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  • 101.
    Hägglund, Patricia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Susanne, Koistinen
    Olai, Lena
    Ståhlnacke, Katri
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Older people with swallowing dysfunction and poor oral health are at greater risk of early death2019In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528Article in journal (Refereed)
    Abstract [en]

    Objectives: We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden.

    Methods: This prospective cohort study investigated 391 older people in 36 intermediate care units (clusters). Swallowing function was assessed with the timed water swallow test (TWST), and oral health with the revised oral assessment guide (ROAG) at baseline. Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI). Time to mortality was recorded during the following year. The mixed effects Cox regression model with cluster as a random factor was used to estimate hazards ratios (HR) with 95% confidence intervals (CI).

    Results: The median age of the participants was 84 years (interquartile range [IQR]: 11), and 53.3% were females. Mortality within one year was 25.1%. In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality (adjusted HR [aHR]: 1.67, 95% CI 1.02‐2.75; P = .041 and aHR: 1.98, 95% CI 1.07‐3.65; P = .029, respectively). Participants with combined swallowing dysfunction and poor oral health showed the highest mortality (35.0%) and 2.6 (95% CI 1.15‐5.89; P = .022) times higher mortality risk than those with normal swallowing function and good oral health (13.0%).

    Conclusions: Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations.

  • 102.
    Häggqvist, Beatrice
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenvall, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Westerberg, Kristina
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    "The balancing act". Licensed practical nurse experiences of falls and fall prevention: a qualitative study2012In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 12, p. 62-Article in journal (Refereed)
    Abstract [en]

    Background: Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients.

    Methods: A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis.

    Results: The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer.

    Conclusions: Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.

  • 103.
    Högström, Gabriel
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men2016In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, no 4, p. 1159-1168Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fitness level and obesity have been associated with death in older populations. We investigated the relationship between aerobic fitness in late adolescence and early death, and whether a high fitness level can compensate the risk of being obese.

    METHODS: The cohort comprised 1 317 713 Swedish men (mean age, 18 years) that conscripted between 1969 and 1996. Aerobic fitness was assessed by an electrically braked cycle test. All-cause and specific causes of death were tracked using national registers. Multivariable adjusted associations were tested using Cox regression models.

    RESULTS: During a mean follow-up period of 29 years, 44 301 subjects died. Individuals in the highest fifth of aerobic fitness were at lower risk of death from any cause [hazard ratio (HR), 0.49; 95% confidence interval (CI), 0.47-0.51] in comparison with individuals in the lowest fifth, with the strongest association seen for death related to alcohol and narcotics abuse (HR, 0.20; 95% CI, 0.15-0.26). Similar risks were found for weight-adjusted aerobic fitness. Aerobic fitness was associated with a reduced risk of death from any cause in normal-weight and overweight individuals, whereas the benefits were reduced in obese individuals (P < 0.001 for interaction). Furthermore, unfit normal-weight individuals had 30% lower risk of death from any cause (HR, 0.70; 95% CI, 0.53-0.92) than did fit obese individuals.

    CONCLUSIONS: Low aerobic fitness in late adolescence is associated with an increased risk of early death. Furthermore, the risk of early death was higher in fit obese individuals than in unfit normal-weight individuals.

  • 104.
    Högström, Gabriel
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Pietilä, Tom
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Body composition and performance: influence of sport and gender among adolescents2012In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 26, no 7, p. 1799-1804Article in journal (Refereed)
    Abstract [en]

    Body composition is well known to be associated with endurance performance amongst adult skiers, however the association among adolescent cross-country and alpine skiers is inadequately explored. The study sample was comprised of 145 male and female adolescent subjects (aged 15-17 years), including 48 cross-country skiers, 33 alpine skiers, and 68 control subjects. Body composition [%body fat, %lean mass, bone mineral density (g/cm2)] was measured with a dual-emission X-ray absorptiometer, and pulse and oxygen uptake were measured at three break points during incremental performance tests to determine physical fitness levels. Female cross-country and alpine skiers were found to have significantly higher %lean mass (mean difference = 7.7%, p < 0.001) and lower %body fat (mean difference = (8.1%, p < 0.001) than female control subjects. Male cross-country skiers were found to have lower %body fat (mean difference = 3.2%, p < 0.05) and higher %lean mass (mean difference = 3.3%, p < 0.01) than male alpine skiers and higher % lean mass (mean difference = 3.7%, p < 0.05) and % body fat (mean difference = 3.2%, p < 0.05) than controls. The present study found strong associations between %lean mass and the OBLA and VO2 max weight adjusted thresholds among both genders of the cross-country skiing cohort (r = 0.47-0.67, p < 0.05) and the female alpine skiing cohort (r = 0.77-0.79, p < 0.001 for all). The present study suggests that body composition is associated with physical performance already in adolescent athletes.

  • 105.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Stroke and depression in very old age2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

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

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

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

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

  • 106.
    Hörnsten, Carl
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    The prevalence of stroke and depression and factors associated with depression in elderly people with and without stroke2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 174Article in journal (Other academic)
    Abstract [en]

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

  • 107.
    Hörnsten, Carl
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Weidung, Bodil
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    High blood pressure as a risk factor for incident stroke among very old people: a population-based cohort studyManuscript (preprint) (Other academic)
  • 108.
    Hörnsten, Carl
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Weidung, Bodil
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    High blood pressure as a risk factor for incident stroke among very old people: a population-based cohort study2016In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 34, no 10, p. 2059-2065Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 109. Illario, Maddalena
    et al.
    Vollenbroek-Hutten, Miriam M R
    Molloy, D William
    Menditto, Enrica
    Iaccarino, Guido
    Eklund, Patrik
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Active and Healthy Ageing and Independent Living 20162016In: Journal of Aging Research, ISSN 2090-2204, E-ISSN 2090-2212, Vol. 2016, article id 8062079Article in journal (Refereed)
  • 110. Illario, Maddalena
    et al.
    Vollenbroek-Hutten, Miriam
    William Molloy, David
    Menditto, Enrica
    Iaccarino, Guido
    Eklund, Patrik
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Active and Healthy Ageing and Independent Living2015In: Journal of Aging Research, ISSN 2090-2204, E-ISSN 2090-2212, Vol. 2015, article id 542183Article in journal (Refereed)
  • 111.
    Ingre, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience. Department of Neurology, The Karolinske University Hospital Huddinge, Stockholm, Sweden.
    Landers, John E.
    Rizik, Naji
    Volk, Alexander E.
    Akimoto, Chizuru
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Birve, Anna
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Hubers, Annemarie
    Keagle, Pamela J.
    Piotrowska, Katarzyna
    Press, Rayomand
    Andersen, Peter M.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Department of Neurology, Ulm University, Ulm, Germany.
    Ludolph, Albert C.
    Weishaupt, Jochen H.
    A novel phosphorylation site mutation in profilin 1 revealed in a large screen of US, Nordic and German amyotrophic lateral sclerosis/frontotemporal dementia cohorts2013In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 34, no 6, article id 1708.e1Article in journal (Refereed)
    Abstract [en]

