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Gustafson, Yngve
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Publications (10 of 196) Show all publications
Hasselgren, L., Conradsson, M., Lampinen, J., Toots, A., Olofsson, B., Nilsson, I., . . . Littbrand, H. (2024). Feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme in community-dwelling people with dementia: a randomised controlled pilot trial. BMC Geriatrics, 24(1), Article ID 794.
Open this publication in new window or tab >>Feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme in community-dwelling people with dementia: a randomised controlled pilot trial
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2024 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, no 1, article id 794Article in journal (Refereed) Published
Abstract [en]

Background: A team-based, individualised rehabilitation approach may be required to meet the complex needs of people with dementia. This randomised controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme for community-dwelling older people with dementia and their informal primary caregivers.

Methods: Participants with dementia were randomised to an intervention group (n = 31, mean age (SD) 78.4 (6.0) years) or usual care (n = 30, mean age 79.0 (7.1)). The rehabilitation programme consisted of a 20-week rehabilitation period containing assessments and interventions based on each individual’s goals, and group-based physical exercise plus social interaction twice a week for 16 weeks at a rehabilitation unit. After 5 and 14 months, the interdisciplinary team followed up participants over two four-week periods. For both groups, dates of deaths and decision to move to nursing home over three years, as well as interventions for the relevant periods, were collected. Blinded assessors measured physical functions, physical activity, activities of daily living, cognitive functions, nutritional status, and neuropsychiatric symptoms at baseline and at 5, 12, 24, and 36 months.

Results: Participants in the intervention group received a mean of 70.7 (20.1) interventions during the 20-week rehabilitation period, delivered by all ten team professions. The corresponding figures for the control group were 5.8 (5.9). In the intervention group, all but one participated in rehabilitation planning, including goal setting, and attendance in the exercise and social interaction groups was 74.8%. None of the adverse events (n = 19) led to any manifest injury or disease. Cox proportional hazard regression showed a non-significant lower relative risk (HR = 0.620, 95% CI 0.27–1.44) in favour of the intervention for moving to nursing home or mortality during the 36-month follow-up period. Linear mixed-effect models showed non-significant but potentially clinically meaningful between-group differences in gait, physical activity, and neuropsychological symptoms in favour of the intervention.

Conclusions: The rehabilitation programme seems feasible among community-dwelling older people with dementia. The overall results merit proceeding to a future definitive randomised controlled trial, exploring effects and cost-effectiveness. One could consider to conduct the programme earlier in the course of dementia, adding cognitive training and a control attention activity.

Trial registration: The study protocol, ISRCTN59155421, was registered online 4/11/2015.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Community-dwelling, Dementia, Feasibility study, Interdisciplinary, Rehabilitation
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-230590 (URN)10.1186/s12877-024-05372-9 (DOI)39342131 (PubMedID)2-s2.0-85205336926 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014−0897Promobilia foundationThe Dementia Association - The National Association for the Rights of the DementedThe Janne Elgqvist Family FoundationRegion VästerbottenAlzheimerfondenFoundation for the Memory of Ragnhild and Einar LundströmStiftelsen Gamla Tjänarinnor
Available from: 2024-10-08 Created: 2024-10-08 Last updated: 2024-10-08Bibliographically approved
Bergfrid, M., Gustafson, Y., Littbrand, H., Olofsson, B. & Weidung, B. (2024). Having plans for the future in very old people. The International Journal of Aging & Human Development, 99(3), 373-394
Open this publication in new window or tab >>Having plans for the future in very old people
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2024 (English)In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 99, no 3, p. 373-394Article in journal (Refereed) Published
Abstract [en]

