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  • 1. Almevall, Albin D.
    et al.
    Zingmark, Karin
    Nordmark, Sofi
    Forslund, Ann-Sofie
    Niklasson, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Accepting the inevitable: A mixed method approach with assessment and perceptions of well-being in very old persons within the northern Sweden Silver-MONICA study2021In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 92, article id 104275Article in journal (Refereed)
    Abstract [en]

    Background: As the group of very old persons will form an increasing part of society, the study of how well-being is described and affected by specific factors will be of importance to meet the future needs of these persons. The aim of the study was to increase knowledge of well-being in very old persons by combining assessments and perceptions using the Philadelphia Geriatric Morale Scale (PGCMS).

    Method: In a mixed method, convergent parallel design, 52 persons 80 years or older were assessed and interviewed using the PGCMS to combine assessment of morale and descriptions of perceptions of well-being using a mixed method approach.

    Results: Quantitative and qualitative results converged in four areas: not feeling lonely and being included, rating and perceiving health as good, high physical function/ability and being physically active, living in own house and feeling at home. Areas perceived as important to well-being captured only in qualitative analysis were having freedom and engagement. An example of insights not achievable from the quantitative or qualitative analysis alone was that individuals with high morale expressed anxiety about losing their health due to potential ageing-related threats and that individuals with low morale struggled with acceptance. Acceptance was the key strategy for handling adverse consequences of ageing in all described areas.

    Conclusion: When using standardized assessment scales in clinical practice, it could be useful to combine quantitative and qualitative data. Acceptance was key for well-being; however, acceptance could be resigned or reorienting in nature.

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  • 2.
    Andersson, P.
    et al.
    Center for Life-span Developmental Research (LEADER), School of Behavioral, Social and Legal Sciences, Örebro University, Sweden.
    Samrani, George
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Aging Research Center (ARC), Karolinska Institute and Stockholm University, Sweden.
    Andersson, Micael
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Persson, J.
    Center for Life-span Developmental Research (LEADER), School of Behavioral, Social and Legal Sciences, Örebro University, Sweden; Aging Research Center (ARC), Karolinska Institute and Stockholm University, Sweden.
    Hippocampal subfield volumes contribute to working memory interference control in aging: evidence from longitudinal associations over 5 years2023In: Neuroimage: Reports, E-ISSN 2666-9560, Vol. 3, no 4, article id 100189Article in journal (Refereed)
    Abstract [en]

    In memory, familiar but no longer relevant information may disrupt encoding and retrieval of to-be-learned information. While it has been demonstrated that the ability to resolve proactive interference (PI) in working memory (WM) is reduced in aging, the neuroanatomical components of this decline have yet to be determined. Hippocampal (HC) involvement in age-related decline in control of PI is currently not known. In particular, the association between HC subfield volumes and control of PI in WM has not been examined previously. Here we investigate the associations between mean level and 5-year trajectories of gray matter subfield volumes and PI in WM across the adult life span (N = 157). Longitudinal analyses over 5-years across all participants revealed that reduced volume in the subiculum was related to impaired control of PI. Age-stratified analyses showed that this association was most pronounced in older adults. Furthermore, we found that in older adults the effect of age on PI was mediated by GM volume in the HC. The current results show that HC volume is associated with the ability to control PI in WM, and that these associations are modulated by age.

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  • 3.
    Aspbäck, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsson, Jennie
    Umeå University, Faculty of Medicine, Department of Nursing.
    ÄLDRE OCH ENSAMHET: Sociala faktorer och livsstilsfaktorer som påverkar ensamhet hos äldre2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Several risk factors can increase the risk of loneliness among the elderly population. In literature, loneliness increases the risk of illness and mortality and causes much emotional suffering. Aim: This study aimed to investigate social factors and lifestyle factors associated with loneliness among older adults> 65 years from northern Sweden. Methods: The design was a quantitative cross-sectional study using material from the Gerontological Regional DAtabase [GERDA]. A postal questionnaire sent to older adults > 65 living in northern Sweden. Results: There were significant associations between several factors and loneliness among older adults in northern Sweden. Protective factors was being married, being satisfied with life, feeling a zest for life and feeling safe. The risk factor was self-assessing yourself as depressed/dejected. Conclusion: Being depressed was a strong risk factor for loneliness. Proactive work and treatment for depression might be interventions that can be important in preventing loneliness among older adults. Screening for loneliness and depression should be a part of the general routine at health centres, in home health care and inpatient care, to find at-risk patients in time for preventively work

  • 4.
    Backman, Annica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.  School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
    Characteristics of highly rated leadership in Swedish nursing homes2016In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 56, p. 283-283Article in journal (Other academic)
  • 5.
    Ballin, Marcel
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Ioannidis, John P.
    Department of Medicine, Stanford University School of Medicine, CA, Stanford, United States; Department of Epidemiology and Population Health, Stanford University School of Medicine, CA, Stanford, United States.
    Bergman, Jonathan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Kivipelto, Miia
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Medical Unit Aging, Karolinska University Hospital, Stockholm, Sweden.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Time-varying risk of death after SARS-CoV-2 infection in Swedish long-term care facility residents: a matched cohort study2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 11, article id e066258Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate whether SARS-CoV-2 infection in residents of long-term care (LTC) facilities is associated with higher mortality after the acute phase of infection, and to estimate survival in uninfected residents.

    DESIGN: Extended follow-up of a previous, propensity score-matched, retrospective cohort study based on the Swedish Senior Alert register.

    SETTING: LTC facilities in Sweden.

    PARTICIPANTS: n=3604 LTC residents with documented SARS-CoV-2 until 15 September 2020 matched to 3604 uninfected controls using time-dependent propensity scores on age, sex, health status, comorbidities, prescription medications, geographical region and Senior Alert registration time. In a secondary analysis (n=3731 in each group), geographical region and Senior Alert registration time were not matched for in order to increase the follow-up time in controls and allow for an estimation of median survival.

    PRIMARY OUTCOME MEASURES: All-cause mortality until 24 October 2020, tracked using the National Cause of Death Register.

    RESULTS: Median age was 87 years and 65% were women. Excess mortality peaked at 5 days after documented SARS-CoV-2-infection (HR 21.5, 95% CI 15.9 to 29.2), after which excess mortality decreased. From the second month onwards, mortality rate became lower in infected residents than controls. The HR for death during days 61-210 of follow-up was 0.76 (95% CI 0.62 to 0.93). The median survival of uninfected controls was 1.6 years, which was much lower than the national life expectancy in Sweden at age 87 (5.05 years in men, 6.07 years in women).

    CONCLUSIONS: The risk of death after SARS-CoV-2 infection in LTC residents peaked after 5 days and decreased after 2 months, probably because the frailest residents died during the acute phase, leaving healthier residents remaining. The limited life expectancy in this population suggests that LTC resident status should be accounted for when estimating years of life lost due to COVID-19.

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  • 6.
    Ballin, Marcel
    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.
    Lundberg, Emmy
    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.
    Sörlén, Niklas
    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.
    Hult, Andreas
    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. School of Sport Sciences, The Arctic University of Norway, Tromsø, Norway..
    Effects of Interval Training on Visceral Adipose Tissue in Centrally Obese 70-Year-Old Individuals: A Randomized Controlled Trial2019In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 67, no 8, p. 1625-1631Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the effects of 10 weeks of progressive vigorous-intensity interval training as a single intervention on body composition among 70-year-old individuals with central obesity.

    DESIGN: Randomized controlled trial (ClinicalTrials.gov registration No. NCT03450655).

    SETTING: Community-dwelling 70-year-old men and women living in the Umeå municipality in Sweden.

    PARTICIPANTS: Seventy-seven 70-year-old men and women with central obesity (greater than 1 kg visceral adipose tissue [VAT] for women and greater than 2 kg VAT for men).

    INTERVENTION: Participants allocated to the intervention group were offered a 10-week progressive concurrent exercise program performed three times per week. All participants in both groups had received tailored lifestyle recommendations focused on diet and physical activity at one occasion within 12 months prior to trial initiation.

    MEASUREMENTS: The primary outcome was changes in VAT, and secondary outcomes included changes in total fat mass (FM), total lean body mass (LBM), and body mass index.

    RESULTS: Comparing the groups, there were no significant differences in decrease of VAT mass (P = .10), although the intervention group significantly decreased FM by 716 g (P = .01) and gained LBM by 508 g (P = .03), compared to the control group. Furthermore, the effects of the training were significantly greater in the male subcohort (P < .05 for interaction), with positive effects also on VAT and FM, where men in the intervention group decreased VAT by 175 g (P < .05) and FM by 1364 g (P = .004), compared to the male controls.

    CONCLUSIONS: The present trial demonstrates that 10 weeks of progressive vigorous interval training is sufficient to significantly decrease FM in older adults with central obesity, with positive effects also on LBM.

  • 7. Banerjee, Partha S.
    et al.
    Lagerlöf, Olof
    Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, MD, USA.
    Hart, Gerald W.
    Roles of O-GlcNAc in chronic diseases of aging2016In: Molecular Aspects of Medicine, ISSN 0098-2997, E-ISSN 1872-9452, Vol. 51, p. 1-15Article, review/survey (Refereed)
    Abstract [en]

    O-GlcNAcylation, a dynamic nutrient and stress sensitive post-translational modification, occurs on myriad proteins in the cell nucleus, cytoplasm and mitochondria. O-GlcNAcylation serves as a nutrient sensor to regulate signaling, transcription, translation, cell division, metabolism, and stress sensitivity in all cells. Aberrant protein O-GlcNAcylation plays a critical role both in the development, as well as in the progression of a variety of age related diseases. O-GlcNAcylation underlies the etiology of diabetes, and changes in specific protein O-GlcNAc levels and sites are responsible for insulin expression and sensitivity and glucose toxicity. Abnormal O-GlcNAcylation contributes directly to diabetes related dysfunction of the heart, kidney and eyes and affects progression of cardiomyopathy, nephropathy and retinopathy. O-GlcNAcylation is a critical modification in the brain and plays a role in both plaque and tangle formation, thus making its study important in neurodegenerative disorders. O-GlcNAcylation also affects cellular growth and metabolism during the development and metastasis of cancer. Finally, alterations in O-GlcNAcylation of transcription factors in macrophages and lymphocytes affect inflammation and cytokine production. Thus, O-GlcNAcylation plays key roles in many of the major diseases associated with aging. Elucidation of its specific functions in both normal and diseased tissues is likely to uncover totally novel avenues for therapeutic intervention.

