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  • 1.
    Bergdahl, Ellinor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Allard, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gender differences in depression among the very old2007Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 19, nr 6, s. 1125-1140Artikel i tidskrift (Refereegranskat)
  • 2.
    Bergdahl, Ellinor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Allard, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Depression among the very old with dementia2011Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, nr 5, s. 756-763Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim of this study was to investigate the prevalence of depression among very old individuals with dementia compared to those without dementia and to examine if there were any differences regarding associated factors between people with or without depression in these conditions.

    Methods: In a population-based study in Sweden, 363 participants aged 85 years and above, were evaluated for depression and dementia.

    Results: The prevalence of depression was significantly higher among the people with dementia than without dementia, 43% vs. 24% (p < 0.001). Approximately 2/3 of the depressed in both groups used antidepressants and of those, approximately 50% had responded. Depression in the group without dementia was, among other factors, associated with higher total number of medication, the use of significant more analgesics and benzodiazepines, loneliness, inability of going outside and recent loss of child. The loss of a child was the only factor that was independently associated with depression in those with dementia.

    Conclusions: The present study confirms that in the very old, depression is more common among people with dementia than without dementia. A large proportion, both with and without dementia, are under-diagnosed and untreated, and in addition many subjects in both groups studied were non-responders to treatment. Many of the factors associated with depression among people without dementia in this study were not associated with depression among those with dementia, thus supporting the theory that the spectrum of associated factors for depression in dementia seems to be different from that for depression in people without dementia.

  • 3.
    Bergdahl, Ellinor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    Gustavsson, Janna M C
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    Kallin, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    von Heideken Wågert, Petra
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Bucht, Gösta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    Depression among the oldest old: the Umeå 85+ study2005Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 17, nr 4, s. 557-575Artikel i tidskrift (Refereegranskat)
  • 4.
    Boström, Gustaf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Hörnsten, Carl
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Brännström, Jon
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Conradsson, Mia
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Allard, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Littbrand, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Antidepressant use and mortality in very old people2016Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 28, nr 7, s. 1201-1210Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Edvardsson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Fetherstonhaugh, Deirdre
    McAuliffe, Linda
    Nay, Rhonda
    Chenco, Carol
    Job satisfaction amongst aged care staff: exploring the influence of person-centered care provision2011Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, nr 8, s. 1205-1212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There are challenges in attracting and sustaining a competent and stable workforce in aged care, and key issues of concern such as low staff job satisfaction and feelings of not being able to provide high quality care have been described. This study aimed to explore the association between person-centered care provision and job satisfaction in aged care staff. Methods: Residential aged care staff (n = 297) in Australia completed the measure of job satisfaction and the person-centered care assessment tool. Univariate analyses examined relationships between variables, and multiple linear regression analysis explored the extent to whichperceived person-centredness could predict job satisfaction of staff. Results: Perceived person-centred care provision was significantly associated with job satisfaction, and person-centred care provision could explain nearly half of the variation in job satisfaction. The regression model with the three person-centered care subscales as predictor variables accounted for 40% of the variance in job satisfaction. Personalizing care had the largest independent influence on job satisfaction, followed by amount of organizational support and degree of environmental accessibility. Personalizing care and amount of organizational support had a statistically significant unique influence. Conclusions: As person-centered care positively correlated with staff job satisfaction, supporting staff in providing person-centered care can enhance job satisfaction and might facilitate attracting and retaining staff in residential aged care. The findings reiterate a need to shift focus from merely completing care tasks and following organizational routines to providing high quality person-centered care that promotes the good life of residents in aged care.

  • 6.
    Edvardsson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Fetherstonhaugh, Deirdre
    Nay, Rhonda
    Gibson, Stephen
    Development and initial testing of the Person-centered Care Assessment Tool (P-CAT).2010Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 22, nr 1, s. 101-108Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Person-centered care is increasingly regarded as being synonymous with best quality care. However, the concept and its precise meaning is a subject of debate and reliable and valid measurement tools are lacking. METHOD: This article describes the development and initial testing of a new self-report assessment scale, the Person-centered Care Assessment Tool (P-CAT), which measures the extent to which long-term aged care staff rate their settings to be person-centered. A preliminary 39-item tool generated from research literature, expert consultations and research interviews with aged care staff (n = 37), people with early onset dementia (n = 11), and family members (n = 19) was distributed to a sample of Australian aged care staff (n = 220) and subjected to item analysis and reduction. RESULTS: Psychometric evaluation of the final 13-item tool was conducted using statistical estimates of validity and reliability. The results showed that the P-CAT was shown to be valid and homogeneous by factor, item and content analyses. Cronbach's alpha was satisfactory for the total scale (0.84), and the three subscales had values of 0.81, 0.77, and 0.31 respectively. Test-retest reliability were evaluated (n = 26) and all analyses indicated satisfactory estimates. CONCLUSION: This study provides preliminary evidence in support of the psychometric properties of the P-CAT when used in an Australian sample of long-term aged care staff. The tool contributes to the literature by making it possible to study person-centered care in relation to health outcomes, organizational models, characteristics and levels of staffing, degrees of care needs among residents, and impact of interventions.