This study aimed to investigate the prevalence of having plans for the future among very old people and the factors associated with having such plans. A longitudinal population-based study with home visits for 85-, 90-, and ≥95-year-old participants in Sweden and Finland was used. Multivariate logistic regression and Cox proportional-hazards regression models with a maximum 5-year follow-up period were used. The prevalence of having plans for the future was 18.6% (174/936). More men than women and more people living in Sweden than in Finland had plans for the future. In multivariate models, having plans for the future was associated with speaking Swedish, being dentate, and living in the community in the total sample; speaking Swedish and being dentate among women; and speaking Swedish, having a lower Geriatric Depression Scale score, and urban residence among men. Having plans for the future was associated univariately, but not multivariately, with increased survival.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
aged 80 and over, future perception, gerontology, optimism, plans for the future, survival
National Category
Gerontology, specialising in Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:umu:diva-221560 (URN)10.1177/00914150241231189 (DOI)001159569300001 ()38342991 (PubMedID)2-s2.0-85185275774 (Scopus ID)
Funder
Umeå UniversityThe Dementia Association - The National Association for the Rights of the DementedSwedish Research Council, K2014-99X-22610-01-6Visare NorrRegion VästerbottenKonung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Available from: 2024-03-05 Created: 2024-03-05 Last updated: 2024-10-28Bibliographically approved
Corneliusson, L., Gustafson, Y. & Olofsson, B. (2024). Prevalence of depressive disorders among the very old in the 21st century. Journal of Affective Disorders, 362, 706-715
Open this publication in new window or tab >>Prevalence of depressive disorders among the very old in the 21st century
2024 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 362, p. 706-715Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Depressive disorder, Epidemiology, Oldest old, Rural health, Sex differences, Urban health
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology Geriatrics
Identifiers
urn:nbn:se:umu:diva-228033 (URN)10.1016/j.jad.2024.07.062 (DOI)39029671 (PubMedID)2-s2.0-85198954651 (Scopus ID)
Funder
Swedish Research Council, K2014–99X-22610–01–6Region VästerbottenThe Dementia Association - The National Association for the Rights of the DementedEU, European Research CouncilEuropean Regional Development Fund (ERDF)Interreg
Available from: 2024-07-25 Created: 2024-07-25 Last updated: 2024-07-25Bibliographically approved
Svahn, S., Appelblad, L., Lövheim, H., Gustafson, Y., Olofsson, B. & Gustafsson, M. (2024). Prevalence of heart failure and trends in its pharmacological treatment between 2000 and 2017 among very old people. BMC Geriatrics, 24(1), Article ID 701.
Open this publication in new window or tab >>Prevalence of heart failure and trends in its pharmacological treatment between 2000 and 2017 among very old people
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2024 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, no 1, article id 701Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to describe a population of very old people with heart failure (HF), to analyse the use of cardiovascular drugs over time, and to explore factors influencing cardiovascular drug treatment for this group.

Methods: All participants with information regarding HF diagnosis were selected from the Umeå 85+/Gerontological Regional Database (GERDA). The people in GERDA are all ≥85 years old. Trained investigators performed structured interviews and assessments. Information regarding medications and diagnoses was obtained from the participants and from medical records. Medical diagnoses were reviewed and confirmed by an experienced geriatrician.

Results: In this very old population, the prevalence of HF was 29.6% among women and 30.7% among men. Between 2000 and 2017, there was an increase in the use of renin-angiotensin (RAS) inhibitors (odds ratio [OR] 1.107, 95% confidence interval [CI] 1.072–1.144) and beta-blockers (BBs) (OR 1.123, 95% CI 1.086–1.161) among persons with HF, whereas the prevalence of loop diuretics (OR 0.899, 95% CI 0.868–0.931) and digitalis (OR 0.864, 95% CI 0.828–0.901) decreased (p < 0.001 for all drug classes). Higher age was associated with lower use of RAS inhibitors and BBs.

