Umeå University's logo

Objectives: Fear of falling (FoF) is a common problem among older adults. It can lead to reduced quality of life and less physical activity, which increases fall risk. Earlier work has shown that FoF can be a manifestation of executive dysfunction in adults over 50 years, but studies on people over age 75 years are lacking. Executive functions (EFs) are cognitive functions associated with the frontal lobes and the prefrontal cortex. The aim of this study was to assess associations of EFs and FoF among people aged 80 years or older.

Methods: This cross-sectional study was based on data from the Northern Sweden Silver-MONICA study and included 434 participants aged 80 years or older. EFs were assessed with the Frontal Assessment Battery (FAB) and FoF with the Falls Self-Efficacy Scale–International (FES-I). Multivariable linear regression analysis was used to examine associations among EF, FoF, and a comprehensive set of adjustment factors. Pearson correlation analysis was used to evaluate associations of FES-I and the subitems of the FAB.

Results: EFs as measured by FAB were inversely associated with FoF (β = -0.23; 95% confidence interval, -0.42 to -0.03; p = 0.021), even after comprehensive adjustments. The FAB subitems measuring lexical fluency, inhibitory control, sustained attention, self-organization, motor programming, and planning also were inversely associated with FoF.

Conclusions: Lower EF is associated with higher FoF among people aged 80 years or older. This information is important for treating and preventing FoF in this population.

Aim: The aim of this work was to investigate whether leadership, person-centred care and social interactions are associated with residents' health, including cognitive impairment, neuropsychiatric symptoms, activities of daily living and health-related quality of life, and to assess whether these relationships change over a period of 5 years.

Design: A repeated cross-sectional survey study was carried out in 2014 and 2019. Valid and reliable scales were used to assess leadership, person-centred care, neuropsychiatric symptoms, cognition, activities of daily living and health-related quality of life. The study involved care units participating in both surveys (n = 182). At T1, there were 1587 residents and 1239 staff. At T2, there were 1382 residents and 1169 staff. Regression analyses were used. Interaction analyses explored changes over time, emphasising leadership and PCC as the main explanatory variables.

Results: Stability was observed over time for person-centred care in relation to health-related quality of life, neuropsychiatric symptoms, activities of daily living function and cognitive function. Person-centred care was associated with a higher level of health-related quality of life and cognitive function, and a lower level of neuropsychiatric symptoms. Leadership showed no significant association with the outcomes.

Patient or Public Contribution: Residents did not actively participate in the study, as data was obtained by proxy rating. No public was involved in the design, data collection, or dissemination plans of this study.

Background: With numbers of very old adults (85+ years) expected to increase, and very old adults often being excluded from research and clinical trials, further knowledge about depressive disorders, antidepressant treatment and mortality among this demographic is of pressing importance.

Aims: To investigate the impact of depressive disorders and antidepressant treatment on 2-year mortality among very old adults and to explore any differences between men and women.

Method: This cross-sectional study used data from the Umeå 85+/ Gerontological Regional Database home visit interviews. The data were collected between 2000 and 2017. The total sample consisted of 2551 participants, of whom 918 had a depressive disorder. Logistic and Cox regression models were used to explore factors associated with depressive disorders and time to death. Mortality rates were illustrated and analysed using Kaplan–Meier curves and log-rank tests.

Results: Having a depressive disorder both with and without antidepressant treatment was associated with increased risk of death within 2 years for both men and women. No survival differences were found between responders and non-responders to treatment. Depressive disorders were significant predictors of 2-year mortality in men. Antidepressant treatment was not independently associated with mortality.

Conclusion: Depressive disorders are significantly associated with increased 2-year mortality among very old adults, especially men, and measures to reduce mortality are urgently needed. Further exploration of the effects of antidepressant treatment among very old adults is warranted.

Background: Alcohol consumption is a leading modifiable risk factor for a range of diseases and social harms globally. Older adults are vulnerable to alcohol-related harms due to physiological changes, multimorbidity, and medication use; however, many older adults continue to drink at high-risk levels. This study examined the prevalence and gender-specific correlates of hazardous and heavy episodic drinking (HED) among Swedish and Finnish community-dwelling older adults.