  • 8.
    Barsoum, Shamiram
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Bossik, Zaka
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Dental care of the seniors in the nursing homes.2022Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT

     Background: During the past years the authorities and the dental care in the world have begun to realize the importance of maintaining a good oral health of the seniors. The care staff at special residences have an essential role in the daily oral care of the elderly. The oral state of health is also important for the rest of the health. Studies show that oral care is deficient in the elderly and needs to be highlighted as the elderly population is expected to increase. 

     Aim: The aim of this literature review is to evaluate the potential improvement regarding the staff's work with oral care in elderly care.

     Methods: Literature study search was performed with MeSh terms in the database PubMed and Scopus. The following keywords have searched:Dental care for aged, Education, Nursing homes, Nursing staff, Oral health, Oral care.   

    Results: Several studies have found improvements that are beginning to emerge to develop the oral care of the elderly. These improvements can be achieved by a convenient oral care training that is designed for the elderly. The training programs for the care staff working with the elderly positively affects their attitudes, routines and documentation of the patient’s information, which benefits the elderly oral health.   

    Conclusion:To achieve good oral care for the elderly, several improvements are needed to be done by the governments involving nursing and working staff´s routines. A little different has been done, but there is significant work still to be done to improve the elderly dental health. 

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  • 9.
    Baxter, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Björk, Sabine
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, VIC, Melbourne, Australia.
    Exploring changes to resident thriving and associated factors in Swedish nursing homes: a repeated cross-sectional study2022In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 37, no 6, article id GPS5731Article in journal (Refereed)
    Abstract [en]

    ObjectiveThis study aimed to explore changes to resident thriving in Swedish nursing homes over a 5-year period and describe changes in associated factors.

    MethodsCross-sectional data were collected from a randomised sample of Swedish nursing homes in 2013/2014 (baseline) and 2018/2019 (follow-up). Descriptive statistics, independent samples t-tests, and chi squared tests were used to statistically evaluate differences between the samples. Simple and multiple linear regression analyses were used to explore associations between thriving and the study variables.

    ResultsResident characteristics were relatively consistent between the full baseline (N = 4831) and follow-up (N = 3894) samples. Within a sub-sample of nursing homes that participated in both data collections mean thriving scores were found to have increased from 152.9 to 155.2 (p ≤ 0.003; d =0.09) and overall neuropsychiatric index scores had decreased from 16.0 to 14.3 (p ≤ 0.004; d =0.09), as had the prevalence of several neuropsychiatric symptoms. Thriving was found to have a positive association with the neuropsychiatric symptom of elation/euphoria, and negative associations with the symptoms of aggression/agitation, depression/dysphoria, apathy, and irritability.

    ConclusionsThe results show an increase in overall thriving scores and a decrease in overall neuropsychiatric scores between baseline and follow-up. This study confirmed associations between thriving and certain neuropsychiatric symptoms and established comparative knowledge regarding changes in resident thriving, characteristics, and symptom prevalence. These findings could inform future care and organisational policies to support thriving in nursing homes, particularly among residents at risk of lower thriving due to cognitive impairment or neuropsychiatric symptoms.

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  • 10. Berendsen, Agnes A M
    et al.
    Kang, Jae H
    van de Rest, Ondine
    Jankovic, Nicole
    Kampman, Ellen
    Kiefte-de Jong, Jessica C
    Franco, Oscar H
    Ikram, M Arfan
    Pikhart, Hynek
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Brenner, Hermann
    Boffetta, Paolo
    Rafnsson, Snorri Bjorn
    Gustafson, Deborah
    Kyrozis, Andreas
    Trichopoulou, Antonia
    Feskens, Edith J M
    Grodstein, Francine
    de Groot, Lisette C P G M
    Association of Adherence to a Healthy Diet with Cognitive Decline in European and American Older Adults: A Meta-Analysis within the CHANCES Consortium2017In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 43, no 3-4, p. 215-227Article in journal (Refereed)
    Abstract [en]

    AIM: To examine the association between a healthy diet, assessed by the Healthy Diet Indicator (HDI), and cognitive decline in older adults. METHODS: Data from 21,837 participants aged ≥55 years from 3 cohorts (Survey in Europe on Nutrition and the Elderly, a Concerted Action [SENECA], Rotterdam Study [RS], Nurses' Health Study [NHS]) were analyzed. HDI scores were based on intakes of saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, fruits and vegetables, and fiber. The Telephone Interview for Cognitive Status in NHS and Mini-Mental State Examination in RS and SENECA were used to assess cognitive function from multiple repeated measures. Using multivariable-adjusted, mixed linear regression, mean differences in annual rates of cognitive decline by HDI quintiles were estimated. RESULTS: Multivariable-adjusted differences in rates in the highest versus the lowest HDI quintile were 0.01 (95% CI -0.01, 0.02) in NHS, 0.00 (95% CI -0.02, 0.01) in RS, and 0.00 (95% CI -0.05, 0.05) in SENECA with a pooled estimate of 0.00 (95% CI -0.01, 0.01), I2 = 0%. CONCLUSIONS: A higher HDI score was not related to reduced rates of cognitive decline in European and American older adults.

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  • 11.
    Bergfrid, Martin
    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.
    Littbrand, Håkan
    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.
    Weidung, Bodil
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Department of Public Health and Caring Sciences, Geriatric Medicine, Uppsala University, Uppsala, Sweden.
    Having plans for the future in very old people2024In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535Article in journal (Refereed)
    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.

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  • 12.
    Björk, Sabine
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Juthberg, Christina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Wimo, Anders
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet; Department of Health Sciences, Luleå University of Technology.
    Winblad, Bengt
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University.
    Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes: a cross-sectional study2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 154Article in journal (Refereed)
    Abstract [en]

    Background: Earlier studies in nursing homes show a high prevalence of cognitive impairment, dependency in activities of daily living (ADL), pain, and neuropsychiatric symptoms among residents. The aim of this study was to explore the prevalence of the above among residents in a nationally representative sample of Swedish nursing homes, and to investigate whether pain and neuropsychiatric symptoms differ in relation to gender, cognitive function, ADL-capacity, type of nursing-home unit and length of stay. Methods: Cross-sectional data from 188 randomly selected nursing homes were collected. A total of 4831 residents were assessed for cognitive and ADL function, pain and neuropsychiatric symptoms. Data were analysed using descriptive statistics and the chi-square test. Results: The results show the following: the prevalence of cognitive impairment was 67 %, 56 % of residents were ADL-dependent, 48 % exhibited pain and 92 % exhibited neuropsychiatric symptoms. The prevalence of pain did not differ significantly between male and female residents, but pain was more prevalent among cognitively impaired and ADL-dependent residents. Pain prevalence was not significantly different between residents in special care units for people with dementia (SCU) and general units, or between shorter-and longer-stay residents. Furthermore, the prevalence of neuropsychiatric symptoms did not differ significantly between male and female residents, between ADL capacities or in relation to length of stay. However, residents with cognitive impairment and residents in SCUs had a significantly higher prevalence of neuropsychiatric symptoms than residents without cognitive impairment and residents in general units. Conclusions: The prevalence rates ascertained in this study could contribute to a greater understanding of the needs of nursing-home residents, and may provide nursing home staff and managers with trustworthy assessment scales and benchmark values for further quality assessment purposes, clinical development work and initiating future nursing assessments.

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  • 13.
    Björk, Sabine
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Wimo, Anders
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Thriving in relation to cognitive impairment and neuropsychiatric symptoms in Swedish nursing home residents2018In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 33, no 1, p. E49-E57Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study was to explore relations among thriving, cognitive function, and neuropsychiatric symptoms (NPS) in nursing home residents.

    Methods: A national, cross-sectional, randomized study of Swedish nursing home residents (N = 4831) was conducted between November 2013 and September 2014. Activities of daily life functioning, cognitive functioning, NPS, and thriving were assessed with the Katz activities of daily living, Gottfries' Cognitive Scale, Nursing Home version of the Neuropsychiatric Inventory, and Thriving of Older People Scale, respectively. Individual NPS were explored in relation to cognitive function. Simple linear and multiple regression models were used to explore thriving in relation to resident characteristics.

    Results: Aggression and depressive symptoms were identified as negatively associated with thriving regardless of resident cognitive functioning. At higher levels of cognitive functioning, several factors showed associations with thriving; however, at lower levels of cognitive functioning, only the degree of cognitive impairment and the NPS was associated with thriving. Most of the individual NPS formed nonlinear relationships with cognitive functioning with higher symptom scores in the middle stages of cognitive functioning. Exceptions were elation/euphoria and apathy, which increased linearly with severity of cognitive impairment.

    Conclusions: The lower the cognitive functioning was, the fewer factors were associated with thriving. Aggression and depressive symptoms may indicate lower levels of thriving; thus, targeting these symptoms should be a priority in nursing homes.