Conclusion: In this HF population, the use of evidence-based medications for HF increased over time. This may be a sign of better awareness among prescribers regarding the under-prescribing of guidelines-recommended treatment to old people. Higher age associated with a lower prevalence of RAS inhibitors and BBs. This might indicate that further improvement is possible but could also represent a more cautious prescribing among frail very old individuals.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Cardiovascular drugs, Drug use, Heart failure, Very old people
National Category
Geriatrics Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:umu:diva-229385 (URN)10.1186/s12877-024-05307-4 (DOI)001297617900008 ()39182036 (PubMedID)2-s2.0-85201929935 (Scopus ID)
Funder
Swedish Research Council, K2014–99X-22610–01–6The Dementia Association - The National Association for the Rights of the DementedInterreg
Available from: 2024-09-12 Created: 2024-09-12 Last updated: 2025-02-10Bibliographically approved
Almevall, A., Dahlin Almevall, A., Öhlin, J., Gustafson, Y., Zingmark, K., Niklasson, J., . . . Olofsson, B. (2024). Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort. Archives of gerontology and geriatrics (Print), 122, Article ID 105392.
Open this publication in new window or tab >>Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort
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2024 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 122, article id 105392Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Aged 80 and over, Aging/psychology, Diagnostic self evaluation, Longitudinal studies, Population characteristics, Self-rated health, Survival analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-222682 (URN)10.1016/j.archger.2024.105392 (DOI)38492492 (PubMedID)2-s2.0-85187986768 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-01074Swedish Research Council, K2014-99X-22610-01-6Visare NorrNorrbotten County CouncilRegion VästerbottenSwedish Dementia CentreFoundation for the Memory of Ragnhild and Einar LundströmSwedish Society of MedicineKonung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Available from: 2024-04-09 Created: 2024-04-09 Last updated: 2024-07-02Bibliographically approved
Corneliusson, L., Öhlin, J., Toots, A., Gustafson, Y. & Olofsson, B. (2024). The association between gait speed and depressive disorders: A cross-sectional analysis of very old adults in the 21st century. Aging & Mental Health
Open this publication in new window or tab >>The association between gait speed and depressive disorders: A cross-sectional analysis of very old adults in the 21st century
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2024 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915Article in journal (Refereed) Epub ahead of print
Abstract [en]

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.

Place, publisher, year, edition, pages
Routledge, 2024
Keywords
antidepressants, depressive disorders, Gait speed, oldest old
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-233324 (URN)10.1080/13607863.2024.2436479 (DOI)001374443900001 ()39648653 (PubMedID)2-s2.0-85211210948 (Scopus ID)
Funder
Swedish Research Council, K2014–99X-22610–01–6Umeå UniversityVästerbotten County Council
Available from: 2025-01-02 Created: 2025-01-02 Last updated: 2025-01-02
Snellman, S., Hörnsten, C., Olofsson, B., Gustafson, Y., Lövheim, H. & Niklasson, J. (2024). Validity and test–retest reliability of the Swedish version of the Geriatric Depression Scale among very old adults. BMC Geriatrics, 24(1), Article ID 261.
Open this publication in new window or tab >>Validity and test–retest reliability of the Swedish version of the Geriatric Depression Scale among very old adults
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2024 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, no 1, article id 261Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Aged 80 and over, Depression, Psychiatric status rating scales, Psychometrics, ROC curve
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-222888 (URN)10.1186/s12877-024-04869-7 (DOI)001187389700003 ()38500031 (PubMedID)2-s2.0-85188072998 (Scopus ID)
Funder
Swedish Research Council, K2014– 99X-22610–01–6Region VästerbottenNorrbotten County CouncilThe Dementia Association - The National Association for the Rights of the Demented
Available from: 2024-04-08 Created: 2024-04-08 Last updated: 2024-07-04Bibliographically approved
Lindelöf, N., Nilsson, I., Littbrand, H., Gustafson, Y., Olofsson, B. & Fjellman-Wiklund, A. (2023). A focus groups study of staff team experiences of providing interdisciplinary rehabilitation for people with dementia and their caregivers: a co-creative journey. BMC Geriatrics, 23(1), Article ID 572.
Open this publication in new window or tab >>A focus groups study of staff team experiences of providing interdisciplinary rehabilitation for people with dementia and their caregivers: a co-creative journey
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2023 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 23, no 1, article id 572Article in journal (Refereed) Published
Abstract [en]

Background: The World Health Organization claims that rehabilitation is important to meet the needs of persons with dementia. Rehabilitation programmes, however, are not routinely available. Person-centred, multidimensional, and interdisciplinary rehabilitation can increase the opportunities for older adults with dementia and their informal primary caregivers to continue to live an active life and participate in society. To our knowledge, staff team experiences of such rehabilitation programmes, involving older adults with dementia and their informal caregivers has not been previously explored.