  • 7.
    Edvardsson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, P. O.
    Borell, Lena
    Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience2014Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 26, nr 7, s. 1171-1179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Person-centeredness has had substantial uptake in the academic literature on care of older people and people with dementia. However, challenges exist in interpreting and synthesizing the evidence on effects of providing person-centered care, as the person-centered components of some intervention studies are unclear -targeting very different and highly specific aspects of person-centeredness, as well as not providing empirical data to indicate the extent to which care practice was actually perceived to become more person-centered post-intervention. Methods: The study employed a quasi-experimental, one-group pre-test-post-test design with a 12-month follow-up to explore intervention effects on person-centeredness of care and the environment (primary endpoints), and on staff strain and stress of conscience (secondary endpoints). Results: The intervention resulted in significantly higher scores on person-centeredness of care at follow-up, and the facility was rated as being significantly more hospitable at follow-up. A significant reduction of staff stress of conscience was also found at follow-up, which suggests that, to a larger extent, staff could provide the care and activities they wanted to provide after the intervention. Conclusions: The results indicated that an interactive and step-wise action-research intervention consisting of knowledge translation, generation, and dissemination, based on national guidelines for care of people with dementia, increased the staff self-reported person-centeredness of care practice, perceived hospitality of the setting, and reduced staff stress of conscience by enabling staff to provide the care and activities they want to provide.

  • 8.
    Edvardsson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Australian Centre for Evidence-Based Aged Care, La Trobe University, Australia.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nay, Rhonda
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Associations between the working characteristics of nursing staff and the prevalence of behavioral symptoms in people with dementia in residential care2008Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 20, nr 4, s. 764-776Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Clinical experience suggests that the work characteristics of staff in residential care may influence the well-being of residents with dementia. However, few studies have explored those anecdotal experiences. The aim of this study was to investigate associations between work characteristics of nursing staff and prevalence of behavioral symptoms among people with dementia in residential care settings.

    METHODS: The self-report job strain assessment scale was used to measure staff perceptions of their working environment, and the Multi Dimensional Dementia Assessment Scale to measure the occurrence of behavioral symptoms among residents in 40 residential care units for people with dementia.

    RESULTS: The findings show that in settings where staff reported high job strain, the prevalence of behavioral symptoms was significantly higher compared to settings where staff reported low job strain. Furthermore, settings characterized by staff having a more positive caring climate had significantly less prevalence of escape, restless and wandering behaviors compared to settings having a less positive caring climate. There was no statistically significant association between staff members' self-reported knowledge in caring for people with dementia and prevalence of behavioral symptoms.

    CONCLUSIONS: This study provides evidence for the oft-cited clinical experience that the well-being of nursing staff is associated with the well-being of people with dementia in residential care settings.

  • 9.
    Elgh, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Larsson, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Eriksson, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nyberg, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Altered prefrontal brain activity in persons at risk for Alzheimer's disease: an f-MRI study2003Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 15, nr 2, s. 121-133Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Early diagnosis of Alzheimer's disease (AD) is critical for adequate treatment and care. Recently it has been shown that functional magnetic resonance imaging (fMRI) can be important in preclinical detection of AD. The purpose of this study was to examine possible differences in memory-related brain activation between persons with high versus low risk for AD. This was achieved by combining a validated neurocognitive screening battery (the 7-minutes test) with memory assessment and fMRI. METHODS: One hundred two healthy community-living persons with subjective memory complaints were recruited through advertisement and tested with the 7-minutes test. Based on their test performance they were classified as having either high (n = 8) or low risk (n = 94) for AD. Six high-risk individuals and six age-, sex-, and education-matched low-risk individuals were investigated with fMRI while engaged in episodic memory tasks. RESULTS: The high-risk individuals performed worse than low-risk individuals on tests of episodic memory. Patterns of brain activity during episodic encoding and retrieval showed significant group differences (p < .05 corrected). During both encoding and retrieval, the low-risk persons showed increased activity relative to a baseline condition in prefrontal brain regions that previously have been implicated in episodic memory. By contrast, the high-risk persons did not significantly activate any prefrontal regions, but instead showed increased activity in visual occipito-temporal regions. CONCLUSION: Patterns of prefrontal brain activity related to episodic memory differ between persons with high versus low risk for AD, and lowered prefrontal activity may predict subsequent disease.

  • 10.
    Eriksson, Irene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Fagerström, Lisbeth
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Urinary tract infection in very old women is associated with delirium2011Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, nr 3, s. 496-502Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of the study was to investigate whether urinary tract infection (UTI) in a representative sample of 85-, 90- and >/=95-year-old women is associated with delirium.

    Methods: In 504 out of 643 women (78.4%) it was possible to evaluate UTI and delirium. Assessments such as the Organic Brain Syndrome (OBS) Scale, the Geriatric Depression Scale-15 (GDS-15) and the Mini-mental State Examination (MMSE) were performed during home visits. Delirium, dementia and depression were diagnosed according to the DSM-IV criteria. A diagnosed, symptomatic UTI with or without ongoing treatment, documented in medical records or detected in association with the assessments, was registered.

    Results: Eighty-seven of 504 women (17.2%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half of them (44.8%) were diagnosed to be delirious or having had episodes of delirium during the past month. One hundred and thirty-seven of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed to have a UTI. In a multivariate logistic regression model, delirium was significantly associated with Alzheimer's disease (OR = 5.8), multi-infarct dementia (OR = 5.4), depression (OR = 3.1), heart failure (OR = 2.3) and urinary tract infection (OR = 1.9).Conclusions: A large proportion of very old women with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering among old women.