    Profilin 1 is a central regulator of actin dynamics. Mutations in the gene profilin 1 (PFN1) have veryrecently been shown to be the cause of a subgroup of amyotrophic lateral sclerosis (ALS). Here, weperformed a large screen of US, Nordic, and German familial and sporadic ALS and frontotemporaldementia (FTLD) patients for PFN1 mutations to get further insight into the spectrum and pathogenicrelevance of this gene for the complete ALS/FTLD continuum. Four hundred twelve familial and 260sporadic ALS cases and 16 ALS/FTLD cases from Germany, the Nordic countries, and the United Stateswere screened for PFN1 mutations. Phenotypes of patients carrying PFN1 mutations were studied. Ina German ALS family we identified the novel heterozygous PFN1 mutation p.Thr109Met, which wasabsent in controls. This novel mutation abrogates a phosphorylation site in profilin 1. The recentlydescribed p.Gln117Gly sequence variant was found in another familial ALS patient from the United States.The ALS patients with mutations in PFN1 displayed spinal onset motor neuron disease without overtcognitive involvement. PFN1 mutations were absent in patients with motor neuron disease anddementia, and in patients with only FTLD. We provide further evidence that PFN1 mutations can causeALS as a Mendelian dominant trait. Patients carrying PFN1 mutations reported so far represent the“classic” ALS end of the ALS-FTLD spectrum. The novel p.Thr109Met mutation provides additional proofof-principle that mutant proteins involved in the regulation of cytoskeletal dynamics can cause motorneuron degeneration. Moreover, this new mutation suggests that fine-tuning of actin polymerization byphosphorylation of profilin 1 might be necessary for motor neuron survival.

  • 112.
    Israelsson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Allard, Per
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Symptoms of Depression are Common in Patients With Idiopathic Normal Pressure Hydrocephalus: The INPH-CRasH Study2016In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 78, no 2, p. 161-168Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: If patients with idiopathic normal pressure hydrocephalus (INPH) also have depression, this could have important clinical ramifications in assessment and management of their cognitive function and response to shunting. In many dementias, depression is overrepresented, but the prevalence of depression in shunted patients with INPH is unknown.

    OBJECTIVE: The objective of this case-control study was to assess the prevalence of symptoms of depression in shunted INPH patients compared with population-based controls.

    METHODS: INPH patients consecutively shunted from 2008 to 2010 in Sweden were analyzed. Patients remaining after inclusion (within 60-85 years and not having dementia, ie, mini-mental state examination >=23) had a standardized visit to their healthcare provider and answered an extensive questionnaire. Age- and sex-matched population-based controls underwent the same procedure. Symptoms of depression were assessed using the Geriatric Depression Scale 15 (suspected depression defined as >=5 points, suspected severe depression as >=12 points). This study is part of the INPH-CRasH study.

    RESULTS: One hundred seventy-six INPH patients and 368 controls participated. After adjustment for age, sex, cerebrovascular disease, and systolic and diastolic blood pressure, patients had a higher mean depression score (patients: 4.9 ± 3.7 SD, controls: 1.9 ± 2.3 SD; OR 1.4, 95% CI 1.3-1.6, P < .001), more patients had suspected depression (46% vs 13%, OR 6.4, 95% CI 3.8-10.9, P < .001), and more patients had suspected severe depression (7.3% vs 0.6%, OR 14.4, 95% CI 3.0-68.6, P < .005).

    CONCLUSION: Symptoms of depression are overrepresented in INPH patients compared with the population, despite treatment with a shunt. Screening for depression should be done in the evaluation of INPH patients in order to find and treat a coexisting depression.

  • 113.
    Israelsson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wikkelsö, Carsten
    Laurell, Katarina
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Kahlon, Babar
    Leijon, Göran
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF).
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Vascular risk factors in INPH A prospective case- control study (the INPH-CRasH study)2017In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 88, no 6, p. 577-585Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the complete vascular risk factor (VRF) profile of idiopathic normal pressure hydrocephalus (INPH) using a large sample of representative patients with INPH and populationbased controls to determine the extent to which vascular disease influences INPH pathophysiology. Methods: All patients with INPH who underwent shunting in Sweden in 2008-2010 were compared to age-and sex-matched population-based controls. Inclusion criteria were age 60-85 years and no dementia. The 10 most important VRFs and cerebrovascular and peripheral vascular disease were prospectively assessed using blood samples, clinical examinations, and standardized questionnaires. Assessed VRFs were hypertension, hyperlipidemia, diabetes, obesity, psychosocial factors, smoking habits, diet, alcohol intake, cardiac disease, and physical activity. Results: In total, 176 patients with INPH and 368 controls participated. Multivariable logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 2.380; 95% confidence interval [CI] 1.434-3.950), diabetes (OR 2.169; 95% CI 1.195-3.938), obesity (OR 5.428; 95% CI 2.502-11.772), and psychosocial factors (OR 5.343; 95% CI 3.219-8.868) were independently associated with INPH. Hypertension, physical inactivity, and cerebrovascular and peripheral vascular disease were also overrepresented in INPH. Moderate alcohol intake and physical activity were overrepresented among the controls. The population-attributable risk percentage was 24%. Conclusions: Our findings confirm that patients with INPH have more VRFs and lack the protective factors present in the general population. Almost 25% of cases of INPH may be explained by VRFs. This suggests that INPH may be a subtype of vascular dementia. Targeted interventions against modifiable VRFs are likely to have beneficial effects on INPH.

  • 114. Itzhaki, Ruth F.
    et al.
    Lathe, Richard
    Balin, Brian J.
    Ball, Melvyn J.
    Bearer, Elaine L.
    Braak, Heiko
    Bullido, Maria J.
    Carter, Chris
    Clerici, Mario
    Cosby, S. Louise
    Del Tredici, Kelly
    Field, Hugh
    Fulop, Tamas
    Grassi, Claudio
    Griffin, W. Sue T.
    Haas, Jurgen
    Hudson, Alan P.
    Kamer, Angela R.
    Kell, Douglas B.
    Licastro, Federico
    Letenneur, Luc
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Mancuso, Roberta
    Miklossy, Judith
    Otth, Carola
    Palamara, Anna Teresa
    Perry, George
    Preston, Christopher
    Pretorius, Etheresia
    Strandberg, Timo
    Tabet, Naji
    Taylor-Robinson, Simon D.
    Whittum-Hudson, Judith A.
    Microbes and Alzheimer's Disease2016In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 51, no 4, p. 979-984Article in journal (Other academic)
    Abstract [en]

    We are researchers and clinicians working on Alzheimer’s disease (AD) or related topics, and we write to express our concern that one particular aspect of the disease has been neglected, even though treatment based on it might slow or arrest AD progression. We refer to the many studies, mainly on humans, implicating specific microbes in the elderly brain, notably herpes simplex virus type 1 (HSV1), Chlamydia pneumoniae, and several types of spirochaete, in the etiology of AD [1–4]. Fungal infection of AD brain [5, 6] has also been described, as well as abnormal microbiota in AD patient blood [7]. The first observations of HSV1 in AD brain were reported almost three decades ago [8]. The ever-increasing number of these studies (now about 100 on HSV1 alone) warrants re-evaluation of the infection and AD concept.