  • 14.
    Brändström, Anders
    et al.
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Meyer, Anna C.
    Modig, Karin
    Sandström, Glenn
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Stockholm University Demography Unit (SUDA), Stockholm University.
    Determinants of home care utilization among the Swedish old: nationwide register-based study2022In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 19, p. 651-662Article in journal (Refereed)
    Abstract [en]

    Since the 1990s, Sweden has implemented aging-in-place policies increasing the share of older adults dependent on home care instead of residing in care homes. At the same time previous research has highlighted that individuals receive home care at a higher age than before. Consequently, services are provided for a shorter time before death, increasing reliance on family and kin as caregivers. Previous studies addressing how homecare is distributed rely primarily on small surveys and are often limited to specific regions. This study aims to ascertain how home care services are distributed regarding individual-level factors such as health status, living arrangements, availability of family, education, and socioeconomic position. To provide estimates that can be generalized to Sweden as a whole, we use register data for the entire Swedish population aged 65 + in 2016. The study's main findings are that home care recipients and the amount of care received are among the oldest old with severe co morbidities. Receiving home care is slightly more common among women, but only in the highest age groups. Childlessness and socioeconomic factors play a small role in who receives home care or not. Instead, the primary home care recipients are those older adults living alone who lack direct support from family members residing in the same household.

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  • 15.
    Brännström, Jon
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Molander, Lena
    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.
    Gender disparities in the pharmacological treatment of cardiovascular disease and diabetes mellitus in the very old: an epidemiological, cross-sectional survey2011In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 28, no 12, p. 993-1005Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There are many reports of disparities in health and medical care both between women and men and between various age groups. In most cases, men receive better treatment than women and young and middle-aged people are privileged compared with the old and the very old. Cardiovascular morbidity and diabetes mellitus are common, increase with age and are often treated extensively with drugs, many of which are known to have significant adverse effects.

    OBJECTIVE: The aim of the study was to analyse gender differences in the pharmacological treatment of cardiovascular disease and diabetes among very old people.

    METHODS: The study took the form of an epidemiological, cross-sectional survey. A structured interview was administered during one or more home visits, and data were further retrieved from medical charts and interviews with relatives, healthcare staff and other carers. Home-dwelling people as well as people living in institutional care in six municipalities in the county of Västerbotten, Sweden, in 2005-7 were included in the study. Half of all people aged 85 years, all of those aged 90 years and all of those aged ≥95 years living in the selected municipalities were selected for inclusion in the study. In total, 467 people were included in the present analysis. The main study outcome measures were medical diagnoses and drug use.

    RESULTS: In total, women were prescribed a larger number of drugs than men (mean 7.2 vs 5.4, p < 0.001). Multiple logistic regression models adjusted for age and other background variables as well as relevant medical diagnoses (hypertension, heart failure) showed strong associations between female sex and prescriptions of thiazide diuretics (odds ratio [OR] 4.4; 95% CI 1.8, 10.8; p = 0.001), potassium-sparing diuretics (OR 3.5; 95% CI 1.4, 8.7; p = 0.006) and diuretics as a whole (OR 1.8; 95% CI 1.1, 2.9; p = 0.021). A similar model, adjusted for angina pectoris, showed that female sex was associated with prescription of short-acting nitroglycerin (OR 3.7; 95% CI 1.6, 8.9; p = 0.003). However, more men had been offered coronary artery surgery (p = 0.001). Of the participants diagnosed with diabetes, 55% of the women and 85% of the men used oral antihyperglycaemic drugs (p = 0.020), whereas no gender difference was seen in prescriptions of insulin.

    CONCLUSIONS: Significant gender disparities in the prescription of several drugs, such as diuretics, nitroglycerin and oral antihyperglycaemic drugs, were observed in this study of very old people. In most cases, women were prescribed more drugs than men. Men more often had undergone coronary artery surgery. These disparities could only in part be explained by differences in diagnoses and symptoms.

  • 16.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Caring Sciences, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University.
    Effects and meanings of a person-centred and health-promoting intervention in home care services: a study protocol of a non-randomised controlled trial2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 57Article in journal (Refereed)
    Abstract [en]

    Background: The literature indicates that current home care service are largely task oriented with limited focus on the involvement of the older people themselves, and studies show that lack of involvement might reduce older people's quality of life. Person-centred care has been shown to improve the satisfaction with care and quality of life in older people cared for in hospitals and nursing homes, with limited published evidence about the effects and meanings of person-centred interventions in home care services for older people. This study protocol outlines a study aiming to evaluate such effects and meanings of a person-centred and health-promoting intervention in home aged care services. Methods/design: The study will take the form of a non-randomised controlled trial with a before/after approach. It will include 270 older people >65 years receiving home care services, 270 relatives and 65 staff, as well as a matched control group of equal size. All participants will be recruited from a municipality in northern Sweden. The intervention is based on the theoretical concepts of person-centredness and health-promotion, and builds on the four pedagogical phases of: theory apprehension, experimental learning, operationalization, and clinical supervision. Outcome assessments will focus on: a) health and quality of life (primary outcomes), thriving and satisfaction with care for older people; b) caregiver strain, informal caregiving engagement and relatives' satisfaction with care: c) job satisfaction and stress of conscience among care staff (secondary outcomes). Evaluation will be conducted by means of self-reported questionnaires and qualitative research interviews. Discussion: Person-centred home care services have the potential to improve the recurrently reported sub-standard experiences of home care services, and the results can point the way to establishing a more person-centred and health-promoting model for home care services for older people.

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  • 17.
    Conradsson, Mia
    et al.
    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. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Boström, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lindelöf, Nina
    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, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Is a change in functional capacity or dependency in activities of daily living associated with a change in mental health among older people living in residential care facilities?2013In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 8, p. 1561-1568Article in journal (Refereed)
    Abstract [en]

    Aim: Functional capacity and dependency in activities of daily living (ADL) could be important mediators for an association between physical exercise and mental health. The aim of this study was to investigate whether a change in functional capacity or dependency in ADL is associated with a change in depressive symptoms and psychological well-being among older people living in residential care facilities, and whether dementia can be a moderating factor for this association.

    Methods: A prospective cohort study was undertaken. Participants were 206 older people, dependent in ADL, living in residential care facilities, 115 (56%) of whom had diagnosed dementia. Multivariate linear regression, with comprehensive adjustment for potential confounders, was used to investigate associations between differences over 3 months in Berg Balance Scale (BBS) and Geriatric Depression Scale (GDS-15) scores, and in BBS and Philadelphia Geriatric Center Morale Scale (PGCMS) scores. Associations were also investigated between differences in Barthel ADL Index and GDS-15 scores, and in Barthel ADL Index and PGCMS scores.

    Results: There were no significant associations between changes in scores over 3 months; the unstandardized beta for associations between BBS and GDS-15 was 0.026 (P=0.31), BBS and PGCMS 0.045 (P=0.14), Barthel ADL Index and GDS-15 0.123 (P=0.06), and Barthel ADL Index and PGCMS -0.013 (P=0.86). There were no interaction effects for dementia.

    Conclusion: A change in functional capacity or dependency in ADL does not appear to be associated with a change in depressive symptoms or psychological well-being among older people living in residential care facilities. These results may offer one possible explanation as to why studies of physical exercise to influence these aspects of mental health have not shown effects in this group of older people.

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    Is a change in functional capacity or dependency in activities of daily living associated with a change in mental health among older people living in residential care facilities?
  • 18. Corazzini, Kirsten N.
    et al.
    Anderson, Ruth A.
    Bowers, Barbara J.
    Chu, Charlene H.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, Melbourne, VIC, Australia.
    Fagertun, Anette
    Gordon, Adam L.
    Leung, Angela Y. M.
    McGilton, Katherine S.
    Meyer, Julienne E.
    Siegel, Elena O.
    Thompson, Roy
    Wang, Jing
    Wei, Sijia
    Wu, Bei
    Lepore, Michael J.
    Toward Common Data Elements for International Research in Long-term Care Homes: Advancing Person-Centered Care2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 5, p. 598-603Article in journal (Refereed)
    Abstract [en]

    To support person-centered, residential long-term care internationally, a consortium of researchers in medicine, nursing, behavioral, and social sciences from 21 geographically and economically diverse countries have launched the WE-THRIVE consortium to develop a common data infrastructure. WE-THRIVE aims to identify measurement domains that are internationally relevant, including in low-, middle-, and high-income countries, prioritize concepts to operationalize domains, and specify a set of data elements to measure concepts that can be used across studies for data sharing and comparisons. This article reports findings from consortium meetings at the 2016 meeting of the Gerontological Society of America and the 2017 meeting of the International Association of Gerontology and Geriatrics, to identify domains and prioritize concepts, following best practices to identify common data elements (CDEs) that were developed through the US National Institutes of Health/National Institute of Nursing Research's CDEs initiative. Four domains were identified, including organizational context, workforce and staffing, person-centered care, and care outcomes. Using a nominal group process, WE-THRIVE prioritized 21 concepts across the 4 domains. Several concepts showed similarity to existing measurement structures, whereas others differed. Conceptual similarity (convergence; eg, concepts in the care outcomes domain of functional level and harm-free care) provides further support of the critical foundational work in LTC measurement endorsed and implemented by regulatory bodies. Different concepts (divergence; eg, concepts in the person-centered care domain of knowing the person and what matters most to the person) highlights current gaps in measurement efforts and is consistent with WE-THRIVE's focus on supporting resilience and thriving for residents, family, and staff. In alignment with the World Health Organization's call for comparative measurement work for health systems change, WE-THRIVE's work to date highlights the benefits of engaging with diverse LTC researchers, including those in low-, middle-, and high-income countries, to develop a measurement infrastructure that integrates the aspirations of person-centered LTC.