  • 11.
    Eriksson Sörman, Daniel
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Rönnlund, Michael
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nilsson, Lars-Göran
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden .
    Social relationships and risk of dementia: a population-based study2015Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 27, nr 8, s. 1391-1399Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The objective was to examine whether aspects of social relationships in old age are associated with all-cause dementia and Alzheimer's disease (AD).

    Methods: We studied 1,715 older adults (≥ 65 years) who were dementia-free at baseline over a period of up to 16 years. Data on living status, contact/visit frequency, satisfaction with contact frequency, and having/not having a close friend were analyzed using Cox proportional hazards regressions with all-cause dementia or AD as the dependent variable. To control for reverse causality and to identify potential long-term effects, we additionally performed analyses with delayed entry.

    Results: We identified 373 incident cases of dementia (207 with AD) during follow-up. The variable visiting/visits from friends was associated with reduced risk of all-cause dementia. Further, a higher value on the relationships index (sum of all variables) was associated with reduced risk of all-cause dementia and AD. However, in analyses with delayed entry, restricted to participants with a survival time of three years or more, none of the social relationship variables was associated with all-cause dementia or AD.

    Conclusions: The results indicate that certain aspects of social relationships are associated with incident dementia or AD, but also that these associations may reflect reverse causality. Future studies aimed at identifying other factors of a person's social life that may have the potential to postpone dementia should consider the effects of reverse causality.

  • 12.
    Gustafsson, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sandman, Per-Olof
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Association between behavioral and psychological symptoms and psychotropic drug use among old people with cognitive impairment living in geriatric care settings2013Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 25, nr 9, s. 1415-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Behavioral and psychological symptoms are common among cognitively impaired individuals and psychotropic drugs are widely used for their treatment. The aim of this study was to describe the prevalence and associated factors of psychotropic and anti-dementia drug use among old people with cognitive impairment living in geriatric care settings. Methods: The study comprised 2,019 cognitively impaired people living in geriatric care units in the county of Västerbotten, Sweden. Data concerning psychotropic and anti-dementia drug use, function in activities of daily living, cognitive function, and prevalence of behavioral and psychological symptoms were collected, using the Multi-Dimensional Dementia Assessment Scale. Results: Of the study population, 1,442 individuals (71%) were prescribed at least one psychotropic drug (antidepressants (49%), anxiolytics, hypnotics, and sedatives (36%), antipsychotics (25%)). Furthermore, 363 individuals (18%) received anti-dementia drugs. Associations between various behavioral and psychological symptoms were found for all psychotropic drug classes and anti-dementia drugs. Verbally disruptive/attention-seeking behavior was associated with all psychotropic drugs. Use of antipsychotics was associated with several behavioral and psychological symptoms, including aggressive behavior. Conclusion: The associations between behavioral and psychological symptoms and psychotropic drug use found in this study indicate that these drugs are prescribed to treat behavioral and psychological symptoms among cognitively impaired individuals despite limited evidence of their efficacy. Given the significant risk of adverse effects among old people with cognitive impairment, it is important to ensure that any medication used is both appropriate and safe.

  • 13.
    Hedberg, Pia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Brulin, Christine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Purpose in life over a five-year period: a longitudinal study in a very old population2011Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, nr 5, s. 806-813Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Few studies have specifically examined purpose in life among very old people, and we know of none that has used a prospective approach. The aim of this study was to examine changes in pupose in life over five years in very old men and women and to investigate whether depressed mood, malnutrition, inactivity in daily life, or cognitive impairment increased the risk for developing low purpose in life.

    Methods: The study includes data from 51 participants (42 women and 9 men) living in Northern Sweden who completed the Purpose in Life Test once at baseline and again five years later.

    Results: Purpose in life decreased over five years and the decrease was significantly associated with being a woman (p<0.001) and having depressed mood (p=0.009) or depression (p=0.002) at baseline. There were no differences in baseline PIL scores between depressed and not depressed, but those who had depression had significantly decreased PIL scores after five years (p=0.001).

    Conclusion: A strong purpose in life does not seem to prevent very old people from developing depression, and being depressed at baseline and living with depression over five years is associated with a loss of purpose in life.

  • 14.
    Josefsson, Maria
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Demographic Data Base.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Pudas, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Nordin Adolfsson, Annelie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nyberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Memory profiles predict dementia over 23–28 years in normal but not successful aging2019Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Prospective studies suggest that memory deficits are detectable decades before clinical symptoms of dementia emerge. However, individual differences in long-term memory trajectories prior to diagnosis need to be further elucidated. The aim of the current study was to investigate long-term dementia and mortality risk for individuals with different memory trajectory profiles in a well-characterized population-based sample.

    Methods: 1062 adults (aged 45–80 years) who were non-demented at baseline were followed over 23–28 years. Dementia and mortality risk were studied for three previously classified episodic memory trajectory groups: maintained high performance (Maintainers; 26%), average decline (Averages; 64%), and accelerated decline (Decliners; 12%), using multistate modeling to characterize individuals’ transitions from an initial non-demented state, possibly to a state of dementia and/or death.