    AD is associated with neuronal loss and progressive synaptic dysfunction, accompanied by the deposition of amyloid-β (Aβ) peptide, a cleavage product of the amyloid-β protein precursor (AβPP), and abnormal forms of tau protein, markers that have been used as diagnostic criteria for the disease [9, 10]. These constitute the hallmarks of AD, but whether they are causes of AD or consequences is unknown. We suggest that these are indicators of an infectious etiology. In the case of AD, it is often not realized that microbes can cause chronic as well as acute diseases; that some microbes can remain latent in the body with the potential for reactivation, the effects of which might occur years after initial infection; and that people can be infected but not necessarily affected, such that ‘controls’, even if infected, are asymptomatic

  • 115.
    Johansson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Olsson Ruzin, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Remaining connected despite separation: former family caregivers’ experiences of aspects that facilitate and hinder the process of relinquishing the care of a person with dementia to a nursing home2014In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 18, no 8, p. 1029-1036Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This qualitative study aimed to illuminate former family caregivers’ experiences of aspects that facilitate and hinder the process of relinquishing the care of a person with dementia to a nursing home. METHOD: Ten narrative interviews with former family caregivers were performed and subjected to qualitative content analysis. RESULTS: An overall theme showed that family caregivers were remaining connected to the person with dementia despite separation. They experienced being ‘caught by surprise’ when the placement occurred. Negative expectations of dementia care made the separation more difficult. Lacking adequate information increased feelings of insecurity. Despite these hurdles, family caregivers found meaning in the new situation as they felt that they could remain connected to their loved one. Being recognized as partners in care of the person with dementia after placement was a facilitating aspect. Family caregivers regarded a well-functioning interaction with staff and a supportive social network as reassuring since they facilitated staying in touch. CONCLUSION: Knowledge of the relinquishing process and adequate information about dementia and its progression may help family caregivers better prepare for and adapt to the situation. Family caregivers need to be recognized as partners in care and a welcoming nursing home environment is of utmost importance.

  • 116.
    Johansson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Cognitive function and walking velocity in people with dementia: a comparison of backward and forward walking2017In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 58, p. 481-486Article in journal (Refereed)
    Abstract [en]

    How forward and backward walking, both central to everyday life, relate to cognition are relatively unexplored in people with dementia. This study aimed to investigate if forward and backward walking velocity respectively, associated with global cognition and executive function in people with dementia, and whether the association differed according to walking aid use or dementia type. Using a cross-sectional design, 161 participants (77% women), a mean Mini-Mental State Examination (MMSE) score of 15, and mean age of 85.5 years and living in nursing homes were included. Self-paced forward walking (FW) and backward walking (BW) velocity over 2.4 m was measured. Global cognitive outcome measurements included MMSE and Alzheimer Disease Assessment Scale - Cognitive subscale (ADAS-Cog). Executive function was measured using Verbal Fluency (VF). In comprehensively adjusted multivariate linear regression analyses, FW was independently associated with VF (p = 0.001), but not MMSE (p = 0.126) or ADAS-Cog (p = 0.818). BW was independently associated with VF (p = 0.043) and MMSE (p = 0.022), but not ADAS-Cog (p = 0.519). Interaction analyses showed that the association between BW velocity and executive function were stronger in participants who walked without a walking aid. No associations differed according to dementia type. In conclusion, executive function appears important to walking velocity, both forward and backward, in people with dementia with mild to moderately severe cognitive impairment. Global cognitive function was associated with backward walking only, perhaps due to it being more challenging. The association between BW velocity and executive function differed according to use of walking aids, which appeared to attenuate the association.

  • 117.
    Johansson, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    The Healthy Ageing Initiative: Prevention of falls and fractures2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The world is currently experiencing a dramatic increase in the number of older individuals, an amount that is expected to double between 2015 and 2050. This increase will likely affect the prevalence of age-related functional impairments, such as those caused by fractures. Fractures are often immobilizing events leading to increased individual suffering and vast healthcare costs. Prevention of these events and detection of underlying risk factors are hence of utmost importance. Fracture prevention strategies have traditionally focused on strengthening the skeleton by improving bone mineral density, partly through the mechanical load of increased physical activity. However, research has shown that nine out of ten hip fractures are attributed to falls. While several risk factors behind falls have been identified, there is less knowledge about how aspects such as gait patterns and postural stability predict future falls. The aim of this thesis was to expand upon the current knowledge by investigating objective measures of physical activity in relation to bone parameters, and measures of gait patterns and postural stability in relation to incident falls, in a large population-based sample of 70-year-olds.

    The samples investigated in the four included studies were drawn from the Healthy Ageing Initiative (HAI) cohort. Study I examined associations between physical activity, objectively measured using accelerometers, and bone parameters, measured by Dual-energy X-ray Absorptiometry and Peripheral Quantitative Computed Tomography. Study II examined how gait variability, measured using the GAITRite electronic walkway system, predicted incident falls in men and women. Studies III and IV examined how center of pressure (COP) sway and limits of stability (LOS), measured using a force platform, predicted incident falls. Independent prediction of bone parameters and incident falls were investigated using multiple linear and logistic regression models.

    Study I revealed that moderate-to-vigorous physical activity and vertical peak acceleration independently predicted parameters of bone in the weight-bearing skeleton. Study II showed that women’s increased risk of falling could be explained by increased gait variability during dual-task assignments. Study III revealed that the risk of falling was increased by 75-90% for individuals in the highest quintile of COP sway. Study IV integrated COP and LOS data, showing that fall risk was increased by 9-16% per 1-unit increase in COP-LOS ratio. In conclusion, this thesis highlighted several objective predictors of incident falls among older adults. Future studies and recommendations should emphasize strategies to improve balance, muscle strength and physical activity in order to prevent falls and fractures.

  • 118.
    Johansson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Westling, Göran
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Increased postural sway during quiet stance as a risk factor for prospective falls in community-dwelling elderly individuals2017In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 46, no 6, p. 964-970Article in journal (Refereed)
    Abstract [en]

    Objective: fall-related injuries constitute major health risks in older individuals, and these risks are projected to increase in parallel with increasing human longevity. Impaired postural stability is a potential risk factor related to falls, although the evidence is inconclusive, partly due to the lack of prospective studies. This study aimed to investigate how objective measures of postural sway predict incident falls.

    Design, setting and participants: this prospectively observational study included 1,877 community-dwelling individuals aged 70 years who participated in the Healthy Ageing Initiative between June 2012 and December 2015.

    Measurements: postural sway was measured during eyes-open (EO) and eyes-closed (EC) trials using the Wii Balance Board. Functional mobility, muscle strength, objective physical activity and cognitive performance were also measured. Participants reported incident falls 6 and 12 months after the examination.