  • 19. Crea, Simona
    et al.
    Edin, Benoni B.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Knaepen, Kristel
    Meeusen, Romain
    Vitiello, Nicola
    Time-Discrete Vibrotactile Feedback Contributes to Improved Gait Symmetry in Patients With Lower Limb Amputations: Case Series2017In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 97, no 2, p. 198-207Article in journal (Refereed)
    Abstract [en]

    Background. Reduced sensory feedback from lower leg prostheses results in harmful gait patterns and entails a significant cognitive burden because users have to visually monitor their locomotion. Objectives. The purpose of this study was to validate a sensory feedback device designed to help elderly patients with transfemoral amputation to improve their temporal gait symmetry after a training program aimed at associating the vibrotactile patterns with symmetrical walking. Design. This was a prospective quasi-experimental study including 3 elderly patients walking with lower leg prostheses. Methods. During training sessions, participants walked on a treadmill equipped with feedback device that controlled vibrotactile stimulators based on signals from a sensorized insole while provided with visual feedback about temporal gait symmetry. The vibrotactile stimulators delivered short-lasting, low-intensity vibrations synchronously with certain gait phase transitions. During pretraining and posttraining sessions, participants walked without visual feedback about gait symmetry under 4 conditions: with or without vibrotactile feedback while performing or not performing a secondary cognitive task. The primary outcome measure was temporal gait symmetry. Results. with <= 52 hours of training,the participants improved their temporal gait symmetry from 0.82 to 0.84 during the pretraining evaluation session to 0.98 to 1.02 during the follow-up session across all conditions. Following training, participants were able to maintain good temporal gait synmsetry, without any evidence of an increased cognitive burden. Limitations. The small sample size and short follow-up time do not allow straightforward extrapolations to larger populations or extended time periods. Conclusions. Low-cost, gait phase-specific vibrotactile feedback after training combined with visual feedback may improve the temporal gait synmsetry in patients with transfemoral amputation without representing an additional cognitive burden.

  • 20. de Frias, Cindy M
    et al.
    Bunce, David
    Wahlin, Åke
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sleegers, Kristel
    Cruts, Marc
    Van Broeckhoven, Christine
    Nilsson, Lars-Göran
    Cholesterol and triglycerides moderate the effect of apolipoprotein E on memory functioning in older adults2007In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 62, no 2, p. P112-P118Article in journal (Refereed)
    Abstract [en]

    We used data from the Betula Study to examine associations between total cholesterol, triglycerides, and apolipoprotein E on 10-year changes in cognitive performance. Tests assessing episodic memory (recall and recognition), semantic memory (knowledge and fluency), and visuospatial ability (block design) were administered to 524 nondemented adults (initial age of 55-80 years); multilevel modeling was applied to the data. Higher triglyceride levels were associated with a decline in verbal knowledge. Lipid levels moderated the influence of apolipoprotein E on episodic memory, such that among epsilon 4 allele carriers, decline in recognition was noted for individuals with higher cholesterol levels. Cholesterol and triglyceride levels are pharmacologically modifiable risk factors that account for variation In normal cognitive aging.

  • 21.
    Demnitz, Naiara
    et al.
    Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.
    Gates, Anne T.
    Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Mortensen, Erik L.
    Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Garde, Ellen
    Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Wimmelmann, Cathrine L.
    Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Siebner, Hartwig R.
    Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health sciences, Copenhagen University, Copenhagen, Denmark.
    Kjaer, Michael
    Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health sciences, Copenhagen University, Copenhagen, Denmark.
    Is it all in the baseline? Trajectories of chair stand performance over 4 years and their association with grey matter structure in older adults2023In: Human Brain Mapping, ISSN 1065-9471, E-ISSN 1097-0193, Vol. 44, no 11, p. 4299-4309Article in journal (Refereed)
    Abstract [en]

    Understanding individual variability in response to physical activity is key to developing more effective and personalised interventions for healthy ageing. Here, we aimed to unpack individual differences by using longitudinal data from a randomised-controlled trial of a 12-month muscle strengthening intervention in older adults. Physical function of the lower extremities was collected from 247 participants (66.3 ± 2.5 years) at four time-points. At baseline and at year 4, participants underwent 3 T MRI brain scans. K-means longitudinal clustering was used to identify patterns of change in chair stand performance over 4 years, and voxel-based morphometry was applied to map structural grey matter volume at baseline and year 4. Results identified three groups showing trajectories of poor (33.6%), mid (40.1%), and high (26.3%) performance. Baseline physical function, sex, and depressive symptoms significantly differed between trajectory groups. High performers showed greater grey matter volume in the motor cerebellum compared to the poor performers. After accounting for baseline chair stand performance, participants were re-assigned to one of four trajectory-based groups: moderate improvers (38.9%), maintainers (38.5%), improvers (13%), and decliners (9.7%). Clusters of significant grey matter differences were observed between improvers and decliners in the right supplementary motor area. Trajectory-based group assignments were unrelated to the intervention arms of the study. In conclusion, patterns of change in chair stand performance were associated with greater grey matter volumes in cerebellar and cortical motor regions. Our findings emphasise that how you start matters, as baseline chair stand performance was associated with cerebellar volume 4 years later.

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  • 22.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, Melbourne, Victoria, Australia.
    Everyday activities in nursing homes: associations with person-centredness and quality of life2016In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 56, p. 195-195Article in journal (Other academic)
  • 23.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, Victoria, Australia.
    Baxter, Rebecca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Corneliusson, Laura
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anderson, Ruth A.
    Beeber, Anna
    Boas, Paulo Villas
    Corazzini, Kirsten
    Gordon, Adam L.
    Hanratty, Barbara
    Jacinto, Alessandro
    Lepore, Michael
    Leung, Angela Y. M.
    McGilton, Katherine S.
    Meyer, Julienne
    Schols, Jos M. G. A.
    Schwartz, Lindsay
    Shepherd, Victoria
    Skoldunger, Anders
    Thompson, Roy
    Toles, Mark
    Wachholz, Patrick
    Wang, Jing
    Wu, Bei
    Zuniga, Franziska
    Advancing Long-Term Care Science Through Using Common Data Elements: Candidate Measures for Care Outcomes of Personhood, Well-Being, and Quality of Life2019In: Gerontology and geriatric medicine, E-ISSN 2333-7214, Vol. 5Article in journal (Refereed)
    Abstract [en]

    To support the development of internationally comparable common data elements (CDEs) that can be used to measure essential aspects of long-term care (LTC) across low-, middle-, and high-income countries, a group of researchers in medicine, nursing, behavioral, and social sciences from 21 different countries have joined forces and launched the Worldwide Elements to Harmonize Research in LTC Living Environments (WE-THRIVE) initiative. This initiative aims to develop a common data infrastructure for international use across the domains of organizational context, workforce and staffing, person-centered care, and care outcomes, as these are critical to LTC quality, experiences, and outcomes. This article reports measurement recommendations for the care outcomes domain, focusing on previously prioritized care outcomes concepts of well-being, quality of life (QoL), and personhood for residents in LTC. Through literature review and expert ranking, we recommend nine measures of well-being, QoL, and personhood, as a basis for developing CDEs for long-term care outcomes across countries. Data in LTC have often included deficit-oriented measures; while important, reductions do not necessarily mean that residents are concurrently experiencing well-being. Enhancing measurement efforts with the inclusion of these positive LTC outcomes across countries would facilitate international LTC research and align with global shifts toward healthy aging and person-centered LTC models.

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  • 24.
    Eklund, Heidi-Tuulia
    et al.
    University of Jyväskylä, Finland.
    Eklund, Patrik
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    A comparative framework for assessment in education and health2023In: Global perspectives on health assessments for an aging population / [ed] Luis Vieira Ribeiro; Anabela Magalhães Ribeiro, IGI Global, 2023, p. 1-12Chapter in book (Refereed)
    Abstract [en]

    In this chapter the authors compare assessment techniques in education and health. These examples are drawn from assessment for learning in secondary school as compared with assessment of functioning in care of older people. Content in these respective assessment environments is obviously quite different, but there is some overlap, in particular related to social circumstances. The authors further argue that the assessment structure and formal analysis techniques are and even should be quite similar. These two domains of assessments share not only a common information and terminological structure, but also a common assessment framework (CAF) which is shown to be extendable by process detail. In this focus on assessment in health, particularly in active and healthy ageing, the model is intended to support the integration of information and processes (decision and intervention pathways) supporting various types of providers.

  • 25.
    Eklund, Patrik
    Umeå University.
    Information and process in health2021In: Integrated care and fall prevention in active and healthy aging / [ed] Patrik Eklund, Hershey, PA: IGI Global, 2021, p. 263-279Chapter in book (Refereed)
    Abstract [en]

    Cooperation and partnership in healthy ageing enhances and enriches the underlying information and process models within integrated care. On information, functioning oriented data as part of health and social data describes medical conditions and functioning capacity of the older person. Similarly, the notion of a good practice, as embracing a conglomerate of guidelines, is also well understood but less so in terms of process substance. Process structure granularity is often quite coarse and less formal, comparable to process descriptions annotated with clinical guidelines. This chapter describes an algebraic framework for representation of functioning data typically found in contexts of integrated care processes in healthy ageing.

  • 26.
    Eriksson, Irene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Fagerström, Lisbeth
    Högskolan i Buskerud, Norge.
    Older women's experiences of suffering from urinary tract infections2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 9-10, p. 1385-1394Article in journal (Other academic)
    Abstract [en]

    Aims and objectives: To describe and explore older women's experiences of having had repeated urinary tract infections (UTIs).

    Background: UTIs are one of the most common bacterial infections among older women. Approximately one-third of very old women suffer from at least one UTI each year. Despite the high incidence of UTI, little is known about the impact of UTI on health and daily life in older women.

    Design: A qualitative descriptive design.

    Methods: A qualitative study using semi-structured interviews was conducted with 20 Swedish women aged 67–96 years who suffered from repeated UTIs the preceding year. The data were analysed using qualitative content analysis.

    Results: Two main themes were identified: being in a state of manageable suffering and depending on alleviation. Being in a state of manageable suffering was described in terms of experiencing physical and psychological health problems, struggling to deal with the illness and being restricted in daily life. Depending on alleviation was illustrated in terms of having access to relief but also receiving inadequate care.

    Conclusions: This study demonstrated that UTIs are a serious health problem among older women that not only affects both physical and mental health but also has serious social consequences. The women in this study described the physical and psychological health problems, struggling to deal with the illness, being restricted in daily life, depending on access to relief and receiving inadequate care.