    Results: The memory groups showed considerable intergroup variability in memory profiles, starting 10–15 years prior to dementia diagnosis, and prior to death. A strong relationship between memory trajectory group and dementia risk was found. Specifically, Decliners had more than a fourfold risk of developing dementia compared to Averages. In contrast, Maintainers had a 2.6 times decreased dementia risk compared to Averages, and in addition showed no detectable memory decline prior to dementia diagnosis. A similar pattern of association was found for the memory groups and mortality risk, although only among non-demented.

    Conclusion: There was a strong relationship between accelerated memory decline and dementia, further supporting the prognostic value of memory decline. The intergroup differences, however, suggest that mechanisms involved in successful memory aging may delay symptom onset.

  • 15.
    Lindgren, Helena
    et al.
    Umeå universitet, Teknisk-naturvetenskaplig fakultet, Institutionen för datavetenskap.
    Eriksson, Sture
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Decision-Support System for the Investigation of Dementia2005Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 17, nr 2, s. 277-277Artikel i tidskrift (Refereegranskat)
  • 16.
    Lindgren, Helena
    et al.
    Umeå universitet, Teknisk-naturvetenskaplig fakultet, Institutionen för datavetenskap.
    Eriksson, Sture
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    DMSS - Dementia management and support system for interactive reasoning and decision-making2007Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 19, nr 1, s. 281-282Artikel i tidskrift (Refereegranskat)
  • 17. Lynöe, Niels
    et al.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    When others decide: reasons for allowing patients with Alzheimer's disease to participate in nontherapeutic research1998Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 10, nr 4, s. 435-436Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The quality of information given to family members of patients with Alzheimer's disease was studied. The patients had participated in a pharmacological investigation. The relatives were generally satisfied with the information given, and perceived it as adequate. The reasons given for allowing the patients to participate in the investigation were mainly altruistic.

  • 18.
    Lövheim, Hugo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Bergdahl, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    One-week prevalence of depressive symptoms and psychotropic drug treatments among old people with different levels of cognitive impairment living in institutional care: changes between 1982 and 20002010Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 22, nr 7, s. 1154-1160Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Dementia and depression are common in advanced age, and often co-exist. There are indications of a decreased prevalence of depressive symptoms among old people in recent years, supposedly because of the manifold increase in antidepressant treatment. Whether the prevalence of depressive symptoms has decreased among people in different stages of dementia disorders has not yet been investigated.Methods: A comparison was undertaken of two cross-sectional studies, conducted in 1982 and 2000, comprising 6864 participants living in geriatric care units in the county of Västerbotten, Sweden. Depressive symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS), and the cognitive score was measured with Gottfries' cognitive scale. Drug data were obtained from prescription records.Results: There was a significant decrease in depressive symptom score between 1982 and 2000 in all cognitive function groups except for the group with moderate cognitive impairment. Antidepressant drug use increased in all cognitive function groups.Conclusion: The prevalence of depressive symptoms decreased between 1982 and 2000, in all levels of cognitive impairment except moderate cognitive impairment. This might possibly be explained by the depressive symptoms having different etiologies in different stages of a dementia disorder, which in turn might not be equally susceptible to antidepressant treatment.

  • 19.
    Lövheim, Hugo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, Per-Olof
    Comparison of behavioral and psychological symptoms of dementia and psychotropic drug treatments among old people in geriatric care in 2000 and 2007.2011Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, nr 10, s. 1616-1622Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Behavioral and psychological symptoms, such as verbal or physical aggression, aberrant motor behaviors, psychotic symptoms, anxiety, depressive symptoms and apathy are common among people with dementia. The aim of the present study was to compare the one-week prevalence of behavioral and psychological symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 2000 and 2007.

    Methods: A comparison was made between two cross-sectional samples, collected in 2000 and 2007, comprising 4054 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to assess cognitive impairment and behavioral and psychological symptoms. The use of psychotropic drugs was recorded.

    Results: Between 2000 and 2007, 15 out of 39 behavioral or psychological symptoms had become less common and no symptoms had become more common, after controlling for demographic changes. Four out of six behaviors within the cluster of aggressive behaviors had declined in prevalence. Patients prescribed anti-dementia drugs increased from 5.1% to 18.0% and antidepressant drug use increased from 43.2% to 49.1%, while anxiolytic, hypnotic, sedative and antipsychotic drug use remained largely unchanged.

    Conclusion: The prevalence of many behavioral symptoms had declined from 2000 to 2007, and among these changes, the decline in aggressive behaviors probably has the greatest clinical impact.

  • 20.
    Lövheim, Hugo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Kallin, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care.2006Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 18, nr 4, s. 713-726Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) commonly occur among cognitively impaired people in geriatric care. BPSD are often managed with antipsychotic drugs, despite the associated serious health risks. The aim of the present study was to discover factors associated with the use of antipsychotics.

    METHODS: A cross-sectional study in all geriatric care units in the county of Västerbotten, Sweden, which included 2017 residents aged 65 years and over with cognitive impairment (mean age was 83.5 years). Data were collected from prescription records and observations made by care staff of BPSD among residents during the preceding week. A multivariate regression model was constructed to find factors independently associated with antipsychotic drug use.

    RESULTS: Eleven factors were independently associated with the use of antipsychotics. Aggressive, verbally disruptive and wandering behavior, hallucinatory and depressive symptoms, male sex, living in a group dwelling for people with dementia, imposed mental workload, the ability to rise from a chair, activities of daily living (ADL) dependency and lower age all correlated significantly.

