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Objectives: To investigate factors associated with depressive disorders and mortality among very old adults (85+) with and without dementia.

Methods: This population-based cohort study with repeated cross-sectional recruitment and prospective mortality follow-up utilized data from the Umeå 85+/GERDA (GErontological Regional DAtabase) home visit interviews with data collected between 2000-2017. The sample consisted of 2485 participants. Of these participants, 969 (39.0%) had dementia, and 466 (48.1%) had dementia and a depressive disorder. Of the 1516 (61.0%) participants without dementia, 387 (25.5%) of them had a depressive disorder. Logistic and cox regression models were utilized to explore the data.

Results: Of participants with dementia and a depression evaluation (n=746), 357 (47.9%) had died within two years from inclusion, and of those with dementia and a depressive disorder 175 (48.5%) had died. Of participants without dementia (n=1266), 216(17.1%) had died within two years, and of those without dementia and with a depressive disorder 73 (22.9%) had died. Depressive disorders were a statistically significant predictor of mortality among participants without dementia (p=.021). Different factors were associated with depression in participants with and without dementia.

Discussion: Dementia disorders were associated with increased two-year mortality, but depressive disorders showed no statistically significant independent association with mortality after adjustment. Among participants without dementia, depressive disorders were independently associated with an increased mortality risk. Measures to better identify and treat depressive disorders among very old adults should urgently be implemented. Further research into the association between depressive disorders and different dementia disorders, as well sex differences, is warranted.

Aim: To explore factors associated with one-year mortality risk after hip fracture among very old adults (85 +) in Northern Sweden.

Methods: This cohort study includes data derived from Umeå 85 + /Gerontological Regional Database (GERDA), encompassing a representative sample of those aged 85, 90 and ≥ 95 years in Northern Sweden. Data were assessed during home visits and interviews conducted between 2000 and 2017. Associations of baseline characteristics with hip fracture during a follow-up period of 5 years and one-year mortality were analyzed using Cox proportional hazards regression.

Results: Of 1,277 participants, 184 (14.4%) sustained a hip fracture during follow-up, of whom 47.8% died within 1 year of the fracture. Among those with hip fracture, 65% were women. Increased 1-year mortality risk was associated with the presence of depressive disorders (hazard ratio, HR 2.55, 95% confidence interval 95%CI, 1.32–4.93), history of stroke (HR 2.34, 95%CI 1.17–4.66) and subtrochanteric fractures (HR 4.40, 95%CI 1.73–11.21). Conversely, obesity (HR 0.26, 95%CI 0.10–0.67) was associated with reduced mortality risk.

Conclusion: Nearly half of all very old adults sustaining a hip fracture die within 1 year. Depressive disorders, history of stroke and subtrochanteric fractures were identified as significant predictors of increased mortality, whereas obesity appeared to mitigate mortality risk. These findings underscore the need for targeted interventions to manage these risk factors in hip fracture patients very old adults.

Objectives: Nursing homes in Sweden provide housing and care for people aged 65 years or older who require assistance with everyday activities. An increasing number of nursing home residents have cognitive and functional decline, which can result in additional time needed for care provision. This study aimed to explore changes in resource use and associated factors in Swedish nursing homes over a 5-year period.

Methods: This repeated cross-sectional study analyzed baseline (2013–2014) and follow-up (2018–2019) proxy-rated data from 4599 participants from the Swedish National Inventory of Care and Health in Residential Aged Care study. Resource use was measured using the Resource Use in Dementia scale. Descriptive statistics, t-tests, chi-square tests, and multiple linear regressions were performed.

Results: Total resource use increased from 7.15 h/day to 7.83 h/day between baseline and follow-up. The number of residents living in a dementia unit increased from 34.6% to 43%. Higher independence in activities of daily living was associated with lower total resource use at follow-up while living in a dementia unit was associated with higher total resource use. Higher total resource use was associated with seven neuropsychiatric symptoms. For residents living in a dementia unit, four neuropsychiatric symptoms were associated with higher total resource use.

Conclusions: Resource use in Swedish nursing homes increased between baseline and follow-up. These results may inform future policy, financing, and implementation decisions to support resource utilization in nursing homes.

Background: Due to a growing number of older people, nurses working in Finnish home care have been subject to increasing efficiency requirements leading to e.g., growing job demands, and turnover. Previous research has indicated that factors such as care continuity and self-organizing teams are beneficial to staff wellbeing and care quality, however, the research incorporating workday characteristics remains scarce. The aims of this study were to examine (1) how individual level work characteristics and job demands are associated with time pressure among home care nurses, and (2) how time pressure varies between work organization factors at the organizational level.

Methods: A cross-sectional wellbeing survey for home care nurses in 16 teams, across Finland (n = 416). Further, items from a managers’ survey and RAI data sources were merged with the survey data. Linear regression analysis was used to analyze time pressure and individual level variables. T-tests and ANOVA were used to analyze the differences in time pressure among organizational level variables.

Results: Lower proportion of breaktime, lower care continuity, working alone, and if something disrupted the course of a workday were associated with higher perceived time pressure. Of the organizational level factors, teams with higher autonomy and an Enterprise Resource Planning (ERP) system that took teams into account when planning client visits perceived lower time pressure.

Conclusions: Flexibility is needed in home care nurses’ workdays. If an ERP system is used, it should ensure care continuity and allow for changes if disruptions during the workday occur. Due to the independent nature of home care work, collegial support is needed to cope with difficult situations. Furthermore, home care teams should have more autonomy over their work, which might lead to higher job satisfaction and retention among staff.

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.