Methods: Cross-sectional data from the 2021/2022 Gerontological Regional Database (GERDA) survey included 11,747 participants aged 65, 70, 75, 80, 85 and 90 years. Missing data were multiple imputed by chained equations. Hazardous drinking was defined as an AUDIT-C score of four or more, and HED was defined as consuming six or more drinks on a single occasion at least monthly. Sociodemographic, psychosocial, functional status, and health-related factors were analyzed using multinomial and logistic regression models, stratified by gender and accounting for regional differences.

Results: Overall, 30.2% (95% CI, 29.0–31.4) of men and 9.8% (95% CI, 9.1–10.6) of women were classified as hazardous drinkers. HED prevalence was 13.0% (95% CI, 12.1–13.9) in men and 2.9% (95% CI, 2.5–3.3) in women. Hazardous drinking and HED in women were associated with higher socioeconomic status and psychosocial stressors, such as depression and bereavement, while functional and health-related factors were significant predictors of problematic alcohol use in men. Across both genders, religious participation was a protective factor, while self-reported cardiovascular disease was associated with increased risk of hazardous drinking.

Conclusions: Hazardous and HED are prevalent among older adults in Sweden and Finland with some regional differences, and notable gender differences in associated risk factors. There is a need for interventions that focus on strengthening resilience to psychosocial stressors and provide older adults with clear, consistent health communication about alcohol's harmful effects on cardiovascular and overall health.

To delay social and healthcare utilisation among the ageing population, there is an increasing focus on the role of health-promoting lifestyle adopted at an individual and/or community level. Longevity is generally viewed as the ultimate outcome of health, although a high life expectancy does not necessarily go together with health and/or a health-promoting lifestyle. The potential coherence between longevity, health and lifestyle may vary in different cultural, political, social and economic contexts. This Nordic regional study situated in regions differing in longevity aims to (i) explore differences in adherence to the comprehensive, health-promoting Blue Zone lifestyle principles in four regions in Western Finland (bilingual Ostrobothnia, Swedish-speaking Åland and Finnish-speaking South Ostrobothnia) and (ii) investigate regional differences in health. Thus, the present study aims to examine if adherence to Blue Zone lifestyle principles and good health is highest in the most longevous region. Survey data from the Gerontological Regional Database in 2021–2022 were used. Marginal means were calculated using ANOVA. The results showed that Åland, Finland’s most longevous region, showed the best health and higher environmental agreeableness, while deviated from several Blue Zone lifestyle principles. Swedish-speaking Ostrobothnia showed good health and adherence to the Blue Zone lifestyle. South Ostrobothnia showed the poorest health but as much adherence to the Blue Zone lifestyle as Swedish-speaking Ostrobothnia. Finnish-speaking Ostrobothnia deviated the most from the Blue Zone lifestyle. The findings imply that Nordic longevous regions do not necessarily adhere to the Blue Zone lifestyle. Future research incorporating individual, community and societal factors could further elucidate whether and how longevity, lifestyle and health are interconnected in different ethnolinguistic contexts to further advance the understanding of healthy ageing and improve the implementation of effective health-promoting initiatives.

Background: During the COVID-19 pandemic, Sweden implemented social distancing measures to reduce infection rates. However, the recommendation meant to protect individuals particularly at risk may have had negative consequences. The aim of this study was to investigate the impact of the COVID-19 pandemic on very old Swedish peoples' mental health and factors associated with a decline in mental health.

Methods: We conducted a cross-sectional study among previous participants of the SilverMONICA (MONItoring of Trends and Determinants of CArdiovascular disease) study. Of 394 eligible participants, 257 (65.2%) agreed to participate. Of these, 250 individuals reported mental health impact from COVID-19. Structured telephone interviews were carried out during the spring of 2021. Data were analysed using the χ² test, t-test, and binary logistic regression.