    Results: during follow-up, 255 (14%) prospective fallers were identified. Division of centre of pressure (COP) sway lengths into quintiles revealed a nonlinear distribution of falls for EO trial data, but not EC trial data. After adjustment for multiple confounders, fall risk was increased by 75% for participants with COP sway lengths ≥400 mm during the EO trial (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.09-2.79), and approximately doubled for sway lengths ≥920 mm during the EC trial (OR 1.90, 95% CI 1.12-3.22).

    Conclusion: objective measures of postural sway independently predict incident falls in older community-dwelling men and women. Further studies are needed to evaluate whether postural sway length is of interest for the prediction of incident falls in clinical settings.

  • 119.
    Johansson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Greater Fall Risk in Elderly Women Than in Men Is Associated With Increased Gait Variability During Multitasking2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 6, p. 535-540Article in journal (Refereed)
    Abstract [en]

    Objective: As 90% of fractures are caused by falls, and as fractures are more common in elderly women than in elderly men, a better understanding of potential sex differences in fall rates and underlying mechanisms is needed. The purpose of this study was to determine whether women are more prone than men to falling, and to evaluate whether the risk of falling is associated with variations in gait patterns.

    Design, setting, and participants: The cohort for this prospective observational study consisted of 1390 community-dwelling men and women aged 70 years, examined in a health survey between July 2012 and November 2014.

    Measurements: Gait patterns were measured using a computerized walkway system during normal-speed, fast-speed, and dual-task trials. Triaxial accelerometers were used to collect objective data on physical activity, and self-reported fall data were collected by telephone 6 and 12 months after examination. Incident low-energy falls were defined as unexpected events in which participants came to rest on the ground.

    Results: During the follow-up period, 148 study participants (88 women, 60 men; P = .01) reported falls. After adjusting for multiple confounders, including objective measures of physical activity, socioeconomic factors, cardiovascular disease, and cognitive function, the odds ratio for falling in women was 1.49 (95% confidence interval [CI] 1.02–2.19). Variations in gait pattern were significantly (20%–40%) increased in fallers compared with nonfallers during the dual-task trial for step width, step length, stride length, step time, stance time, stride velocity, and single support time (all P < .05). Furthermore, women showed 15% to 35% increased variability in all of these gait parameters during the dual-task trial compared with men (all P < .01).

    Conclusion: In the present cohort, 70-year-old women were at greater risk of falls compared with their male counterparts. This increased risk was associated with increased variation in gait pattern during dual-task activities, and may contribute to women's greater fracture risk compared with men.

  • 120.
    Johansson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Objectively measured physical activity is associated with parameters of bone in 70-year-old men and women2015In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 81, p. 72-79Article in journal (Refereed)
    Abstract [en]

    As the world's population ages, the occurrence of osteoporosis-related fractures is projected to increase. Low areal bone mineral density (aBMD), a well-known risk factor for fractures, may be influenced by physical activity (PA). In this cross-sectional study, we aimed to investigate potential associations between objective measures of PA and bone properties, in a population-based cohort of 1228 70-year-old men and women. We measured volumetric BMD (vBMD, mg/cm3) together with cross-sectional area (CSA, mm2) by peripheral quantitative computed tomography at sites located 4% and 66% in the distal–proximal trajectory at the tibia and radius. We also measured aBMD (g/cm2) by dual energy X-ray absorptiometry at the femoral neck, lumbar spine (L1–L4) and radius. Participants wore triaxial accelerometers for 7 consecutive days to obtain objective estimates of PA. The intensity of the objective PA was divided into light (100–1951 counts/min [CPM]), moderate (1952– 5724 cpm) and vigorous (≥5725 cpm). Maximal accelerations for the anterior–posterior (z), medio-lateral (x), and vertical (y) axes were also separately assessed. Associations were investigated using bivariate correlations and multiple linear regression, adjusted for height, weight and sex. Vigorous PA showed the strongest association with femoral neck aBMD (β = 0.09, p b 0.001), while both moderate and vigorous PAs were associated with cor- tical area and trabecular vBMD in the weight-bearing tibia (all p b 0.05). Peak vertical accelerations were associated significantly with cortical area (β = 0.09, p b 0.001) and trabecular vBMD (β = 0.09, p = 0.001) of the tibia, whereas peak anterior–posterior accelerations showed no correlation with these properties. No positive association was found between objectively measured PA and bone parameters of the radius. In conclusion, vertical accelerations and moderate to vigorous PA independently predict bone properties, especially in the weight-bearing tibia, in 70-year-old men and women. 

  • 121.
    Juthberg, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Perceptions of conscience, stress of conscience and burnout among registered nurses and nurse assistants in municipal residential care of older people2010In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 66, no 8, p. 1708-18Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study of patterns of perceptions of conscience, stress of conscience and burnout in relation to occupational belonging among Registered Nurses and nursing assistants in municipal residential care of older people.Background. Stress and burnout among healthcare personnel and experiences of ethical difficulties are associated with troubled conscience. In elder care the experience of a troubled conscience seems to be connected to occupational role, but little is known about how Registered Nurses and nursing assistants perceive their conscience, stress of conscience and burnout.Method. Results of previous analyses of data collected in 2003, where 50 Registered Nurses and 96 nursing assistants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire and Maslach Burnout Inventory, led to a request for further analysis. In this study Partial Least Square Regression was used to detect statistical predictive patterns.Result. Perceptions of conscience and stress of conscience explained 41·9% of the variance in occupational belonging. A statistical predictive pattern for Registered Nurses was stress of conscience in relation to falling short of expectations and demands and to perception of conscience as demanding sensitivity. A statistical predictive pattern for nursing assistants was perceptions that conscience is an authority and an asset in their work. Burnout did not contribute to the explained variance in occupational belonging.Conclusion. Both occupational groups viewed conscience as an asset and not a burden. Registered Nurses seemed to exhibit sensitivity to expectations and demands and nursing assistants used their conscience as a source of guidance in their work. Structured group supervision with personnel from different occupations is needed so that staff can gain better understanding about their own occupational situation as well as the situation of other occupational groups.

  • 122. Jönhagen, Maria Eriksdotter
    et al.
    Edlund, Ann-Katrin
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Granqvist, Nicklas
    Kilander, Lena
    Mattson, Ulla-Britt
    Nelvig, Anders
    Nägga, Katarina
    Wimo, Anders
    Winblad, Bengt
    [Diagnosis of dementia in the elderly is not unnecessary]2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 49, p. 3357-Article in journal (Refereed)
  • 123.
    Kahnlund, Arvid
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Inflammatory patterns among individuals at risk of developing HSV1-associated Alzheimer’s disease2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 124.
    Kallin, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Factors associated with falls among older, cognitively impaired people in geriatric care settings: a population-based study2005In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 13, no 6, p. 501-509Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The authors studied factors associated with falls among cognitively impaired older people in geriatric care settings.

