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Background: To meet the complex needs of adults with dementia, a team-based, individualized rehabilitation approach may be required. This randomized controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation program for older adults with dementia, in terms of follow-up and response rates, and potential short- and long-term effects in adults with dementia on social participation, loneliness, and mental health.

Methods: Participants (mean age (SD) 78.7 (±6.6) years), were randomized to an intervention group (n = 31) or usual care (n = 30). The rehabilitation program consisted of a 20-week rehabilitation period and two follow-ups after 5 and 14 months. An interdisciplinary team performed assessments and interventions based on the individual's goals. Assessors blinded to group allocation performed structured assessments at baseline and after 5, 12, 24, and 36 months.

Results: Initially, response rates in participants with dementia were high for all assessments in the areas of social participation, loneliness, and mental health. Response rates after 12 months decreased, particularly for cognitively demanding questions with multiple-choice options in the area of social participation. Overall, there were few statistically significant differences between the groups in the outcomes over 36 months, but some of the findings seemed potentially clinically meaningful in favor of the intervention group: increased frequency of active recreation and organized social activities outside the home, as reported by both participants with dementia and caregivers or staff; as well as experienced more frequent visits to family and friends; and short-term reduction in depressive symptoms.

Conclusions: Assessments made of loneliness and mental health in this study over three years seemed feasible. It seemed cognitively demanding for participants with dementia to answer questions regarding social participation over time; therefore it seemed worthwhile to also ask informal caregivers or staff to avoid data loss. The positive findings noted during assessments and potential effects indicate that it is relevant to proceed further to an adequately powered RCT and conducted in additional geographical regions.

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.

BACKGROUND: Femoral neck fractures (FNF) are a severe and common injury that affect older adults physically, psychologically, and socially. Variation in the trajectory of recovery remains underexplored. This study was conducted to investigate older adults' recovery experiences during the first year after FNF.

METHOD: This longitudinal interview-based study was conducted with 13 participants aged ≥75 years with FNF who were admitted to the orthopedics wards of two hospitals in Sweden. Semi-structured interviews were conducted with participants at 1, 4, and 12 months after fracture. Reflexive thematic analysis of the interview transcripts was performed.

RESULTS: Participants described their recovery after FNF as a complex and non-linear journey. Four interrelated themes were identified as key aspects influencing recovery during the first year after FNF: engagement in daily activities, fear of falling, family members' bridging of the support gap, and striving for independence. Recovery was represented as a fluctuating personal experience that evolves over time.

CONCLUSION: Recovery after FNF extends beyond physical healing, encompassing emotional adjustment and social reintegration. The understanding of recovery as an evolving and individualized process highlights the need for follow-up and rehabilitation strategies that address not only functional outcomes, but also patients' confidence, motivation, and support in daily life.

Aims: This longitudinal study investigated the prevalence of and risk factors for loneliness among older new informal caregivers, long-term informal caregivers, former informal caregivers and non-caregivers in selected regions of Finland and Sweden over 5 years.

Methods: A longitudinal sample of 5083 respondents from the Gerontological Regional Database (GERDA) survey data in 2016 and 2021 was used. Bivariate correlation tests and multivariate logistic regression analyses were performed.

Results: Loneliness prevalence rates varied between 6% and 8% in 2016 and increased in all groups, although not significantly among new informal caregivers. In 2021, the prevalence of loneliness varied between 8% and 14%. Among the baseline variables, reporting loneliness, single/unmarried/bereaved civil status, infrequent contact with friends and neighbours, poor self-rated health, depressive symptoms, living in Finland and financial strain increased the likelihood of reporting loneliness in 2021. Among the change variables, being a long-term caregiver, a negative change in civil status, a reduced number of confidants, a negative change in self-rated health and depressive symptoms increased the likelihood of reporting loneliness.

Conclusions: Loneliness increased among all four groups of comparison. Being a long-term caregiver was a significant risk factor for reporting loneliness over time (odds ratio 2.00, 95% confidence interval 1.20–3.35), when controlling for several other social and health-related variables. To develop effective support, future research could address risk factors for loneliness among distinct groups of informal caregivers based on whether the care recipients have neurological or functional health limitations and examine the availability of support measures.

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.

Background: Delirium is a common neurological complication after cardiac surgery. The purpose of the present study was to analyze the association between hemodynamic fluctuations during cardiopulmonary bypass (CPB) and the incidence of postoperative delirium (POD) in patients undergoing cardiac surgery with CPB.

Methods: This post hoc analysis included one-hundred-ninety-five (n = 195) patients aged ≥ 65 years of whom seventy (n = 70) patients developed POD. Intraoperative hemodynamic variables specifically related to the conduct of CPB were digitally recorded at 1-minute intervals. Variables outside the presumed safe boundaries for mean arterial pressure (MAP), systemic perfusion flow index– L/min/BSA (QBSA_I), systemic venous oxygen saturation (S_VO₂) and arterial oxygen delivery– ml/min/BSA (DO₂) were defined and analyzed with reference to indices of area under the curve (AUC) and the relative proportion of registrations related to POD. POD was diagnosed according to DSM-5 criteria based on a test battery performed preoperatively and repeated twice postoperatively. Statistical tests used to verify observations outside the predefined norm included the Mann-Whitney U test and the chi-squared test.

Results: Markers of hemodynamic control during CPB showed significant associations with POD. Both DO₂ (P = 0.02) and QBSA_I (P < 0.001) identified POD patients outside the predefined upper and lower safety limits. S_VO₂ values > 84% (P < 0.001) werealso associated with the development of POD. The number of S_VO₂ registrations below the lower safety limit was negligible, why statistical analysis seemed not useful. No association between MAP and POD registrations was identified.

Conclusions: This study revealed a clear association between markers of hemodynamic control and POD. These associations were most pronounced for DO₂ and QBSA_I. The detected association between high S_VO₂ and POD warrants further insight.

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.

Aim: To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context.

Design: A modified Delphi method.

Methods: A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study.

Results: The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment.

Conclusion: Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety.

Implications for the profession and patient care:This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement.

Impact: The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care.

Reporting Method: The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'.

Patient or Public Contribution: No patient or public contribution.

Background: Due to pressured social and health care systems, the role of health promoting lifestyle behaviors increases in importance. The aim of this study is to investigate the association between socioeconomic position (SEP) and health-promoting lifestyle among older adults in six Nordic regions - and potential regional variation in the associations.

Methods: Data from the Gerontological Regional Database survey collected in 2021/2022 (N = 11,984) is used. The regions in Finland are Aland, South Ostrobothnia, Swedish-speaking Ostrobothnia, and Finnish-speaking Ostrobothnia. In Sweden, the city of Umea and rural Vasterbotten were included. Lifestyle is defined as adherence to seven Blue Zone principles.

Results: A high SEP was associated with higher likelihood of a health-promoting lifestyle in several principles. Simultaneously, a high SEP was associated with risk-drinking, and lower likelihood of belief in a higher power and weekly contact with family members. The association between SEP and lifestyle was weaker in rural Vasterbotten (Swe) and Swedish-speaking Ostrobothnia (Fin), and stronger in Umea (Swe) and Aland (Fin).

Conclusions: There is a gradient of SEP for adopting a health-promoting lifestyle in old age in Nordic regions - although with some (regional) exceptions and unexpected directions of the relationship. The Nordic setting reflects a secularised, de-familialised culture with a comparatively heavy reliance on a mainly tax-based welfare system. Simultaneously, there is regional variation in culture and social and health care services between and within Nordic countries, which underline the need to adopt regional, contextual perspectives to identify clues to healthy ageing - such as equalising community measures.

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.