    CONCLUSIONS: Antipsychotic drug treatment of old people with cognitive impairment in geriatric care is common, and determined not only by the patient's symptoms but also by factors related more closely to the caregiver and the caring situation. These findings raise important questions about the indications for drug treatment in relation to the patient's quality of life.

  • 21.
    Lövheim, Hugo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment.2008Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 20, nr 4, s. 777-789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Many people with dementia exhibit some behavioral or psychological symptoms, e.g. aggressive or aberrant motor behavior, depression or hallucinations, at some time during the course of the disorder. The aim of the present study was to describe the probability of the occurrence of these symptoms of dementia in relation to the level of cognitive impairment.

    METHODS: 3404 people with cognitive impairment were selected from two large cross-sectional surveys of those in geriatric care settings, conducted in 1982 and 2000 in the county of Västerbotten, Sweden. Symptoms were assessed using the Multi-Dimensional Dementia Assessment Scale (MDDAS), subsumed with a rotated factor analysis, and investigated in relation to level of cognitive impairment, measured using the Gottfries cognitive scale.

    RESULTS: The passiveness factor had an almost linear correlation to the level of cognitive impairment (r2 = 0.237). Non-linear correlations, with highest prevalences in middle-stage cognitive impairment, were found for aggressive behavior (r2 = 0.057), wandering behavior (r2 = 0.065), restless behavior (r2 = 0.143), verbally disruptive/attention-seeking behavior (r2 = 0.099), regressive/inappropriate behavior (r2 = 0.058), hallucinatory symptoms (r2 = 0.021) and depressive symptoms (r2 = 0.029).

    CONCLUSION: The relations between the behavioral and psychological symptoms of dementia and level of cognitive impairment were non-linear, with higher prevalence rates in the middle stages of dementia, apart from the symptom of passiveness, which increased almost linearly with the severity of cognitive impairment.

  • 22.
    Lövheim, Hugo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Changes between 1982 and 2000 in the prevalence of behavioral symptoms and psychotropic drug treatment among old people with cognitive impairment in geriatric care.2009Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 21, nr 5, s. 941-948Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: People with a dementia disorder often live in institutional care facilities, particularly when the dementia disorder becomes severe or complicated by various behavioral disturbances. The aim of the present study was to analyze and compare the one-week prevalence of various behavioral symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 1982 and 2000. METHODS: A comparison was made between two cross-sectional samples, collected in 1982 and 2000 respectively, comprising 3404 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. Behavioral symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS) and cognition was measured using Gottfries' cognitive scale. RESULTS: Eight out of 25 behavioral symptoms had become less common, and six more common, after controlling for demographic changes. Regressive behavior, resistance to care and passiveness became less common, while certain aberrant motor behaviors showed an increased prevalence. Antidepressant drug use increased from 6.8% to 43.2%, antipsychotic drug use decreased from 38.0% to 26.2% and anxiolytics, hypnotic and sedative drug use increased from 12.7% to 38.5%. CONCLUSION: One-week prevalence of regressive symptoms and resistance to care had decreased and there were signs of a generally increased activity level among old people with cognitive impairment living in institutional geriatric care in 2000 compared to 1982. These changes may be an effect of the extensive changes in pharmacological treatments and in the organization of institutional geriatric care.

  • 23.
    Lövheim, Hugo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sex differences in the prevalence of behavioral and psychological symptoms of dementia.2009Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 21, nr 3, s. 469-475Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: When a person has dementia, non-cognitive behaviors and symptoms might constitute a greater problem than the cognitive decline itself. Male or female sex might be a predisposing factor for certain types of behavior disturbances and symptoms. The aim of the present analysis was to explore the correlation between sex and the prevalence of behavioral and psychological symptoms of dementia. METHOD: A total of 3395 people with cognitive impairment (1056 men and 2339 women) were selected from two large cross-sectional surveys of those in geriatric care settings, conducted in 1982 and 2000 in the county of Västerbotten, Sweden. Symptoms were assessed using the Multi-Dimensional Dementia Assessment Scale (MDDAS), and prevalence was compared using multivariate logistic regression. Drug data were obtained from prescription records. RESULTS: For 17 out of 39 behaviors and symptoms, the prevalence differed significantly between men and women. Men more often exhibited aggressive behavior and regressive behaviors, and women more often exhibited depressive symptoms. There were no sex differences for passiveness and hallucinations. The prevalence of antipsychotic drug use was higher among men (35.5% compared to 28.9%, p < 0.001) and antidepressant drug use higher among women (30.1% compared to 25.6%, p = 0.006). The prevalence of use of anxiolytics, hypnotics and sedatives did not differ. CONCLUSION: There are some differences in the prevalence of behavioral and psychological symptoms of dementia between men and women. These different symptom profiles might possibly explain some of the differences found in the pharmacological treatment of men and women with a dementia disorder.

  • 24. Morandi, A
    et al.
    Davis, D
    Taylor, JK
    Bellelli, G
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Kreisel, S
    Teodorczuk, A
    Kamholz, B
    Hasemann, W
    Young, J
    Agar, M
    de Rooij, SE
    Meagher, D
    Trabucchi, M
    MacLullich, AM
    Consensus and variations in opinions on delirium care: a survey of European delirium specialists2013Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 25, nr 12, s. 2067-2075Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There are still substantial uncertainties over best practice in delirium care. The European Delirium Association (EDA) conducted a survey of its members and other interested parties on various aspects of delirium care.