Methods: The aim of this qualitative focus group study was to explore the experiences of a comprehensive staff team providing person-centred multidimensional, interdisciplinary rehabilitation to community-dwelling older adults with dementia, including education and support for informal primary caregivers. The 13 staff team members comprised 10 professions who, during a 16-week intervention period, provided individualised interventions while involving the rehabilitation participants. After the rehabilitation period the staff team members were divided in two focus groups who met on three occasions each (in total six focus groups) and discussed their experiences. The Grounded Theory method was used for data collection and analysis.

Results: The analysis resulted in four categories: Achieving involvement in rehabilitation is challenging, Considering various realities by acting as a link, Offering time and continuity create added value, and Creating a holistic view through knowledge exchange, and the core category: Refining a co-creative process towards making a difference. The core category resembles the collaboration that the staff had within their teams, which included participants with dementia and caregivers, and with the goal that the intervention should make a difference for the participants. This was conducted with flexibility in a collaborative and creative process.

Conclusions: The staff team perceived that by working in comprehensive teams they could provide individualised rehabilitation in creative collaboration with the participants through interaction, knowledge exchange, time and continuity, coordination and flexibility, and a holistic view. Challenges to overcome were the involvement of the person with dementia in goal setting and the mediating role of the staff team members. The staff pointed out that by refinement they could achieve well-functioning, competence-enhancing and timesaving teamwork.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Dementia, Experiences, Grounded theory, Informal caregiver, Interdisciplinary health team, Person-centered care, Rehabilitation
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:umu:diva-214772 (URN)10.1186/s12877-023-04269-3 (DOI)37723442 (PubMedID)2-s2.0-85171536442 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0897Promobilia foundationThe Dementia Association - The National Association for the Rights of the DementedThe Janne Elgqvist Family FoundationRegion VästerbottenAlzheimerfondenFoundation for the Memory of Ragnhild and Einar LundströmStiftelsen Gamla Tjänarinnor
Available from: 2023-10-18 Created: 2023-10-18 Last updated: 2024-07-04Bibliographically approved
Olofsson, E., Gustafson, Y., Mukka, S., Tengman, E., Lindgren, L. & Olofsson, B. (2023). Association of depressive disorders and dementia with mortality among older people with hip fracture. BMC Geriatrics, 23(1), Article ID 135.
Open this publication in new window or tab >>Association of depressive disorders and dementia with mortality among older people with hip fracture
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2023 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 23, no 1, article id 135Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hip fracture (HF) is a significant cause of mortality among older people. Almost half of the patients with HF have dementia, which increases the mortality risk further. Cognitive impairment is associated with depressive disorders (DDs) and both dementia and DDs are independent risk factors for poor outcome after HF. However, most studies that evaluate mortality risk after HF separate these conditions.

AIMS: To investigate whether dementia with depressive disorders (DDwD) affects the mortality risk at 12, 24, and 36 months after HF among older people.

METHODS: Patients with acute HF (n = 404) were included in this retrospective analysis of two randomized controlled trials performed in orthopedic and geriatric departments. Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive function was assessed using the Mini-Mental State Examination. A consultant geriatrician made final depressive disorder and dementia diagnoses using the Diagnostic and Statistical Manual of Mental Disorders criteria, with support from assessments and medical records. The 12-, 24- and 36-month mortality after HF was analyzed using logistic regression models adjusted for covariates.