    Method: This was a study using all geriatric care settings in a county in northern Sweden. Residents were assessed by means of the Multi-Dimensional Dementia Assessment Scale, supplemented with questions concerning the use of physical restraints, pain, previous falls during the stay, and falls and injuries during the preceding week. Data about both falls and cognition were collected in 3,323 residents age 65 and older. Of these residents 2,008 (60.4%) were cognitively impaired, and they became the study population. Of the participants, 69% were women; mean age: 83.5 years.

    RESULTS: Of 2,008 cognitively impaired residents, 189 (9.4%) had fallen at least once during the preceding week. Being able to get up from a chair, previous falls, needing a helper when walking, and hyperactive symptoms were the factors most strongly associated with falls.

    CONCLUSION: Preventing falls in cognitively impaired older people is particularly difficult. An intervention strategy would probably have to include treatment of psychiatric and behavioral symptoms, improvement of gait and balance, and adjustment of drug treatment, as well as careful staff supervision.

  • 125.
    Karlsson, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Berggren, Monica
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenvall, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Effects of Geriatric Interdisciplinary Home Rehabilitation on Walking Ability and Length of Hospital Stay After Hip Fracture: A Randomized Controlled Trial2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 5, p. 464.e9-464.e15Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate if Geriatric Interdisciplinary Home Rehabilitation could improve walking ability for older people with hip fracture compared with conventional geriatric care and rehabilitation. A secondary aim was to investigate the postoperative length of hospital stay (LOS).

    Design: Randomized controlled trial.

    Setting: Geriatric ward, ordinary housing, and residential care facilities.

    Participants: People operated on for a hip fracture (n = 205), aged 70 or older, including those with cognitive impairment, and living in the north of Sweden.

    Intervention: Home rehabilitation with the aim of early hospital discharge that was individually designed and carried out by an interdisciplinary team for a maximum of 10 weeks. Special priority was given to prevention of falls, independence in daily activities, and walking ability both indoors and outdoors.

    Measurements: Walking ability and the use of walking device was assessed in an interview during the hospital stay. These assessments were repeated along with gait speed measurements at 3- and 12-month follow-up. The length of the hospital stay after the hip fracture was recorded.

    Results: No significant differences were observed in walking ability, use of walking device, and gait speed at the 3- and 12-month follow-up between the groups. At 12 months, 56.3% of the intervention group and 57.7% of the control group had regained or improved their prefracture walking ability. The median postoperative LOS in the geriatric ward was 6 days shorter for the intervention group (P = .003).

    Conclusion: Participants receiving Geriatric Interdisciplinary Home Rehabilitation regained walking ability in the short-and long-term similar to those receiving conventional geriatric care and rehabilitation according to a multifactorial rehabilitation program. The intervention group had a significantly shorter postoperative LOS in the hospital.

  • 126. Katsoulis, M
    et al.
    Benetou, V
    Karapetyan, T
    Feskanich, D
    Grodstein, F
    Pettersson-Kymmer, Ulrika
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Wilsgaard, T
    Jørgensen, L
    Ahmed, L A
    Schöttker, B
    Brenner, H
    Bellavia, A
    Wolk, A
    Kubinova, R
    Stegeman, B
    Bobak, M
    Boffetta, P
    Trichopoulou, A
    Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project2017In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 281, no 3, p. 300-310Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hip fractures are associated with diminished quality of life and survival especially amongst the elderly.

    OBJECTIVE: All-cause mortality after hip fracture was investigated to assess its magnitude.

    METHODS: A total of 122 808 participants from eight cohorts in Europe and the USA were followed up for a mean of 12.6 years, accumulating 4273 incident hip fractures and 27 999 deaths. Incident hip fractures were assessed through telephone interviews/questionnaires or national inpatient/fracture registries, and causes of death were verified with death certificates. Cox proportional hazards models and the time-dependent variable methodology were used to assess the association between hip fracture and mortality and its magnitude at different time intervals after the injury in each cohort. We obtained the effect estimates through a random-effects meta-analysis.

    RESULTS: Hip fracture was positively associated with increased all-cause mortality; the hazard ratio (HR) in the fully adjusted model was 2.12, 95% confidence interval (CI) 1.76-2.57, after adjusting for potential confounders. This association was stronger amongst men [HR: 2.39, 95% CI: 1.72-3.31] than amongst women [HR: 1.92, 95% CI: 1.54-2.39], although this difference was not significant. Mortality was higher during the first year after the hip fracture [HR: 2.78, 95% CI: 2.12-3.64], but it remained elevated without major fluctuations after longer time since hip fracture [HR (95% CI): 1.89 (1.50-2.37) after 1-4 years; 2.15 (1.81-2.55) after 4-8 years; 1.79 (1.57-2.05) after 8 or more years].

    CONCLUSION: In this large population-based sample of older persons across eight cohorts, hip fracture was associated with excess short- and long-term all-cause mortality in both sexes.

  • 127. Kivimaki, Mika
    et al.
    Singh-Manoux, Archana
    Pentti, Jaana
    Sabia, Severine
    Nyberg, Solja T.
    Alfredsson, Lars
    Goldberg, Marcel
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Oksanen, Tuula
    Strandberg, Timo
    Suominen, Sakari B.
    Theorell, Tores
    Vahtera, Jussi
    Vaananen, Ari
    Virtanen, Marianna
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Seshadri, Sudha
    Batty, G. David
    Sipila, Pyry N.
    Shipley, Martin J.
    Lindbohm, Joni V.
    Ferrie, Jane E.
    Jokela, Markus
    Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis2019In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 365, article id l1495Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

  • 128.
    Lindelöf, Nina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences of a high-intensity functional exercise programme among older people dependent in activities of daily living2012In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 28, no 4, p. 307-316Article in journal (Refereed)
    Abstract [en]

    The purpose of this qualitative study was to describe the experience of participating in a high-intensity functional exercise programme among older people dependent in activities of daily living (ADL) and living in residential care facilities. Interviews were conducted with nine older people, aged 73-91, and dependent in ADL who had participated in a high-intensity functional exercise programme. Qualitative content analysis was used in analysing the interviews. The findings show that the informants, despite extensive impairments, multiple diagnoses, and advanced age, displayed a belief in the positive effects of the programme, a strong desire to be active, and the will to strive to avoid further loss of capacity. They were struggling with failing bodies that constituted barriers to exercise. Support from the supervisors and belief in personal success facilitated performance of the exercises. The informants related physical and mental improvements that affected their daily life positively and that exercising in a group was stimulating and created a sense of togetherness. The effort was seen as worthwhile because participating in strenuous exercise could imply that they might overcome bodily limitations to achieve increased vitality and improved quality of life.