    Methods: The invitation to participate in the online survey was distributed among the EDA membership. The survey covered assessment, treatment of hyperactive and hypoactive delirium, and organizational management.

    Results: A total of 200 responses were collected (United Kingdom 28.6%, Netherlands 25.3%, Italy 15%, Switzerland 9.7%, Germany 7.1%, Spain 3.8%, Portugal 2.5%, Ireland 2.5%, Sweden 0.6%, Denmark 0.6%, Austria 0.6%, and others 3.2%). Most of the responders were doctors (80%), working in geriatrics (45%) or internal medicine (14%). Ninety-two per cent of the responders assessed patients for delirium daily. The most commonly used assessment tools were the Confusion Assessment Method (52%) and the Delirium Observation Screening Scale (30%). The first-line choice in the management of hyperactive delirium was a combination of non-pharmacological and pharmacological approaches (61%). Conversely, non-pharmacological management was the first-line choice in hypoactive delirium (67%). Delirium awareness (34%), knowledge (33%), and lack of education (13%) were the most commonly reported barriers to improving the detection of delirium. Interestingly, 63% of the responders referred patients after an episode of delirium to a follow-up clinic.

    Conclusions: This is the first systematic survey involving an international group of specialists in delirium. Several areas of lack of consensus were found. These results emphasise the importance of further research to improve care of this major unmet medical need.

  • 25.
    Pellfolk, Tony
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafsson, Ted
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Risk factors for falls among residents with dementia living in group dwellings2009Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 21, nr 1, s. 187-194Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Falls are a major cause of morbidity and mortality among elderly people, and people with dementia run an increased risk of falling. The aim of this study is to identify risk factors for falls in people with dementia.

    METHOD: The study was performed over a six-month period in northern Sweden using a sample of 160 residents living in 20 group dwellings for people with dementia.

    RESULTS: Sixty-four residents (40%) sustained at least one fall during the period. The total number of falls during the study period was 191, and the fall incidence was 2.6 per person year (169 falls/130 residents). Using logistic regression analysis, the independent risk factors strongly associated with falling were: requiring help with hygiene, displaying verbally disruptive/attention-seeking behavior, able to rise from a chair, walking with assistive devices, and participating in outdoor walks. These factors explained 36.1% of the variance in falls with a concordance of 79.6%. Thirty-five percent of the falls occurred between 9 pm and 6 am, with a peak between 5 pm and 6 pm. Symptoms preceding the falls were anxiety (31.1%) and confusion (13.3%).

    CONCLUSION: Among residents with dementia it is important to identify those who run an increased risk of falling and need more careful supervision, especially in the evening and during the night. In addition, the causes of anxiety and confusion have to be prevented and treated.

  • 26.
    Pellfolk, Tony
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sandman, Per-Olof
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Physical restraint use in institutional care of old people in Sweden in 2000 and 20072012Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 24, nr 7, s. 1144-1152Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Physical restraint use is common in institutional care for old people and mainly used to prevent falls, despite the fall-preventive effect of physical restraints being questioned in previous research. The aim of the study was to investigate the use of physical restraints in Sweden in 2000 and 2007. Methods: Data were collected from two comparable census surveys conducted in all institutional care units for old people in 2000 (n = 3,669) and 2007 (n = 2,914). Information on residents' characteristics and physical restraint use was collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS). Results: In 2000 16.0% (95% confidence interval (CI) 14.8%-17.2%) of the residents were restrained compared to 18.2% (95% CI 16.8%-19.6%) in 2007 (p = 0.017). Adjusting for residents' characteristics showed that residents in 2007 were more likely to be physically restrained, relative to the residents in 2000 (odds ratio (OR) 1.031, 95% CI 1.005-1.058, p = 0.017). In 2007 the residents had been restrained longer, and a higher proportion were restrained for unknown reasons. Conclusions: Physical restraint use is still common. Moreover, the findings of this study suggest a small increase (OR 1.031) in the prevalence of physical restraint use from 2000 to 2007 adjusted for residents' characteristics.

  • 27.
    Rasmuson, Sigbritt
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Näsman, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Increased serum levels of dehydroepiandrosterone (DHEA) and interleukin-6 (IL-6) in women with mild to moderate Alzheimer's disease2011Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, nr 9, s. 1386-1392Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It has been suggested that hypercortisolism contributes to the pathophysiology of Alzheimer's disease (AD), based on the fact that excess glucocorticoid exposure has potent adverse effects on the central nervous system. In contrast, dehydroepiandrosterone (DHEA) has been linked to a broad range of beneficial physiological effects including neuronal excitability and neuroprotection and even memory enhancing properties. Of note, proinflammatory cytokines are present in neuritic plaques (a hallmark of AD) and may regulate cortisol/DHEA release. In this exploratory study, we hypothesized that there is a flattened diurnal curve of cortisol and DHEA in mild to moderate AD, linked to increased cytokine levels.

    Methods: Diurnal profiles of cortisol, adrenocorticotropic hormone (ACTH), and DHEA were studied in 15 patients with mild to moderate AD (7 men and 8 women, 75.6 ± 5.5 years) and 15 healthy elderly controls (7 men and 8 women, 73.3 ± 5.8 years, respectively). Interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and soluble TNF receptors were analyzed.