RESULTS: In analyses adjusted for age, sex, comorbidity, pre-fracture walking ability, and fracture type, patients with DDwD had increased mortality risks at 12 [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.75-12.51], 24 (OR 3.61, 95% CI 1.71-7.60), and 36 (OR 4.53, 95% CI 2.24-9.14) months. Similar results were obtained for patients with dementia, but not depressive disorders, alone.

CONCLUSION: DDwD is an important risk factor for increased mortality at 12, 24, and 36 months after HF among older people. Routinely assessments after HF for cognitive- and depressive disorders could identify patients at risk for increased mortality, and enable early interventions.

TRIAL REGISTRATION: RCT2: International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN15738119.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Dementia, Depressive disorders, Hip fracture, Mortality, Older people
National Category
Orthopaedics Geriatrics
Identifiers
urn:nbn:se:umu:diva-205678 (URN)10.1186/s12877-023-03862-w (DOI)000945613200001 ()36890449 (PubMedID)2-s2.0-85149626612 (Scopus ID)
Funder
Vårdal FoundationVisare NorrThe Kempe FoundationsUmeå UniversityRegion VästerbottenSwedish Research Council, K2005‐27VX‐15357‐01A
Available from: 2023-03-14 Created: 2023-03-14 Last updated: 2024-07-04Bibliographically approved
Claesson Lingehall, H., Gustafson, Y., Svenmarker, S., Appelblad, M., Davidsson, F., Holmner, F., . . . Olofsson, B. (2023). Is a hyperosmolar pump prime for cardiopulmonary bypass a risk factor for postoperative delirium?: A double blinded randomised controlled trial. Scandinavian Cardiovascular Journal, 57(1), Article ID 2186326.
Open this publication in new window or tab >>Is a hyperosmolar pump prime for cardiopulmonary bypass a risk factor for postoperative delirium?: A double blinded randomised controlled trial
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2023 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 57, no 1, article id 2186326Article in journal (Refereed) Published
Abstract [en]

Objective: Postoperative delirium (POD) is common after cardiac surgery. We have previously identified plasma sodium concentration and the volume of infused fluids during surgery as possible risk factors. Both are linked to the selection and composition of the pump prime used for cardiopulmonary bypass (CPB). Present study aims to examine whether hyperosmolality increases the risk for POD.

Design: Patients ≥65 years (n = 195) scheduled for cardiac surgery were prospectively enrolled into this double blinded randomised clinical trial. Study group received a pump prime containing mannitol and ringer-acetate (966 mOsmol) (n = 98) vs. ringer-acetate (388 mOsmol) (n = 97) in the control group. Postoperative delirium was defined according to DSM-5 criteria based on a test-battery pre- and postoperatively (days 1–3). Plasma osmolality was measured on five occasions and coordinated with the POD assessments. The primary outcome was the POD incidence related to hyperosmolality as the secondary outcome.

Results: The incidence of POD was 36% in the study group and 34% in the control group, without intergroup difference (p=.59). The plasma osmolality was significantly higher in the study group, both on days 1 and 3 and after CPB (p<.001). Post hoc analysis indicated that high osmolality levels increased the risk for delirium on day 1 by 9% (odds ratio (OR) 1.09, 95% CI 1.03–1.15) and by 10% on day 3 (OR 1.10, 95% CI 1.04–1.16).

Conclusions: Use of a prime solution with high osmolality did not increase the incidence of POD. However, the influence of hyperosmolality as a risk factor for POD warrants further investigation.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Cardiac surgery, cardiopulmonary bypass, delirium, mannitol, osmolality
National Category
Cardiology and Cardiovascular Disease Nursing Surgery
Identifiers
urn:nbn:se:umu:diva-206772 (URN)10.1080/14017431.2023.2186326 (DOI)000962391200001 ()37009834 (PubMedID)2-s2.0-85151638529 (Scopus ID)
Funder
Region VästerbottenUmeå University
Available from: 2023-04-26 Created: 2023-04-26 Last updated: 2025-02-10Bibliographically approved
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