  • 129.
    Lindelöf, Nina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Skelton, Dawn A.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes: "While it's tough, it's useful"2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 11, article id e0188225Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to describe the views and experiences of participation in a high-intensity functional exercise (HIFE) program among older people with dementia in nursing homes. The study design was a qualitative interview study with 21 participants (15 women), aged 74-96, and with a Mini-Mental State Examination score of 10-23 at study start. The HIFE-program comprises exercises performed in functional weight-bearing positions and including movements used in everyday tasks. The exercise was individually designed, supervised in small groups in the nursing homes and performed during four months. Interviews were performed directly after exercise sessions and field notes about the sessions were recorded. Qualitative content analysis was used for analyses. The analysis revealed four themes: Exercise is challenging but achievable; Exercise gives pleasure and strength; Exercise evokes body memories; and Togetherness gives comfort, joy, and encouragement. The intense and tailored exercise, adapted to each participant, was perceived as challenging but achievable, and gave pleasure and improvements in mental and bodily strength. Memories of previous physical activities aroused and participants rediscovered bodily capabilities. Importance of individualized and supervised exercise in small groups was emphasized and created feelings of encouragement, safety, and coherence. The findings from the interviews reinforces the positive meaning of intense exercise to older people with moderate to severe dementia in nursing homes. The participants were able to safely adhere to and understand the necessity of the exercise. Providers of exercise should consider the aspects valued by participants, e.g. supervision, individualization, small groups, encouragement, and that exercise involved joy and rediscovery of body competencies.

  • 130.
    Lindelöf, Nina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gustafsson, S.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nygaard, J.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nyberg, L.
    Perceptions of participating in high-intensity functional exercise among older people dependent in activities of daily living (ADL)2013In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 57, no 3, p. 369-376Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to evaluate how older people, dependent in ADL perceive their participation in a high-intensity, functional exercise program compared to the perceptions of those participating in a control activity. Forty-eight older people living in residential care facilities answered a questionnaire about their perceptions of participating in an activity for three months. They were aged 65-98, had a mean score of 24 on Mini Mental State Examination (MMSE) and 14 on Barthel ADL Index. The participants had been randomized to exercise (n=20) or control activity (n=28). Differences in responses between exercise and control activity were evaluated using logistic and ordinal regression analyses. The results show that a majority of the exercise group perceived positive changes in lower limb strength, balance, and in the ability to move more safely and securely compared to a minority of the control group (p<0.001). Significantly more respondents in the exercise activity answered that they felt less tired due to the activity (p=0.027) and that they prioritized this activity above other activities (p=0.010). More exercise participants reported that meeting for three months was too short, and fewer that it was too long compared to the control group (p=0.038). This study shows that older people living in residential care facilities, dependent in ADL, and with mild or no cognitive impairment had positive perceptions about participating in high-intensity functional exercise. The findings support the use of a high-intensity exercise program in this population of older people.

  • 131.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Sociotechnical integration of decision support in the dementia domain2010In: Information Technology in Health Care: Socio-Technical Approaches 2010 : from Safe Systems to Patient Safety / [ed] Nøhr, C., Aarts, J., IOS Press, 2010, Vol. 157, p. 79-84Chapter in book (Refereed)
    Abstract [en]

    The need for improving dementia care has driven the development of the clinical decision support system DMSS (Dementia Management and Support System). A sociotechnical approach to design and development has been applied, with an activity-centered methodology and user participation throughout the process. Prototypes have been developed based on the characteristics of clinical practice and domain knowledge, while clinical practice has been subjected to different efforts for development such as education and organizational change. This paper addresses the lessons learned and role and impact DMSS has had, and is expected to have on the clinical assessment of dementia in different clinics in Sweden, South Korea and Japan. Furthermore, it will be described in what way the development of DMSS and the development of dementia care in these three areas are interlinked. Results indicate that the most important contribution of DMSS at the point of care, is the educational support that DMSS provides, part from the tailored explanatory support related to a patient case. This effect was partly manifested in a change of routines in the encounter with patients.

  • 132.
    Littbrand, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlsson, Maine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effect of a high-intensity functional exercise program on functional balance: preplanned subgroup analyses of a randomized controlled trial in residential care facilities.2011In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 59, no 7, p. 1274-1282Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate whether age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity influences the effect of a high-intensity functional weight-bearing exercise program on functional balance.

    DESIGN: Preplanned subgroup analyses of a randomized controlled trial.

    SETTING: Nine residential care facilities.

    PARTICIPANTS: One hundred ninety-one people aged 65 to 100 dependent in activities of daily living and with Mini-Mental State Examination scores of 10 or greater.

    INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity, each comprising 29 sessions over 3 months.

    MEASUREMENTS: Functional balance capacity was assessed blindly using the Berg Balance Scale (BBS) at baseline, 3 months, and 6 months. The BBS consists of 14 tasks, common in everyday life, such as standing up from sitting and, while standing, reaching forward or turning 360°. Interactions between allocation to activity group and each subgroup were evaluated according to the intention-to-treat principle.

    RESULTS: The subgroup analyses revealed no statistically significant interaction for age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity at 3 (P=.65, .65, .51, .78, .09, .67, respectively) or 6 (P=.69, .62, .20, .94, .48, .85, respectively) months. In addition, at 3 and 6 months there was no significant interaction for cognitive level (P=.28, .47, respectively) or number of depressive symptoms (P=.85, .49, respectively).

    CONCLUSION: Older age, female sex, depression, mild to moderate dementia syndrome, malnutrition, and severe physical impairment do not seem to have a negative effect on functional balance from a high-intensity functional weight-bearing exercise program. Consequently, people with these characteristics in residential care facilities should not be excluded from offers of rehabilitation including high-intensity exercises.

  • 133.
    Littbrand, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Stenvall, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review2011In: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 90, no 6, p. 495-518Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: : The aim of this study was to systematically review the applicability (attendance, achieved intensity, adverse events) and effects of physical exercise on physical functions, cognitive functions, and activities of daily living among people with dementia.

    DESIGN: : Randomized controlled trials were identified in PubMed, the Cumulative Index to Nursing and Allied Health, the Allied and Complementary Medicine Database, and the Cochrane Library on August 30 and September 1, 2010, according to predefined inclusion criteria. Two reviewers independently extracted predetermined data and assessed methodologic quality.

    RESULTS: : A qualitative analysis was performed, including ten studies. Most participants were people with Alzheimer disease in residential care facilities. Four studies reached "moderate" methodologic quality, and six reached "low." The studies of moderate quality evaluated the effects of combined functional weight-bearing exercise, combined functional and nonfunctional exercise, and walking exercise.

    CONCLUSIONS: : Among older people with Alzheimer disease in residential care facilities, combined functional weight-bearing exercise seems applicable for use regarding attendance and adverse events, and there is some evidence that exercise improves walking performance and reduces the decline in activities of daily living. Furthermore, there is some evidence that walking exercise performed individually reduces decline in walking performance, but adverse events need to be evaluated. Among older people with various types of dementia disorders who are staying in a hospital, there is some evidence that combined functional and nonfunctional exercise over 2 wks has no effect on mobility. It seems important that the interventions last for at least a few months and that the exercises are task-specific and are intended to challenge the individual's physical capacity. Among older people with unspecified dementia disorders in residential care facilities, there is some evidence that walking exercise performed at a self-selected speed has no effect on cognitive functions. Whether physical exercise can improve cognitive functions among people with dementia remains unclear because studies evaluating this have either been of low methodologic quality or used an intervention of presumably insufficient intensity. There is a need for more studies of high methodologic quality, especially among people with dementia disorders other than Alzheimer disease.