    Relevance to clinical practice: It is important to improve the knowledge about how UTI affects the health of older women. This knowledge may help nurses develop strategies to support these women. One important part in the supportive strategies is that nurses can educate these women in self-care.

  • 27.
    Esquivel, Karla Muñoz
    et al.
    Department of Computer Science, Atlantic Technological University, Letterkenny, Ireland.
    Gillespie, James
    Faculty of Computing, Engineering, and the Built Environment, Ulster University, Derry, United Kingdom.
    Kelly, Daniel
    Faculty of Computing, Engineering, and the Built Environment, Ulster University, Derry, United Kingdom.
    Condell, Joan
    Faculty of Computing, Engineering, and the Built Environment, Ulster University, Derry, United Kingdom.
    Davies, Richard
    Faculty of Computing, Engineering, and the Built Environment, Ulster University, Derry, United Kingdom.
    McHugh, Catherine
    Faculty of Computing, Engineering, and the Built Environment, Ulster University, Derry, United Kingdom.
    Duffy, William
    Faculty of Computing, Engineering, and the Built Environment, Ulster University, Derry, United Kingdom.
    Nevala, Elina
    Department of Physiotherapy, Karelia University of Applied Sciences, Karelia, Finland.
    Alamäki, Antti
    Department of Physiotherapy, Karelia University of Applied Sciences, Karelia, Finland.
    Jalovaara, Juha
    Department of Physiotherapy, Karelia University of Applied Sciences, Karelia, Finland.
    Tedesco, Salvatore
    Wireless Sensors Network Group, Tyndall National Institute, University College Cork, Cork, Ireland.
    Barton, John
    Wireless Sensors Network Group, Tyndall National Institute, University College Cork, Cork, Ireland.
    Timmons, Suzanne
    Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Factors influencing continued wearable device use in older adult populations: quantitative study2023In: JMIR Aging, E-ISSN 2561-7605, Vol. 6, article id e36807Article in journal (Refereed)
    Abstract [en]

    Background: The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services.

    Objective: This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device.

    Methods: Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants’ intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device.

    Results: The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants’ age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (τ=0.34) and whether the device was fit for purpose (τ=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%.

    Conclusions: This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies.

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  • 28.
    Farooqi, Nighat
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine. Umea Univ Hosp, Dept Resp Med & Allergy, SE-90185 Umea, Sweden.
    Slinde, F.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sandström, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Assessment of energy intake in women with chronic obstructive pulmonary disease: A doubly labeled water method study2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 5, p. 518-524Article in journal (Refereed)
    Abstract [en]

    To maintain energy balance, reliable methods for assessing energy intake and expenditure should be used in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to validate the diet history and 7-day food diary methods of assessing energy intake (EI) using total energy expenditure (TEE) with the doubly labeled water (DLW) method (TEEDLW) as the criterion method in outpatient women with COPD. EI was assessed by diet history (EIDH) and a 7-day food diary (EIFD) in 19 women with COPD, using TEEDLW as the criterion method. The three methods were compared using intra-class correlation coefficients (ICC) and Bland-Altman analyses. The participants were classified according to their reporting status (EI/TEE) as valid-reporters 0.79-1.21, under-reporters < 0.79 or over-reporters > 1.21. Diet history underestimated reported EI by 28%, and 7-day food diary underestimated EI by approximately 20% compared with TEEDLW. The ICC analysis showed weak agreement between TEEDLW and EIDH (ICC=-0.01; 95%CI-0.10 to 0.17) and between TEEDLW and EIFD (ICC=0.11; 95%CI -0.16 to 0.44). The Bland-Altman plots revealed a slight systematic bias for both methods. For diet history, six women (32%) were identified as valid-reporters, and for the 7-day food diary, twelve women (63%) were identified as valid-reporters. The accuracy of reported EI was only related to BMI. The diet history and 7-day food diary methods underestimated energy intake in women with COPD compared with the DLW method. Individuals with higher BMIs are prone to underreporting. Seven-day food diaries should be used with caution in assessing EI in women with COPD.

  • 29.
    Fischer, Regina Santamäki
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Embracing opposites: meanings of growing old as narrated by people aged 852008In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 67, no 3, p. 259-271Article in journal (Refereed)
    Abstract [en]

    Many old people suffer from prolonged and multiple bodily ailments, new diseases, and increased risk for disadvantages and losses in life. Aging also means becoming mature and wise. This study illuminates the meaning of the lived experience with respect to changes in late life. Using a phenomenological hermeneutic method, this study analyzes transcribed interviews of 15 85-year-old people. Four themes were formulated: embracing weakness and strength, embracing slowness and swiftness of time, embracing reconciliation and regret, and embracing connectedness and loneliness. From these analyses, growing old was described as—maintaining one's identity in spite of the changes that come with aging and, embracing opposites—being changed and feeling being the same.

  • 30. Fjell, Anders M.
    et al.
    Sørensen, Øystein
    Amlien, Inge K.
    Bartrés-Faz, David
    Bros, Didac Maciá
    Buchmann, Nikolaus
    Demuth, Ilja
    Drevon, Christian A
    Düzel, Sandra
    Ebmeier, Klaus P
    Idland, Ane-Victoria
    Kietzmann, Tim C
    Kievit, Rogier
    Kühn, Simone
    Lindenberger, Ulman
    Mowinckel, Athanasia M
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Price, Darren
    Sexton, Claire E
    Solé-Padullés, Cristina
    Pudas, Sara
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Sederevicius, Donatas
    Suri, Sana
    Wagner, Gerd
    Watne, Leiv Otto
    Westerhausen, René
    Zsoldos, Enikő
    Walhovd, Kristine B
    Self-reported sleep relates to hippocampal atrophy across the adult lifespan: results from the Lifebrain consortium2020In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 43, no 5, article id zsz280Article in journal (Refereed)
    Abstract [en]

    Objectives: Poor sleep is associated with multiple age-related neurodegenerative and neuropsychiatric conditions. The hippocampus plays a special role in sleep and sleep-dependent cognition, and accelerated hippocampal atrophy is typically seen with higher age. Hence, it is critical to establish how the relationship between sleep and hippocampal volume loss unfolds across the adult lifespan.

    Methods: Self-reported sleep measures and MRI-derived hippocampal volumes were obtained from 3105 cognitively normal participants (18–90 years) from major European brain studies in the Lifebrain consortium. Hippocampal volume change was estimated from 5116 MRIs from 1299 participants for whom longitudinal MRIs were available, followed up to 11 years with a mean interval of 3.3 years. Cross-sectional analyses were repeated in a sample of 21,390 participants from the UK Biobank.

    Results: No cross-sectional sleep—hippocampal volume relationships were found. However, worse sleep quality, efficiency, problems, and daytime tiredness were related to greater hippocampal volume loss over time, with high scorers showing 0.22% greater annual loss than low scorers. The relationship between sleep and hippocampal atrophy did not vary across age. Simulations showed that the observed longitudinal effects were too small to be detected as age-interactions in the cross-sectional analyses.

    Conclusions: Worse self-reported sleep is associated with higher rates of hippocampal volume decline across the adult lifespan. This suggests that sleep is relevant to understand individual differences in hippocampal atrophy, but limited effect sizes call for cautious interpretation.

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  • 31. Gardner, Michael
    et al.
    Bann, David
    Wiley, Laura
    Cooper, Rachel
    Hardy, Rebecca
    Nitsch, Dorothea
    Martin-Ruiz, Carmen
    Shiels, Paul
    Sayer, Avan Aihie
    Barbieri, Michelangela
    Bekaert, Sofie
    Bischoff, Claus
    Brooks-Wilson, Angela
    Chen, Wei
    Cooper, Cyrus
    Christensen, Kaare
    De Meyer, Tim
    Deary, Ian
    Der, Geoff
    Roux, Ana Diez
    Fitzpatrick, Annette
    Hajat, Anjum
    Halaschek-Wiener, Julius
    Harris, Sarah
    Hunt, Steven C.
    Jagger, Carol
    Jeon, Hyo-Sung
    Kaplan, Robert
    Kimura, Masayuki
    Lansdorp, Peter
    Li, Changyong
    Maeda, Toyoki
    Mangino, Massimo
    Nawrot, Tim S.
    Nilsson, Peter
    Nordfjäll, Katarina
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Paolisso, Giuseppe
    Ren, Fu
    Riabowol, Karl
    Robertson, Tony
    Roos, Goran
    Staessen, Jan A.
    Spector, Tim
    Tang, Nelson
    Unryn, Brad
    van der Harst, Pim
    Woo, Jean
    Xing, Chao
    Yadegarfar, Mohammad E.
    Park, Jae Yong
    Young, Neal
    Kuh, Diana
    von Zglinicki, Thomas
    Ben-Shlomo, Yoav
    Gender and telomere length: Systematic review and meta-analysis2014In: Experimental Gerontology, ISSN 0531-5565, E-ISSN 1873-6815, Vol. 51, p. 15-27Article, review/survey (Refereed)
    Abstract [en]

    Background: It is widely believed that females have longer telomeres than males, although results from studies have been contradictory. Methods: We carried out a systematic review and meta-analyses to test the hypothesis that in humans, females have longer telomeres than males and that this association becomes stronger with increasing age. Searches were conducted in EMBASE and MEDLINE (by November 2009) and additional datasets were obtained from study investigators. Eligible observational studies measured telomeres for both females and males of any age, had a minimum sample size of 100 and included participants not part of a diseased group. We calculated summary estimates using random-effects meta-analyses. Heterogeneity between studies was investigated using sub-group analysis and meta-regression. Results: Meta-analyses from 36 cohorts (36,230 participants) showed that on average females had longer telomeres than males (standardised difference in telomere length between females and males 0.090, 95% CI 0.015, 0.166; age-adjusted). There was little evidence that these associations varied by age group (p = 1.00) or cell type (p = 0.29). However, the size of this difference did vary by measurement methods, with only Southern blot but neither real-time PCR nor Flow-FISH showing a significant difference. This difference was not associated with random measurement error. Conclusions: Telomere length is longer in females thanmales, although this difference was not universally found in studies that did not use Southern blot methods. Further research on explanations for the methodological differences is required. (C) 2013 Published by Elsevier Inc.

