorders, treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) and occurrence of fall/s in the preceding year. These factors should all be considered in fall prevention programmes.

The morale of very old people was found in this study to be rather high, with similar scores among age groups and sexes. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and having few symptoms. The PGCMS seems applicable in the evaluation of morale in very old people.

In conclusion, there were wide variations in health status and physical ability in this northern population of very old people. Women had poorer health and physical ability than men. Falls and fractures were common and serious health problems. Morale seemed to be high, despite the fact that a large proportion of the participants suffered from many diseases and functional decline.

Place, publisher, year, edition, pages
Umeå: Samhällsmedicin och rehabilitering , 2006. , 89 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1038
Keyword [en]
Aged, 80 and over, accidental falls, epidemiological studies, geriatric assessment, health status, morale, physical ability, population characteristics, reference values
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-871ISBN: 91-7264-130-4 (print)OAI: oai:DiVA.org:umu-871DiVA: diva2:144824
Public defence
2006-10-28, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2006-09-25 Created: 2006-09-25 Last updated: 2009-10-30Bibliographically approved
List of papers
1. Health status in the oldest old: Age and sex differences in the Umeå 85+ Study.
Open this publication in new window or tab >>Health status in the oldest old: Age and sex differences in the Umeå 85+ Study.
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2006 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, Vol. 18, no 2, 116-126 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: With an increasing population aged 85 years and over, the aim of this study was to describe health status and living conditions in the oldest old and to estimate age and sex differences in a Northern European population. METHODS: A population-based cross-sectional study, The Umeå 85+ Study, was carried out in the municipality of Umeå in northern Sweden. Out of 319 eligible participants aged 85, 90 and 95 years and over, 253 participated. Structured interviews and assessments were conducted with the participants in their homes, and data were also collected from relatives, caregivers and medical charts. Cognition was screened with the Mini-Mental State Examination (MMSE), depressive symptoms with the Geriatric Depression Scale-15 (GDS-15) and nutritional status with the Mini Nutritional Assessment (MNA). Activities of daily living (ADL) were assessed applying the Staircase of ADL (including Katz' Index of ADL) and morale with the Philadelphia Geriatric Center Morale Scale (PGCMS). Participants also rated their own health. RESULTS: Over half of the participants had hypertension, one out of four was depressed, and the same proportion had had a hip fracture; the mean number of drugs taken was 6.4+/-4.0. Younger participants had lower rates of diagnoses and prescribed drugs, and were less dependent in ADL and other functional variables; men had lower rates of diagnoses and reported symptoms. The majority of participants rated their general health and morale as good. CONCLUSIONS: There were large variations in social, medical and functional variables within and between age and sex groups. This northern population of the oldest old seems to have a very high prevalence of hypertension, depression, hip fractures, and many prescribed drugs.

Keyword
Activities of Daily Living/*psychology, Age Factors, Aged; 80 and over, Cross-Sectional Studies, Dementia/drug therapy/epidemiology, Depression/drug therapy/epidemiology, Female, Geography, Geriatric Assessment/*statistics & numerical data, Health Status, Hip Fractures/epidemiology, Humans, Hypertension/drug therapy/epidemiology, Interpersonal Relations, Male, Mental Health, Neuropsychological Tests, Quality of Life/psychology, Sex Factors, Social Class, Sweden
Identifiers
urn:nbn:se:umu:diva-6577 (URN)16702780 (PubMedID)
Available from: 2008-01-16 Created: 2008-01-16 Last updated: 2016-02-01Bibliographically approved
2. Reference values for gait, chair stands and balance in very old people
Open this publication in new window or tab >>Reference values for gait, chair stands and balance in very old people
Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-5335 (URN)
Available from: 2006-09-25 Created: 2006-09-25 Last updated: 2010-01-13Bibliographically approved
3. Falls in very old people: the population-based Umeå 85+ Study
Open this publication in new window or tab >>Falls in very old people: the population-based Umeå 85+ Study
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2009 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 49, 390-396 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe incidences of falls and fall-related injuries, and to identify predisposing factors for falls in very old people in a prospective population-based follow-up study for falls. The study is part of the Umeå 85+ Study which includes half of the population aged 85, and the total population aged 90 and ≥95 (−103), in Umeå, Sweden. Of the 253 people interviewed, 220 (87%) were followed up for falls for 6 months, of whom 109 lived in ordinary and 111 in institutional housing. A comprehensive geriatric baseline assessment was made through interviews and testing during home visits. Forty percent of the participants did fall a total 304 times, corresponding to 2.17 falls per Person Year (PY). It occurred 0.83 injuries per PY, including 0.14 fractures per PY. In a Cox regression analysis, the independent explanatory risk factors for time to first fall were dependency in activities of daily living (ADL), thyroid disorders, treatment with selective serotonin reuptake inhibitors (SSRIs) and occurrence of falls in the preceding year. It could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture within 1 year. ADL, thyroid disorders and treatment with SSRIs should be considered in fall prevention programmes.

Place, publisher, year, edition, pages
Clare: Elsevier, 2009
Keyword
Aged, 80 and over, Accidental falls, Incidence of falls, Risk factors, Geriatric assessment
National Category
Geriatrics
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-5336 (URN)10.1016/j.archger.2008.12.005 (DOI)000270472300014 ()19144414 (PubMedID)
Available from: 2006-09-25 Created: 2006-09-25 Last updated: 2016-02-29Bibliographically approved
4. Morale in the oldest old: the Umeå 85+ study
Open this publication in new window or tab >>Morale in the oldest old: the Umeå 85+ study
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2005 (English)In: Age and Ageing, ISSN 0002-0729, Vol. 34, no 3, 249-255 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: to describe morale among the oldest old, and to investigate which social, functional and medical factors are associated with morale in this population. DESIGN: a cross-sectional study. SETTING: a population-based study in the municipality of Umeå, a city in Northern Sweden. SUBJECTS: half of the 85-year-old population, and the total population of 90-year-olds and > or = 95-year-olds (95-103) were asked to participate (n = 319) and 238 were interviewed. METHODS: structured interviews and assessments during home visits, interviews with relatives and caregivers and review of medical charts. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to measure morale. Participants were assessed with the Barthel Activities of Daily Living (ADL) Index, Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), and a symptom questionnaire. Multiple regression analyses were conducted to find independent factors to explain the variation in the PGCMS score. RESULTS: eighty-four per cent (n = 199) of those interviewed answered the PGCMS. Three-quarters had middle range or high morale. GDS score, type of housing, previous stroke, loneliness and number of symptoms, adjusted for age group and sex, explained 49.3% of the variance of total PGCMS score. CONCLUSIONS: a large proportion of the oldest old had high morale. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and low number of symptoms. The PGCMS seems applicable in the evaluation of morale among the oldest old.

Keyword
Activities of Daily Living/psychology, Aged, Aged; 80 and over, Depression/epidemiology/psychology, Geriatric Assessment, Health Status, Humans, Interviews as Topic, Morale, Psychological Tests, Sweden/epidemiology
Identifiers
urn:nbn:se:umu:diva-6578 (URN)doi:10.1093/ageing/afi044 (DOI)15784647 (PubMedID)
Available from: 2008-01-15 Created: 2008-01-15 Last updated: 2016-02-01Bibliographically approved

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