  • 134.
    Lopatko Lindman, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Plasma amyloid beta in relation to antibodies towards Herpes Simplex virus, Cytomegalovirus and Chlamydia pneumoniae2016Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 135.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Prediction and prevention of falls among elderly people in residential care2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Among elderly people, falls lead to a considerable amount of immobility, morbidity, and mortality. The purpose of this study was to develop and evaluate methods for predicting falls, and to evaluate a fall prevention program among elderly people living in residential care facilities. A fall was defined as any event in which the resident unintentionally came to rest on the floor or the ground regardless of whether or not an injury was sustained.

    In developing the prediction methods, it was hypothesised that older persons showing difficulties in performing a familiar second task while walking were more likely to fall within six months. For residents who stopped walking when talking, the relative risk of falling was 3.5 (95% CL2.0-6.2) compared to those who continued walking. For residents with a time difference (diffTUG) of at least 4.5 seconds between two performances of the Timed Up&Go test, with and without carrying a glass, the hazard ratio for falls was 4.7 (95% Cl: 1.5-14.2) compared to those with a shorter diffTUG.

    A screening tool, the Mobility Interaction Fall (MIF) chart, was developed and evaluated, then validated in a new sample. This tool included a mobility rating, ‘Stops walking when talking’, ‘diffTUG’, a test of vision, and a concentration rating. In the first sample, the hazard ratio was 12.1 (95% 0:4.6-31.8) for residents classified as ‘high-risk’ compared to ‘low-risk’. The positive predictive value was 78%, and the negative predictive value, the sensitivity, and the specificity were above 80% for falling in six months. In the second sample the prediction accuracy of the MIF chart was lower (hazard ratio 1.7, 95% Cl: 1.1-2.5) and a 6-month fall history or a global rating of fall risk by staff were at least equally valuable. A combination of any two of the methods - the MIF chart, staff judgement, fall history - was more accurate at identifying high risk residents than any method alone. Half of the residents classified by two methods as ‘high risk’ sustained a fall within 6 months.

    In a randomised study a prevention program directed to residents, staff, and environment resulted in a significant reduction in the number of residents falling (44% vs. 56%; odds ratio 0.62, 95% CF0.41-0.92), the incidence of falls (incidence rate ratio IRR 0.80, 95% CF0.69-0.94) and of femoral fractures (IRR 0.25, 95% 0:0.08-0.82) in the intervention compared to the control group.

    In conclusion, a combination of any two of the staff judgement, fall history or MIF chart has the potential to identify a large proportion of residents at particular high fall risk. A multidisciplinary and multifactorial fall prevention program directed to residents, staff, and the environment can reduce the numbnumber of residents falling, of falls and of femoral fractures.

  • 136.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Forsberg, Karl Anton
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Kent
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Sense of coherence (SOC) related to health and mortality among the very old: The Umeå 85+ study2010In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 51, p. 329-332Article in journal (Refereed)
    Abstract [en]

    We describe associations between sense of coherence (SOC) and sense of well-being, diseases, physical function and the predictive value of SOC on depression and mortality. The study included 190 participants, aged 85-103 years. Linear correlation analysis was used for relationships between SOC scores and continuous variables. The effects of SOC score on 1- and 4-year mortality, as well as on depression at the 5-year follow-up, were investigated using Cox regression models. The mean SOC score was 71.8+/-10.2 (+/-S.D.). SOC score was positively related to well-being (p

  • 137.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Årestedt, Kristofer
    Ersta Sköndal University College, Stockholm, Sweden.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Sköndal University College, Stockholm, Sweden.
    Norberg, Catharina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing. Åland University of Applied Science, Finland.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Psychometric properties of the Swedish version of the Self-Transcendence Scale among very old people2015In: Journal of Nursing Measurement, ISSN 1061-3749, E-ISSN 1945-7049, Vol. 23, no 1, p. 96-111Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: This study tested the psychometric properties of a Swedish version of the Self-Transcendence Scale (STS).

    METHODS: Cohen's weighted kappa, agreement, absolute reliability, relative reliability, and internal consistency were calculated, and the underlying structure of the STS was established by exploratory factor analysis. There were 2 samples available: 1 including 194 people aged 85-103 years and a convenience sample of 60 people aged 21-69 years.

    RESULTS: Weighted kappa values ranged from .40 to .89. The intraclass correlation coefficient for the original STS was .763, and the least significant change between repeated tests was 6.25 points.

    CONCLUSION: The revised STS was found to have satisfactory psychometric properties, and 2 of the 4 underlying dimensions in Reed's self-transcendence theory were supported.

  • 138.
    Lundström, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Delirium in old patients with femoral neck fracture: risk factors, outcome, prevention and treatment2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Delirium is probably the most common presenting symptom of disease in old age. Delirium, as defined in DSM-IV, is a neuropsychiatric syndrome characterized by disturbance in attention and consciousness, which develops over a short period of time and where the symptoms tend to fluctuate during the course of the day. The overall aim was to increase knowledge about the risk factors and outcome of delirium in old patients with femoral neck fracture and to develop and evaluate a multi-factorial intervention program for prevention and treatment of delirium in these patients.

    In a prospective study of 101 consecutive patients with a femoral neck fracture, 29.7% were delirious before surgery and another 18.8% developed delirium postoperatively. Of those who were delirious preoperatively all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and seemed to have more postoperative complications, such as infections. Patients with preoperative delirium had a poorer walking ability on discharge compared to patients with postoperative delirium only.

    In a five-year prospective follow up study 30 out of 78 (38.5%) non-demented patients with a femoral neck fracture developed dementia. Twenty out of 29 (69%) who were delirious postoperatively developed dementia compared to 10 out of 49 (20%) who were not delirious during hospitalization (p<0.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years compared to 17/49 (34.7%) of those who remained lucid postoperatively (p=0.001).

    A non-randomized multi-factorial intervention study with the aim of preventing and treating delirium among patients with femoral neck fracture (n=49) showed that the incidence of delirium was significantly lower than reported in previously published studies. The incidence of other postoperative complications was also lower and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge.

    A similar multi-factorial intervention program evaluated as a randomized controlled trial including 199 femoral neck fracture patients showed that fewer intervention patients than controls suffered postoperative delirium (56/102, 55% vs. 73/97, 75%, p=0.003). For intervention patients the postoperative delirium was also of shorter duration (5.0±7.1 days vs. 10.2±13.3 days, p=0.009). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from significantly fewer in-hospital complications, such as decubital 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).

    In conclusion, pre- and postoperative delirium is common and seems to be associated with various risk factors, which require different strategies for prevention and treatment. Delirium is also associated with the development of dementia and a higher mortality rate. Multifactorial intervention programs can successfully be implemented and result in the reduction of delirium, fewer complications and shorter hospitalization.

  • 139.
    Lundström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Edlund, Agneta
    Bucht, Gösta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Dementia after delirium in patients with femoral neck fractures.2003In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 51, no 7, p. 1002-1006Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate whether delirium in older patients with femoral neck fractures is associated with an increased risk of developing dementia and a higher mortality rate.