  • 32. Geldsetzer, Pascal
    et al.
    Vaikath, Maria
    Wagner, Ryan
    Rohr, Julia K.
    Montana, Livia
    Gomez-Olive, Francesc X.
    Rosenberg, Molly S.
    Manne-Goehler, Jennifer
    Mateen, Farrah J.
    Payne, Collin F.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Salomon, Joshua A.
    Gaziano, Thomas A.
    Baernighausen, Till
    Berkman, Lisa F.
    Depressive Symptoms and Their Relation to Age and Chronic Diseases Among Middle-Aged and Older Adults in Rural South Africa2019In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 74, no 6, p. 957-963Article in journal (Refereed)
    Abstract [en]

    Background: Understanding how depression is associated with chronic conditions and sociodemographic characteristics can inform the design and effective targeting of depression screening and care interventions. In this study, we present some of the first evidence from sub-Saharan Africa on the association between depressive symptoms and a range of chronic conditions (diabetes, HIV, hypertension, and obesity) as well as sociodemographic characteristics. Methods: A questionnaire was administered to a population-based simple random sample of 5,059 adults aged 40 years and older in Agincourt, South Africa. Depressive symptoms were measured using a modified version of the eight-item Center for Epidemiological Studies-Depression screening tool. Diabetes was assessed using a capillary blood glucose measurement and HIV using a dried blood spot. Results: 17.0% (95% confidence interval: 15.9%-18.1%) of participants had at least three depressive symptoms. None of the chronic conditions were significantly associated with depressive symptoms in multivariable regressions. Older age was the strongest correlate of depressive symptoms with those aged 80 years and older having on average 0.63 (95% confidence interval: 0.40-0.86; p<.001) more depressive symptoms than those aged 40-49 years. Household wealth quintile and education were not significant correlates. Conclusions: This study provides some evidence that the positive associations of depression with diabetes, HIV, hypertension, and obesity that are commonly reported in high-income settings might not exist in rural South Africa. Our finding that increasing age is strongly associated with depressive symptoms suggests that there is a particularly high need for depression screening and treatment among the elderly adults in rural South Africa.

  • 33.
    Genbäck, Minna
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stanghellini, Elena
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Predictors of decline in self-reported health: addressing non-ignorable dropout in longitudinal studies of ageing2018In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 15, no 2, p. 211-220Article in journal (Refereed)
    Abstract [en]

    Predictors of decline in health in older populations have been investigated in multiple studies before. Most longitudinal studies of aging, however, assume that dropout at follow-up is ignorable (missing at random) given a set of observed characteristics at baseline. The objective of this study was to address non-ignorable dropout in investigating predictors of declining self-reported health (SRH) in older populations (50 years or older) in Sweden, the Netherlands, and Italy. We used the SHARE panel survey, and since only 2895 out of the original 5657 participants in the survey 2004 were followed up in 2013, we studied whether the results were sensitive to the expectation that those dropping out have a higher proportion of decliners in SRH. We found that older age and a greater number of chronic diseases were positively associated with a decline in self-reported health in the three countries studies here. Maximum grip strength was associated with decline in self-reported health in Sweden and Italy, and self-reported limitations in normal activities due to health problems were associated with decline in self-reported health in Sweden. These results were not sensitive to non-ignorable dropout. On the other hand, although obesity was associated with decline in a complete case analysis, this result was not confirmed when performing a sensitivity analysis to non-ignorable dropout. The findings, thereby, contribute to the literature in understanding the robustness of longitudinal study results to non-ignorable dropout while considering three different population samples in Europe.

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  • 34.
    Gustafsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Constipation and laxative use among people living in nursing homes in 2007 and 20132019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 38Article in journal (Refereed)
    Abstract [en]

    Background: Constipation is a common condition among older people, particularly among people living in nursing homes, and the use of drugs such as opioids is one of many factors that contribute to its high prevalence. The aim of this study was to compare the prevalence of constipation and the use of laxatives between 2007 and 2013, to analyze constipation and laxative use among people who are prescribed opioids, and to identify factors associated with constipation. Methods: In 2007 and 2013, two surveys were performed in the county of Vasterbotten in Northern Sweden, comprising all those living in nursing homes. The Multi-Dimensional Dementia Assessment Scale was used to collect data regarding laxative, opioid and anticholinergic drug use, functioning in activities of daily living (ADL), cognition and symptoms of constipation. A comparison was made between 2820 people from 2007 and 1902 people from 2013. Results: The prevalence of symptoms of constipation among people living in nursing homes increased from 36% in 2007 to 40% in 2013. After controlling for age, sex, ADL, cognitive impairment and use of opioid and anticholinergic drugs, this difference was found to be statistically significant. When controlled for demographic changes, there was a statistically significant difference in the regular use of laxatives between the respective years, from 46% in 2007 to 59% in 2013. People prescribed opioids and anticholinergic drugs were at increased risk of constipation, while people with a higher ADL score were at decreased risk. Further, among people prescribed opioids and rated as constipated, 35% in 2007 and 20% in 2013 were not prescribed laxatives for regular use, a difference that was found to be statistically significant. Conclusions: The prevalence of symptoms of constipation increased between 2007 and 2013. Although there was a decrease between the years, there were still a number of people being prescribed with opioids and rated as constipated who were not treated with laxatives. This study therefore indicates that constipation remains a significant problem among people in nursing homes and also indicates that those prescribed opioids could benefit from an increased awareness of the risk of constipation and treatment, if required.

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  • 35. Gylling, Anne Theil
    et al.
    Eriksen, Christian Skou
    Garde, Ellen
    Wimmelmann, Cathrine Lawaetz
    Reislev, Nina Linde
    Bieler, Theresa
    Ziegler, Andreas Kraag
    Andersen, Kasper Winther
    Bauer, Christian
    Dideriksen, Kasper
    Baekgaard, Maria
    Mertz, Kenneth Hudlebusch
    Bayer, Monika Lucia
    Bloch-Ibenfeldt, Mads
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, NV, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hvidovre Hospital, Hvidovre, Denmark.
    Siebner, Hartwig Roman
    Mortensen, Erik Lykke
    Kjaer, Michael
    The influence of prolonged strength training upon muscle and fat in healthy and chronically diseased older adults2020In: Experimental Gerontology, ISSN 0531-5565, E-ISSN 1873-6815, Vol. 136, article id 110939Article in journal (Refereed)
    Abstract [en]

    Background: Physical muscle function and brain hippocampus size declines with age, accelerating after the age of 60. Strength training over a few months improves physical function, but less is known about how long-term strength training affects physical function and hippocampus volume. Therefore, we aimed to investigate the effect of 1-year strength training of two different intensities upon muscle mass, function, and hippocampus volume in retirement-age individuals.

    Methods: In this multidisciplinary randomized controlled trial (clinicaltrials.gov: NCT02123641), participants were allocated to either a) supervised, heavy resistance training (HRT, n = 149, 3/wk), b) moderate intensity resistance training (MIT, n = 154, 3/wk) or c) non-exercise activities (CON, n = 148). 451 participants were randomized (62-70 yrs., women 61%, approximate to 80% with a chronic medical disease) and 419 were included in the intention-to-treat analysis (n = 143, 144 and 132; HRT, MIT and CON). Changes in muscle power (primary outcome), strength and size, physical function, body composition, hippocampus volume and physical/mental well-being were analyzed.

    Findings: Of the participants (HRT + MIT), 83% completed training at least 2/week. Leg extensor power was unchanged in all groups, but strength training had a positive effect on isometric knee extensor strength in both groups, whereas an increased muscle mass, cross-sectional area of vastus lateralis muscle, a decreased whole-body fat percentage, visceral fat content and an improved mental health (SF-36) occurred in HRT only. Further, chair-stand performance improved in all groups, whereas hippocampus volume decreased in all groups over time with no influence of strength training.

    Interpretation: Together, the results indicate that leg extensor power did not respond to long-term supervised strength training, but this type of training in a mixed group of healthy and chronically diseased elderly individuals can be implemented with good compliance and induces consistent changes in physiological parameters of muscle strength, muscle mass and abdominal fat.

  • 36. Harling, Guy
    et al.
    Payne, Collin F.
    Davies, Justine I.
    Gomez-Olive, F. Xavier
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Manderson, Lenore
    Mateen, Farrah J.
    Tollman, Stephen M.
    Umeå University. University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Witham, Miles D.
    Impairment in Activities of Daily Living, Care Receipt, and Unmet Needs in a Middle-Aged and Older Rural South African Population: Findings From the HAALSI Study2020In: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 32, no 5-6, p. 296-307Article in journal (Refereed)
    Abstract [en]

    Objectives: The objective of this study is to analyze the degree to which care needs are met in an aging rural African population. Method: Using data from the Health and Aging in Africa: Longitudinal Study of an INDEPTH Community (HAALSI) baseline survey, which interviewed 5,059 adults aged older than 40 years in rural South Africa, we assessed the levels of limitations in activities of daily living (ADLs) and in unmet care for these ADLs, and evaluated their association with sociodemographic and health characteristics. Results: ADL impairment was reported by 12.2% of respondents, with the proportion increasing with age. Among those with ADL impairment, 23.9% reported an unmet need and 51.4% more a partially met need. Relatives provided help most often; formal care provision was rare. Unmet needs were more frequent among younger people and women, and were associated with physical and cognitive deficits, but not income or household size. Discussion: Unmet care needs in rural South Africa are often found among individuals less expected to require care.