Results: Of 250 individuals (mean age: 85.5 ± 3.3 years, 54.0% women), 75 (30.0%) reported a negative impact on mental health, while 175 (70.0%) reported either a positive impact (n = 4) or no impact at all (n = 171). In the binary logistic regression model, factors associated with a decline in mental health included loneliness (odds ratio [95% confidence interval]) (3.87 [1.83-8.17]) and difficulty adhering to social distancing recommendations (5.10 [1.92-13.53]). High morale was associated with positive or no impact on mental health (0.37 [0.17-0.82]).

Conclusions: A high percentage of very old people reported a negative impact on mental health from the COVID-19 pandemic, primarily from loneliness and difficulty adhering to social distancing measures, while high morale seemed to be a protective factor.

Introduction: Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population.

Aim: To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival.

Methods: All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests.

Findings: Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05).

Conclusion: This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.

Background: The Geriatric Depression Scale (GDS) has shown good validity and reliability, but few studies have examined the GDS among very old adults or the Swedish translation.

Objectives: Evaluate the validity and reliability of the Swedish version of GDS-15 among very old adults.

Methods: In the Umeå85 + /GErontological Regional DAtabase (GERDA) study, 387 participants were assessed with both the GDS-15 and the Montgomery-Åsberg Depression Rating Scale (MADRS). The mean age was 91 years. Concurrent validity between the scales was calculated using Spearman's correlation. We used the Diagnostic and Statistical Manual of Mental Disorders (DSM) V symptom criteria for depression based on MADRS item scores to define depression. We calculated the Area Under the Curve (AUC) and found an optimal cut-off. A convenience sample with 60 individuals was used to calculate test–retest reliability with Cohen’s kappa and Intraclass Correlation Coefficient (ICC).

Results: Spearman's correlation coefficients between total scores for GDS-15 and MADRS were 0.60. Cronbach's alpha for the whole scale was 0.73. The AUC was 0.90 for distinguishing major depression, and the recommended cut-off of ≥ 5 showed a sensitivity of 95.2% and specificity of 65.8%. The test–retest showed that Cohen’s kappa was substantial (0.71) and the ICC was excellent (0.95).

Conclusions: The Swedish version of the GDS-15 showed good validity and reliability among very old adults. The generally recommended cut-off of ≥ 5 seems reasonable to use with the Swedish version and among very old adults.

Objectives: To extract the items most suitable for a short version of the 15-item Geriatric Depression Scale (GDS-15) in a sample of adults aged ≥ 85 years using item response theory (IRT).

Method: This population-based cross-sectional study included 651 individuals aged ≥ 85 years from the Umeå 85+/GErontological Regional DAtabase (GERDA) study. Participants were either community dwelling (approximately 70%) or resided in institutional care (approximately 30%) in northern Sweden and western Finland in 2000–2002 and 2005–2007. The psychometric properties of GDS-15 items were investigated using an IRT-based approach to find items most closely corresponding to the GDS-15 cut off value of ≥5 points. Receiver operating characteristic curves were used to compare the performance of the proposed short version with that of previously proposed short GDS versions.

Results: GDS-15 items 3, 8, 12, and 13 best differentiated respondents’ levels of depressive symptoms corresponding to the GDS-15 cut off value of ≥5, regardless of age or sex, and thus comprise the proposed short version of the scale (GDS-4 GERDA). For the identification of individuals with depression (total GDS-15 score ≥ 5), the GDS-4 GERDA with a cut-off score of ≥2 had 92.9% sensitivity and 85.0% specificity.

Conclusion: The GDS-4 GERDA could be used as an optimized short version of the GDS-15 to screen for depression among adults aged ≥ 85 years.

Studies that objectively investigate patterns of everyday physical activity in relation to well-being and that use measures specific to older adults are scarce. This study aimed to explore objectively measured everyday physical activity and sedentary behavior in relation to a morale measure specifically constructed for older adults. A total of 77 persons (42 women, 35 men) aged 80 years or older (84.3 ± 3.8) wore an accelerometer device for at least 5 days. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS scores were significantly positively associated with number of steps, time spent stepping, and time spent stepping at >75 steps per minute. Sedentary behavior did not associate with PGCMS. Promoting PA in the form of walking at any intensity–or even spending time in an upright position—and in any quantity may be important for morale, or vice versa, or the influence may be bidirectional.