    DESIGN: A 5-year prospective follow-up study.

    SETTING: Department of Orthopedic Surgery at the University Hospital in Umeå, Sweden.

    PARTICIPANTS: Seventy-eight nondemented patients aged 65 and older operated on for femoral neck fractures were followed for 5 years.

    MEASUREMENTS: The patients were assessed using the Organic Brain Syndrome (OBS) Scale pre- and postoperatively. Medical and social data were collected from the patients, their caregivers, and medical records, and the survivors were visited and assessed with the OBS Scale and the Mini-Mental State Examination in their homes 5 years after the fracture.

    RESULTS: Thirty of 78 (38.5%) nondemented patients with a femoral neck fracture developed dementia within a 5-year period. Twenty of 29 (69%) who were delirious postoperatively developed dementia, compared with 10 of 49 (20%) who were not delirious during their hospital stay (P <.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years, compared with 17 of 49 (34.7%) of those who remained lucid postoperatively (P =.001).

    CONCLUSION: Delirium in nondemented femoral neck fracture patients is associated with the development of dementia and a higher mortality rate. Patients with preoperative or postoperative delirium should therefore be assessed not only for the etiology of the delirium but also for any underlying organic brain disorder. Questions that remain unanswered are whether postoperative delirium is a marker of undetected dementia and whether postoperative delirium contributes to the development of dementia.

  • 140.
    Lundström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Edlund, Agneta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Brännström, Benny
    Bucht, Gösta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients.2005In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 53, no 4, p. 622-628Article in journal (Refereed)
  • 141.
    Lundström, Maria
    et al.
    Department of Rehabilitation, Piteå River Valley Hospital, Umeå University Hospital, Umeå, Sweden.
    Edlund, Agneta
    Department of Rehabilitation, Piteå River Valley Hospital, Umeå University Hospital, Umeå, Sweden.
    Lundström, Gudrun
    Department of Rehabilitation, Piteå River Valley Hospital, Umeå University Hospital, Umeå, Sweden.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures1999In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 13, no 3, p. 193-200Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the effectiveness of a nursing and medical intervention programme for the prevention and treatment of delirium in elderly patients treated for femoral neck fractures. Forty-nine patients consecutively admitted to an orthogeriatric rehabilitation unit in a county hospital in northern Sweden were compared with historical cohorts of corresponding patients in the same and other hospitals. There was a total reorganization of nursing and medical care of patients with femoral neck fractures. The intervention programme consisted of staff education, co-operation between orthopaedic surgeons and geriatricians, individual care and planning of rehabilitation, improved ward environment, active nutrition, improved continuity of care and prevention and treatment of complications associated with delirium. The main result of the study was that the incidence of delirium was significantly lower than in all previously published studies. The incidence of other postoperative complications was also lower, and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. It can be concluded that the intervention programme reduced the incidence and duration of delirium and improved functional outcome for elderly patients treated for femoral neck fractures.

  • 142.
    Lundström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenvall, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Elinge, Eva
    Englund, Undis
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Edlund, Agneta
    Borssén, Bengt
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Vårdprogram för patienter med höftfrakturer: 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 Umeå2004Report (Other academic)
  • 143.
    Lundström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Stenvall, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Englund, Undis
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Borssén, Bengt
    Svensson, Olle
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study.2007In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 19, no 3, p. 178-186Article in journal (Refereed)
    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.

  • 144.
    Långström Berggren, Monica
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Consequences of a hip fracture among old people2017Doctoral thesis, comprehensive summary (Other academic)
  • 145. Lövdén, Martin
    et al.
    Bergman, Lars
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lindenberger, Ulman
    Nilsson, Lars-Göran
    Studying individual aging in an interindividual context: typical paths of age-related, dementia-related, and mortality-related cognitive development in old age2005In: Psychology and Aging, ISSN 0882-7974, E-ISSN 1939-1498, Vol. 20, no 2, p. 303-316Article in journal (Refereed)
    Abstract [en]

    This study has 2 objectives: (a) to explore typical paths of cognitive development associated with aging, terminal decline, and dementia and (b) to promote and illustrate an individual-oriented approach to the study of cognitive aging based on longitudinal panel data from a population-based sample (N = 500; age range(TI) = 60-80, where T refers to time) tested at 3 occasions 5 years apart. Results document interindividual differences in multivariate patterns of change. Although cognitive changes generally covary, the present study indicates that subgroups of individuals develop along different paths characterized by selective changes in subsets of cognitive functions. Typical progression of dementia followed a developmental cascade from low declarative memory, via low functioning across all observed cognitive measures, to dementia diagnosis, and finally, death.

  • 146.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    A new perspective on the autonomic nervous system2013In: Medical Hypotheses, ISSN 0306-9877, E-ISSN 1532-2777, Vol. 81, no 2, p. 356-356Article in journal (Refereed)
  • 147.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Psychotropic and analgesic drug use among old people: with special focus on people living in institutional geriatric care2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years.

    Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders.

    This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006.

    The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation.

    Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder.

    Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common.

    In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

  • 148.
    Lövheim, Hugo
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Bergdahl, Ellinor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    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 20002010In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 22, no 7, p. 1154-1160Article in journal (Refereed)
    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.

  • 149.
    Lövheim, Hugo
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Comparison of behavioral and psychological symptoms of dementia and psychotropic drug treatments among old people in geriatric care in 2000 and 2007.2011In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, no 10, p. 1616-1622Article in journal (Refereed)
    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.

  • 150.
    Lövheim, Hugo
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kallin, Kristina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
    Poor staff awareness of analgesic treatment jeopardises adequate pain control in the care of older people2006In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 35, no 3, p. 257-261Article in journal (Refereed)
    Abstract [en]

    Background: undertreatment of pain is a common problem in geriatric care. The aim of this study was to compare the caring staff 's answers concerning the resident's pain treatment with actual pharmacological pain treatment in a cross-sectional survey of the geriatric care population in the county of Vasterbotten, Sweden. Methods: a cross-sectional study in all geriatric care units in the county of Vasterbotten, Sweden, including 3,724 inhabitants aged 65 years and over. The mean age was 83.3 and the number of cognitively impaired 2,047 (55.0%). Medication data were obtained from prescription records. The member of staff who knew the resident best judged their pain based on observations the preceding week. Results: the reported pain prevalence in the sample was 56.7%. Of those residents reported to suffer from pain, 27.9% received no analgesics as regular medication. In 72.7% of those cases with reported pain and no pharmacological treatment, the staff member who knew the resident best still thought that the resident was receiving treatment for her/his pain. Conclusion: a large proportion of the old people in geriatric care settings suffer from pain, and undertreatment of pain appears to be a significant problem. Even when the resident was not receiving pharmacological treatment for their pain, the assessor, who was expected to know the resident best, still believed in a majority of cases that the resident was receiving treatment. This highlights the need for better communication between the various professional categories involved in geriatric care.

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