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  • 37.
    Hornsten, Carl
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Molander, Lena
    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 the association between stroke and depression among a very old population2012In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 55, no 3, p. 555-559Article in journal (Refereed)
    Abstract [en]

    There are few studies comparing those who have had and have not had a stroke among those aged 80 years and over, the very old. The aim of this paper was to investigate the prevalence of stroke and the association between stroke and depression in a very old population. This paper is based on cross-sectional data from a population-based study performed between 2005 and 2007. Half of those aged 85 years, all 90-, and 95-year-olds and older in eight urban and rural municipalities in northern Sweden and Finland were invited to participate. A sample of 601 individuals who participated fully in the study was selected. Data were collected through assessments, structured interviews and investigation of medical charts. A specialist in geriatric medicine determined disease status for depression based on medical records and results from the Geriatric Depression Scale (GDS)-15, the Montgomery A Asberg Depression Rating Scale (MADRS) and the Organic Brain Syndrome (OBS) scale, and for stroke based on medical records and reported disease. The prevalence of stroke was 21.5%. The prevalence of depression was 50.4% among those with stroke compared to 34.3% among those without stroke (OR 1.944, p < 0.001). In a logistic regression model adjusted for several demographic variables, diseases and functional level, stroke was independently associated with depression (OR 1.644, p = 0.038). A large proportion of those with depression, both with and without stroke, were not receiving antidepressant medication. In conclusion, the stroke prevalence was high and stroke showed a strong association with depression among very old people. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

  • 38.
    Hörnsten, Carl
    et al.
    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. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Boström, Gustaf
    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, Section of Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    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.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Measurement error of the Mini-Mental State Examination among individuals with dementia that reside in nursing homes2021In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 18, no 1, p. 109-115Article in journal (Refereed)
    Abstract [en]

    Few studies have investigated the measurement error of the Mini-Mental State Examination (MMSE) in the same unit of measurement, also known as absolute reliability. This measurement can help determine whether an observed score change for an individual is likely to represent true change. The aim of this study was to investigate the absolute reliability of the MMSE among individuals with dementia that reside in nursing homes. Among 88 participants, 19 (21.6%) were men, 35 (39.8%) had Alzheimer's disease, 35 (39.8%) had vascular dementia, and the mean age was 84.0 years (range 65-98). The participants were tested and retested with the MMSE within 1-6 days. Both tests were administered by the same assessor at the same time of day. The mean MMSE score was 13.7 (range 0-28). The absolute difference between MMSE scores varied from 0 to 6 points, and the differences did not correlate with the corresponding score means (p = 0.874). The smallest detectable change (SDC) between two measurements was 4.00. The SDC was independent of depression, impaired vision and hearing, delirium within the last week, dementia type and age. However, the SDC was 5.56 among men and 3.50 among women (p = 0.003). In conclusion, for individuals with dementia that reside in nursing homes, it seems like their MMSE score needs to change by four or more points between two measurements in order for their score change to be reliably higher than the measurement error.

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  • 39.
    Jemberie, Wossenseged Birhane
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Alcohol and aging: a multimethod study on heterogeneity and multidimensionality2023Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and Objectives: With an ageing population, the number of older persons with substance use problems, particularly problematic alcohol use, is increasing. Despite grow­ing recognition of the negative consequences of problematic alcohol use on older persons, there is a dearth of knowledge about the alcohol use profiles and the dimensionality of alcohol problems in older people. Moreover, little is known about older persons’ experi­ences and perspectives on alcohol use in relation to their ageing and their personal goals regarding treatment and recovery. This thesis aimed to (i) describe the characteristics of older persons who accessed municipal substance use treatment and care services (addic­tion services) and to investigate their future hospitalization; (ii) examine the heterogeneity and multidimensionality of problematic alcohol use among older persons; and (iii) to shed light on the experiences and perspectives of older persons regarding ageing, alcohol prob­lems and recovery.

    Methods: For studies I-III, municipal Addiction Severity Index (ASI) assessment data (between 2003 and 2017) from adults aged 50 years and older were used to select the study samples. Generalized linear regression models investigated hospitalization related out­comes among 3624 older persons in Study-I. In Study-II, a latent class analysis was applied on ASI data from 1747 individuals with alcohol problems. Study-III linked the ASI data from Study-II to hospital discharge and mortality data forming time-to-repeated-event dataset; Andersen-Gill regression model with a robust variance estimator was used for the analysis. Study-IV applied qualitative content analysis on interview data from ten older persons re­cruited from a specialist outpatient clinic for alcohol treatment. 

    Results: Nearly three-fourth of older persons assessed for substance use severity at municipal addiction services were later hospitalized (Study-I). Individuals diagnosed with substance use disorders, psychiatric or dual diagnoses had more cumulative hospitalized days, higher rates of hospital readmissions, and shorter time to first admission following an initial ASI assessment at municipal addiction services (Study-I). Five distinct groups of older persons with comparable alcohol problem severity but with variation in onset age, psychiatric comorbidities, polysubstance use, social support and gender composition were identified (Study-II). The five groups varied in risks of repeated hospitalizations due to substance use and psychiatric disorders (Study-III). Older persons experienced their ageing and alcohol use having a dynamic interplay (Study-IV). They needed to constantly negotiate with their environment to maintain a positive ageing trajectory. They perceived moderate alcohol use fosters healthy ageing, but over time, experienced their alcohol use as unsustainable and a threat to their pursuit of healthy ageing. Stigma and ambivalence delayed treatment seeking (Study-IV). They accessed treatment programs which re­spected their preferences and autonomy, engaged them in goal setting and strengthened their agency. After reducing their alcohol use, positive changes in their biopsychosocial functioning encouraged them to continue their recovery journey even in the presence of setbacks (Study-IV).

    Conclusion: Most older persons who access municipal addiction services are hospitalized repeatedly. Many older persons with alcohol problems live with medical and psychiatric comorbidities suggesting multiple care needs from health and social care services. Incor­porating older persons’ desire for healthy ageing into alcohol treatment plan can facilitate treatment engagement and recovery. Many older persons aim to moderate their alcohol consumption. Clinicians can deliver person-centered care for older persons, by consider­ing their heterogeneity in treatment goals, biopsychosocial functioning, and available re­sources. A multidimensional identification of alcohol use profiles could improve treatment by establishing the variation in alcohol problems among older treatment seekers. Older persons stay engaged in alcohol treatment programs which value their experiences and expertise, incorporate their personal treatment and life goals, respect their autonomy and agency, and involve them as active participants. Sensitizing service providers on old age substance use problems could provide multiple points of contact for screening of older persons and earlier referral to treatment. A streamlined data sharing within and between health and social care services fosters timely and equitable care and facilitates an inte­grated and person-centered care across the continuum. 

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  • 40.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Studying the trajectories and mediators of old-age problematic alcohol use and the agency of older persons2023Data set
    Abstract [en]

    Unit of analysis: Individual

    Population: Older people aged between 61 and 73 years who have sought treatment for alcohol at a specialist outpatient clinic in a metropolitan city in Sweden.

    Time Method: Cross-section

    Sampling procedure: Non-probability: Purposive

    The study participants were purposefully recruited from a specialist outpatient alcohol treatment clinic located in a Swedish metropolitan city. To be eligible for the study, participants had to be 55 years or older, had to self-report a history of problematic alcohol use and treatment for alcohol use after the age of 50. Individuals who were unable or unwilling to provide informed consent or participate in the interview via Zoom, Skype, or telephone were excluded from the study.

    Time period(s) investigated: 2021-12 – 2022-04

    Number of individuals/objects: 10

    Data format / data structure: Text

  • 41.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School for Competitive Science On Aging and Health (SWEAH), Faculty of Medicine, Lund University, Lund, Sweden.
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hammarberg, Anders
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    "Ageing with an alcohol problem is not what I envision": reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems2023In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, article id 866Article in journal (Refereed)
    Abstract [en]

    Background: Eliciting and understanding older persons’ descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.

    Methods: Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.

    Results: Three themes were identified: “Tipping the balance”, “Staying behind a veil” and “Lifting the vail”. First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.

    Conclusions: Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons’ desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.

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  • 42.
    Kylén, Maya
    et al.
    Lund University, Lund, Skåne Län, Sweden.
    Slaug, Björn
    Lund University, Lund, Skåne Län, Sweden.
    Iwarsson, Susanne
    Lund University, Lund, Skåne Län, Sweden.
    Dahlgren, David
    Lund University, Lund, Skåne Län, Sweden.
    Bjork, Jonas
    Lund University, Lund, Skåne Län, Sweden.
    Zingmark, Magnus
    Lund University, Lund, Skåne Län, Sweden.
    Housing attribute preferences when considering relocation in older age2023In: Innovation in Aging, E-ISSN 2399-5300, Vol. 7, no Supplement_1, p. 223-223Article in journal (Refereed)
  • 43.
    Lampinen, Josefine
    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, Section of Occupational Therapy.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nyqvist, Fredrica
    Faculty of Education and Welfare Studies, Social Policy, Åbo Akademi University, Vaasa, Finland.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. 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.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Loneliness among very old people with and without dementia: prevalence and associated factors in a representative sample2022In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 19, p. 1441-1453Article in journal (Refereed)
    Abstract [en]

    Loneliness and dementia are common among very old (aged ≥ 80 years) people, but whether the prevalence of loneliness differs between very old people with and without dementia is unknown and few studies have investigated associated factors. The aims of the present study were to compare the prevalence of loneliness between people with and without dementia in a representative sample of very old people, and to investigate factors associated with loneliness in the two groups separately. This population-based study was conducted with data on 1176 people aged 85, 90, and ≥ 95 years (mean age 89.0 ± 4.47 years) from the Umeå 85 + /Gerontological Regional Database study conducted in northern Sweden, during year 2000–2017. Structured interviews and assessments were conducted during home visits. Loneliness was assessed using the question “Do you ever feel lonely?.” Multivariable logistic regression analysis was conducted to identify factors associated with loneliness in participants with and without dementia. The prevalence of loneliness did not differ between people with and without dementia (50.9% and 46.0%, respectively; p = 0.13). Seven and 24 of 35 variables were univariately associated with the experience of loneliness in participants with and without dementia, respectively. In the final models, living alone and having depressive symptoms were associated with the experience of loneliness in both study groups. In participants without dementia, living in a nursing home was associated with the experience of less loneliness. These findings contribute with important knowledge when developing strategies to reduce loneliness in this growing age group.