    Results: Women with AD had significantly increased morning levels of ACTH, DHEA, and IL-6 compared to healthy elderly women. Cortisol levels were significantly increased in men with AD at 0300 h versus healthy elderly men, in spite of slightly decreased ACTH levels.

    Conclusions: Our data suggest important sex differences in hypothalamic-pituitary-adrenal (HPA) axis regulation and steroid hormone clearance in patients with AD. Increased secretion of IL-6 may have a contributory role in this difference.

  • 28.
    Sjögren, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Sandman, Per-Olof
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutetet.
    Zingmark, Karin
    Research Department, County Council of Norrbotten.
    Edvardsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT)2012Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 24, nr 3, s. 406-415Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Person-centered care is a multidimensional concept describing good care, especially within aged care and care for people with dementia. Research studies evaluating person-centered care interventions seldom use direct measurement of levels of person-centeredness. Existing scales that measure person-centeredness need further testing. This study evaluated the psychometric properties of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT).

    Methods: A cross-sectional sample of 1465 staff from 195 residential care units for older people in Sweden participated in the study. Validity, reliability, and discrimination ability of the scale were evaluated.

    Results: Confirmatory factor analysis, parallel analysis and exploratory factor analysis supported the construct validity of a two-factor solution. Reliability and homogeneity were satisfactory for the whole P-CAT as demonstrated by a Cronbach's α of 0.75. Test-retest reliability showed temporal stability of the scale, and the discrimination ability of the scale was satisfactory.

    Conclusion: The Swedish version of the P-CAT was found to be valid, reliable, and applicable for further use. Two subscales are recommended for the Swedish version.

  • 29.
    Skottheim, Andreas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum). Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden; Department of Health Sciences, Luleå University of Technology, Sweden.
    Gustafsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Insomnia symptoms among old people in nursing homes2018Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, s. 77-85Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Insomnia symptoms are common among old people, and hypnotics and sedative drugs are often prescribed in spite of small benefits. The aim of this study was to estimate the prevalence of insomnia symptoms and to analyze the association between insomnia symptoms, cognitive level, and prescription of hypnotics and sedatives among old people living in nursing homes.

    METHODS: The study comprised 2,135 people living in nursing homes in the county of Västerbotten, Sweden. Data concerning hypnotic and sedative drugs, cognitive function, and prevalence of insomnia symptoms were collected, using the Multi-Dimensional Dementia Assessment Scale (MDDAS).

    RESULTS: The three most common insomnia symptoms were "sleeps for long periods during the day," "interrupted night-time sleep," and "wakes up early in the morning" with 57.8%, 56.4%, and 48.0%, respectively, of the residents exhibiting the symptoms at least once a week. Different insomnia symptoms showed different association patterns with sex and age. Most insomnia symptoms were more common among people with cognitive impairment compared to those with no cognitive impairment and seemed to reach their peak prevalence in people with moderate to severe cognitive impairment, subsequently decreasing with further cognitive decline. Of the study population, 24.0% were prescribed hypnotics and sedatives. Prescriptions were more common among those without cognitive impairment, and among those exhibiting the symptom "difficulty initiating sleep."

    CONCLUSIONS: Insomnia symptoms and prescription of hypnotics and sedatives are common among old people living in nursing homes. Considering the risk of adverse effects, it is important to regularly re-evaluate the need for these drugs.

  • 30.
    Sundström, Anna
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nilsson, Lars-Göran
    Department of Psychology, Stockholm University, Sweden.
    Cruts, M.
    Department of Molecular Genetics, Flanders Interuniversity Institute for Biotechnology, University of Antwerp, Belgium.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Van Broeckhoven, C.
    Department of Molecular Genetics, Flanders Interuniversity Institute for Biotechnology, University of Antwerp, Belgium.
    Nyberg, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Increased risk of dementia following mild head injury for carriers but not for non-carriers of the APOE ε4 allele2007Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 19, nr 1, s. 159-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The ε4 allele of apolipoprotein E (APOE) and head injury are risk factors for dementia diseases, and may act synergistically to further increase the risk. The aim of this study was to examine the association between mild head injury, APOE and dementia.

    Methods: Data were obtained from the Betula prospective population-based study of aging, memory, and health. The study included 543 participants in the age range 40–85 years, free of dementia at baseline, who were followed up within a 5-year interval. Dementia was classified using DSM-IV criteria. Information on previous head injury was obtained through screening of the participants' answers to health questionnaires at baseline and at follow-up.

    Results: Subjects with head injury but without APOE ε4 had no increased risk of dementia. Subjects with APOE ε4 had an increased risk and those with both APOE ε4 and head injury had the highest risk of dementia (odds ratio = 5.2).

    Conclusions: APOE ε4 constitutes a risk factor for dementia, mild injury in isolation does not increase the risk, but head injury in combination with the APOE ε4 leads to increased risk of dementia.

  • 31.
    Sundström, Anna
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Rönnlund, Michael
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nilsson, Lars-Göran
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Stressful life events are not associated with development of dementia2014Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 26, s. 147-154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The impact of stressful life events as a risk factor of dementia diseases is inconclusive. We sought to determine whether stressful negative life events are associated with incidental dementia in a population-based study with long-term follow-up. We also tested the hypothesis that the occurrence of positive life events could mitigate or overcome the possible adverse effects of negative life events on dementia conversion.