Hard-to-heal arterial leg ulcers in older adults are a challenging and complex condition. In this quasi-experimental study, three treatment approaches were compared. The purpose was to investigate (1) the healing time of arterial leg ulcers in older adults (≥ 70 years) who underwent photobiomodulation, revascularisation, or conservative treatment; (2) the importance of factors associated with impaired healing; and (3) ulcer recurrence after healing with photobiomodulation. Participants who received photobiomodulation (n = 51) were frail older adults recruited from municipal home healthcare and matched with participants who received revascularisation (n = 71) or conservative treatment (n = 153). The latter two groups were retrieved from the Swedish Quality Registry RiksSår for ulcer treatment. Photobiomodulation was performed at wavelengths of 635 and 904 nm twice weekly. The results showed that the photobiomodulation group had a significantly shorter healing time (p < 0.001) and a higher proportion of healed ulcers; photobiomodulation 66.7%, revascularized 50.7% and conservatively treated group 41.2%. The median healing times for the photobiomodulation group were 135 days (confidence interval 95–175), compared to 252 (confidence interval 181–323) and 316 (confidence interval 192–440) in revascularized and conservatively treated groups, respectively. Neither ulcer duration nor other pretreatment factors exerted clinically relevant effects on healing time. In this study, recurrence within 24 months of healing with photobiomodulation was < 12%. In conclusion, photobiomodulation has the potential to heal hard-to-heal arterial ulcers markedly faster than revascularisation or conservative treatment. It could be a suitable treatment alternative for frail older adults, including those with previous substantial ulcer duration.

Aim: To explore how staff promote resident thriving in an Australian nursing home.

Design: Qualitative research design using content analysis.

Methods: Interviews were held with 14 nursing staff working in an Australian nursing home in March/April 2018. Data were analysed using qualitative content analysis.

Results: Four themes were revealed: promoting personalized care; promoting opportunities for autonomy; promoting connection and meaning; and promoting a curated environment.

Conclusions: Staff promoted resident thriving in relation to everyday care, activities, capabilities, relationships and the lived environment. Interventions that were perceived to promote thriving were described relative to the nurse, the resident, the care team and the wider nursing home context.

Objectives: To investigate the association between gait speed and depressive disorders among very old adults (≥85 years).

Method: This study utilized the GERDA-database, which encompasses a representative sample of those aged 85, 90, and 95+ years residing in northern Sweden and western Finland. From four data collections between 2000 and 2017, this study included 1794 participants. Self-paced gait speed was measured over 2.4-m and depressive disorders was evaluated by a specialist in geriatric medicine according to the DSM-IV-TR criteria. T-tests and multivariable logistic regressions were used to explore differences and associations between gait speed and depressive disorders.

Results: Gait speed was independently associated with depressive disorders among very old adults (p <.001). The results showed significantly different mean gait speeds (m/s) between individuals with/without a depressive disorder (0.34 ± 0.24/0.52 ± 0.26, p <.001), between individuals with a depressive disorder with/without antidepressant treatment (0.35 ± 0.24/0.44 ± 0.24, p <.001) and between non-responders/responders to antidepressants (0.36 ± 0.21/0.42 ± 0.22, p =.020).

Conclusion: This is the first study focusing on very old adults that has shown an independent association between gait speed and depressive disorders. Responders to antidepressant medication had a higher mean gait speed than non-responders, which may imply shifts in function upon successful treatment.

Background: Ageing populations and care workforce shortages across Europe are causing challenges for care services for older people. Therefore, it is paramount that limited care resources are allocated optimally, based on the clients’ care needs. Multiple functioning-related factors have been identified that determine the amount of care time clients receive, while organizational and other factors remain largely unexplored. The aim was to examine how various individual and organizational factors are associated with clients’ received care time in different care settings.

Methods: Cross-sectional observational study design with data from time and motion study, registers, and surveys was used. In total, 1477 home care clients and 1538 residents from assisted living facilities with 24/7 service participated, from 61 Finnish care units. Linear mixed-effect modeling was used to examine the association between individual and organizational-level variables and received care time.

Results: Physical functioning was the strongest predictor of received care time in both care settings. In home care, greater pain, more unstable health, and higher team autonomy were associated with increased care time. In assisted living, depressive mood and higher staffing level of the organization were associated with care time. Clients who received informal care also received significantly more care time from nurses in both care settings.

Conclusions: Physical functioning was the main driver of received care time. Interventions that maintain or improve physical functioning can help restrain the growing need of care resources, although it is important to ensure that each client receives care according to their holistic care needs.

Background: The aim of this study is to explore the prevalence of depressive disorders in very old adults over time, in rural/urban environments, between men/women, as well as to explore other factors associated with depressive disorders.

Methods: This study was conducted utilizing the GERDA-database data, which consists of four cohorts of 85, 90 and 95+ year olds living in Northern Sweden. Participants could reside independently or in residential care. Data collections took place between 2000 and 2017. Descriptive data and logistic regression models were utilized to explore data.

Results: The prevalence of depressive disorders increased between 2000/02 and 2015/17 in all age groups, with the highest percentages observed in the 95+ age group, reaching 53.6 % in 2015/17. The prevalence varied from 20.3 % in those without dementia to 65.1 % in those with dementia. Sex or living in an urban/rural environment was not associated with an increased risk of depression in the fully adjusted models. Dementia and reduced capacity in activities of daily living were associated with depressive disorders among 85 and 90-year-olds, while living alone was associated with depressive disorders in the 95+ age group.

Limitations: Potentially limited generalizability, as this study took place in northern Sweden.

Conclusions: The prevalence of depressive disorders among very old adults increases with age and the prevalence also increases throughout cohorts and time. These alarming rates of depressive disorders among the very old require immediate measures and further investigation. Future studies are needed to explore and monitor trends and to plan and design tailored interventions.