    Methods: The study involved 2,462 dementia-free participants aged 55 years and older. Information on life events was ascertained at baseline from a comprehensive Life Event Inventory, which included 56 questions about specific life events. For each life event, the emotional impact (both positive and negative) and emotional adjustment were asked for.

    Results: During follow-up, 423 participants developed dementia; of these, 240 developed Alzheimer's disease (AD). Cox regression analysis showed no association between the total number of negative life events and the incidence of dementia when adjusted solely for age and gender (hazard ratio = 0.97, 95% CI = 0.92-1.02), or with multiple adjustments for a range of covariates (hazard ratio = 0.96, 95% CI = 0.91-1.01). Similarly, neither emotional impact nor emotional adjustment to these life events was associated with incident dementia. A separate analysis of AD did not alter the results.

    Conclusions: The result of this population-based study finds no association between negative or positive life events and dementia. Accordingly, our results reject the hypothesis that stressful life events trigger the onset of dementia diseases.

  • 32.
    Sundström, Anna
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Westerlund, Olle
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Mousavi-Nasab, Hossein
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nilsson, Lars-Göran
    The relationship between marital and parental status and the risk of dementia2014Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 26, nr 5, s. 749-757Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study examines the association between marital and parental status and their individual and combined effect on risk of dementia diseases in a population-based longitudinal study while controlling for a range of potential confounders, including social networks and exposure to stressful negative life events. Methods: A total of 1,609 participants without dementia, aged 65 years and over, were followed for an average period of 8.6 years (SD = 4.8). During follow-up, 354 participants were diagnosed with dementia. Cox regression was used to investigate the effect of marital and parental status on risk of dementia. Results: In univariate Cox regression models (adjusted for age as time scale), widowed (hazard ratio (HR) 1.42, 95% confidence interval (CI) = 1.13-1.78), and not having children (HR 1.54, 95% CI = 1.15-2.06) were significantly associated with incident dementia. In multivariate analyses that included simultaneously marital and parental status and covariates that were found to be significant in univariate models (p < 0.10), the HR was 1.30 (95% CI = 1.01-1.66) for widowed, and 1.51 (95% CI = 1.08-2.10) for those not having children. Finally, a group of four combined factors was constructed: married parents (reference), married without children, widowed parents, and widowed without children. The combined effect revealed a 1.3 times higher risk (95% CI = 1.03-1.76) of dementia in widow parents, and a 2.2 times higher risk (95% CI = 1.36-3.60) in widowed persons without children, in relation to married parents. No significant difference was observed for those being married and without children. Conclusions: Our findings suggest that marital- and parental status are important risk factors for developing dementia, with especially increased risk in those being both widowed and without children.

  • 33.
    Tängman, Sofie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Eriksson, Staffan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Precipitating factors for falls among patients with dementia on a psychogeriatric ward2010Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 22, nr 4, s. 641-649Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is possible to identify many precipitating factors that may contribute to a fall. Falls in people with dementia should be regarded as a symptom of acute disease or as a drug side-effect until proven otherwise. Prompt detection of these relevant factors is, therefore, essential.

  • 34. Vikström, Sofia
    et al.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Karolinska Inst, Dept Neurobiol Caring Sci & Soc, Div Nursing, S-14183 Huddinge, Sweden.
    Stenwall, Ewa
    Boström, Anne-Marie
    Saarnio, Lotta
    Kindblom, Kristina
    Edvardsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. La Trobe Univ, Sch Nursing & Midwifery, Bundoora, Vic 3086, Australia.
    Borell, Lena
    A model for implementing guidelines for person-centered care in a nursing home setting2015Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 27, nr 1, s. 49-59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care. Methods: The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis. Results: Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced. Conclusions: One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.

  • 35.
    Wallin, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Boström, Gustaf
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Kivipelto, Miia
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Risk factors for incident dementia in the very old2013Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 25, nr 7, s. 1135-1143Artikel i tidskrift (Refereegranskat)
    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.

  • 36. Wimo, A
    et al.
    Asplund, K
    Mattsson, B
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lundgren, K
    Patients with dementia in group living: experiences 4 years after admission.1995Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 7, nr 1, s. 123-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sixteen patients with dementia were studied 4 years after admission to group-living (GL) units, an intermediate level of dementia care. Of eight patients who were still alive, four lived in the GL units and four had been institutionalized. The eight patients who had died had spent 89% of their survival time in GL. Aggression was the most frequent cause of institutionalization.

  • 37. Wimo, A
    et al.
    Nelvig, A
    Nelvig, J
    Adolfsson, R
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Mattsson, B
    Sandman, P O
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Can changes in ward routines affect the severity of dementia? A controlled prospective study.1993Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 5, nr 2, s. 169-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An extensive new caring program--including the introduction of Individual Care Plans and changes in ward organization, caring techniques, and caring philosophy--was introduced at two psychogeriatric wards with severely demented patients. The hypotheses were that the patients (n = 31) would improve in psychosocial capacity and orientation and the staff work load would decline in contrast to two other wards with a similar clientele (n = 31). After ten months the milieu was more "homelike," routines were more flexible, and the staff communicated more with the patients. However, the hypotheses were not proven. All patients in both groups deteriorated in ADL capacity, orientation, and behavior. The patients in the program wards became significantly more restless and disoriented and ate less than the patients in the contrast wards. The conclusion is that, despite optimal care, a humanistic approach, and support from staff, the progression of dementia symptoms is inevitable.

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