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  • 44.
    Laurell, H
    et al.
    Department of Surgery, Mora Hospital, Mora, Sweden.
    Hansson, L-E
    Gunnarsson, Ulf
    The Department of Surgical Sciences, Akademiska sjukhuset, Colorectal Unit, Uppsala University, SE 751 85, Uppsala, Sweden.
    Acute abdominal pain among elderly patients.2006In: Gerontology, ISSN 0304-324X, E-ISSN 1423-0003, Vol. 52, no 6, p. 339-44Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Diagnosis of acute abdominal pain in older persons is a challenge, with the age-related increase in concurrent diseases. In most western countries the number of elderly people is constantly rising, which means that an increasing proportion of patients admitted for abdominal pain at the emergency department are elderly.

    OBJECTIVE: To characterize differences in clinical presentation and diagnostic accuracy between younger and more elderly patients with acute abdominal pain.

    METHODS: Patients admitted to Mora Hospital with abdominal pain of up to seven days' duration were registered according to a detailed schedule. From 1st February 1997 to 1st June 2000, 557 patients aged 65-79 years and 274 patients aged > or = 80 years were registered. Patients aged 20-64 years (n = 1,458) served as a control group.

    RESULTS: A specific diagnosis, i.e. other than 'nonspecific abdominal pain', was established in 76 and 78% of the patients aged 65-79 and > or = 80 years respectively, and in 64% of those aged 20-64 (p < 0.001). Pain duration before admission increased with age (p < 0.003), as did frequency and duration of hospitalization (p < 0.0001). Hospital stay increased from 170 days per 100 emergency admissions in the control group to 320 and 458 days in the younger and older study groups, respectively. At the emergency department, older patients were more often misdiagnosed than control patients (52 vs. 45%; p = 0.002). At discharge the diagnosis was more accurate in the control group (86 vs. 77%; p < 0.0001). Hospital mortality was higher among older patients (23/831 vs. 2/1,458; p < 0.001). The admission-to-surgery interval was increased (1.8 vs. 0.9 days, p < 0.0001) in patients > or = 65 years. Rebound tenderness (p < 0.0001), local rigidity (p = 0.003) and rectal tenderness (p = 0.004) were less common in the older than in the control patients with peritonitis. In patients > or = 65 years, C-reactive protein did not differ between patients operated on and those not, contrary to the finding in patients < 65 years (p < 0.0001).

    CONCLUSION: Both the preliminary diagnosis at the emergency department and the discharge diagnosis were less reliable in elderly than in younger patients. Elderly patients more often had specific organic disease and arrived at the emergency department after a longer history of abdominal pain compared to younger patients.

  • 45.
    Lestari, Septi K.
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE).
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Malmberg, Gunnar
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Department of Geography.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    A longitudinal study on social support, social participation, and older Europeans' quality of life2021In: SSM - Population Health, ISSN 2352-8273, Vol. 13, article id 100747Article in journal (Refereed)
    Abstract [en]

    The association between quality of life (QoL) and social relationships is well established. This paper further analyses whether and how participation in social activities as well as providing and receiving social support, independently, are associated with QoL among the older population in 16 European countries. QoL was measured using the CASP-12 scale. The baseline data came from Wave 6 and the outcome from Wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The associations of interest were analysed using multivariable linear regression. The effect of possible non-ignorable dropout was tested. Then, doubly robust estimation and sensitivity analyses for unobserved confounding were performed to evaluate the possible causal interpretation of the associations found. Our findings show that participation in at least one of the socially productive activities was positively associated with QoL at two-year follow-up (Average Causal Effect, ACE: 0.474; 95%CI: 0.361, 0.587). The association was stronger among women, people aged 75+, and those in the Southern European region. Providing social support had a positive association with QoL, but only among people aged 75+ (ACE: 0.410; 95%CI: 0.031, 0.789). Conversely, receiving social support had a negative association (ACE: -0.321; 95%CI: -0.448, -0.195) with QoL, especially for men, people aged 75+, and those in Eastern European countries. Sensitivity analyses for unobserved confounders showed that the associations found cannot be attributed to causal effects.

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  • 46.
    Lestari, Septi K
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Malmberg, Gunnar
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Department of Geography.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Frailty and types of social relationships among older adults in 17 European countries: A latent class analysis2022In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 101, article id 104705Article in journal (Refereed)
    Abstract [en]

    Background: Frailty is a syndrome commonly associated with old age. Social relationships are an essential determinant of frailty progression, and frailty can negatively affect social relationships.

    Objectives: To identify social relationship types among older adults in Europe; to evaluate whether social relationship types differ across European regions; and to assess the association between frailty status and social relationship type.

    Methods: We used data from 56,226 individuals from 17 European countries who participated in Wave 6 of the Survey of Health, Ageing and Retirement in Europe. We constructed social relationship types from social relationship variables (contacts frequency, perceived emotional support, participation in social activities, providing and receiving instrumental support) using latent class analysis (LCA). Associations between social relationship types and frailty were examined using multinomial regression analyses integrated with LCA.

    Results: We identified four social relationship types: ‘poor’; ‘frequent and emotionally close’; ‘frequent, emotionally close, and supportive’; and ‘frequent, emotionally close, and active’. Type 3 is also characterised by participation in sport/social clubs (in the northern region) or receiving support (in the eastern region). Participation in volunteering/charity activities (in the central and northern regions) and instrumental support provision (in the northern region) are Type 4′s characteristics as well. In all regions, being frail was associated with less active social relationships (Types 1, 2, and 3) relative to the more ‘active’ type (Type 4).

    Conclusion: Frailty status was associated with social relationship types. The identified types may help tailor intervention programmes for older adults to prevent worsening frailty.

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  • 47.
    Lopatko Lindman, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hemmingsson, Eva-Stina
    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. Department of Public Health and Caring Sciences, Geriatric Medicine, Uppsala University, Uppsala, Sweden.
    Brännström, Jon
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Josefsson, Maria
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Olsson, Jan
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Section of Virology.
    Elgh, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Section of Virology.
    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. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Herpesvirus infections, antiviral treatment, and the risk ofdementia: a registry-based cohort study in Sweden2021In: Alzheimer’s & Dementia: Translational Research & Clinical Interventions, E-ISSN 2352-8737, Vol. 7, no 1, article id e12119Article in journal (Refereed)
    Abstract [en]

    Introduction: Herpesviruses, including Herpes simplex virus type 1 (HSV1) and varicella zoster‐virus (VZV), have been implicated in Alzheimer's disease (AD) development. Likewise, antiviral treatment has been suggested to protect against dementia development in herpes‐infected individuals.

    Methods: The study enrolled 265,172 subjects aged ≥ 50 years, with diagnoses of VZV or HSV, or prescribed antiviral drugs between 31 December 2005 and 31 December 2017. Controls were matched in a 1:1 ratio by sex and birth year.

    Results: Antiviral treatment was associated with decreased risk of dementia (adjusted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.86 to 0.92), while herpes infection without antiviral drugs increased the risk of dementia (adjusted HR 1.50, 95% CI 1.29 to 1.74).

    Discussion: Antiviral treatment was associated with a reduced long‐term risk of dementia among individuals with overt signs of herpes infection. This is consistent with earlier findings indicating that herpesviruses are involved in the pathogenesis of AD.

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  • 48.
    Lopatko Lindman, Karin
    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. Department of Public Health and Caring Sciences, Geriatric Medicine, Uppsala University, Uppsala, Sweden.
    Olsson, Jan
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Section of Virology.
    Josefsson, Maria
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Eriksson, Sture
    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, Section of Sustainable Health.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Elgh, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Section of Virology.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Plasma Amyloid-β in Relation to Antibodies Against Herpes Simplex Virus, Cytomegalovirus, and Chlamydophila pneumoniae2021In: Journal of Alzheimer's Disease Reports, E-ISSN 2542-4823, Vol. 5, no 1, p. 229-235Article in journal (Refereed)
    Abstract [en]

    Background: Amyloid-β (Aβ), the key constituent of Alzheimer’s disease (AD) plaques, has antimicrobial properties.

    Objective: To investigate the association between plasma Aβ and antibodies against the AD-related pathogens herpes simplex virus (HSV), cytomegalovirus (CMV), and C. pneumoniae.

    Methods: Plasma from 339 AD cases, obtained on average 9.4 years (±4.00) before diagnosis, and their matched controls were analyzed for Aβ40 and Aβ42 concentrations with Luminex xMAP technology and INNOBIA plasma Aβ-form assays. Enzyme-linked immunosorbent assays were utilized for analyses of anti-HSV immunoglobulin (Ig) G, anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG. Follow-up samples were available for 150 of the cases.

    Results: Presence and levels of anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG did not correlate with concentrations of Aβ42 or Aβ40 in cases or controls.

    Conclusion: Levels of plasma Aβ were not associated with antibodies against different AD-related pathogens.

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  • 49.
    Lundgren, Anna Sofia
    et al.
    Umeå University, Faculty of Arts, Department of culture and media studies. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Liliequist, Evelina
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Arts, Department of culture and media studies.
    Sjöstedt Landén, Angelika
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Arts, Department of culture and media studies.
    Between activity and solidarity: comprehending retirement and extendedworking lives in Swedish rural areas2018In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 44, p. 1-8Article in journal (Refereed)
    Abstract [en]

    The expected costs of population ageing have generally led to perceived needs to postpone the age of retirement. Drawing on 20 semi-structured interviews, the aim of this paper is to describe the ways that the possibility of an extended working life is comprehended by persons over the age of 60 living in sparsely populated areas in northern Sweden. While defining themselves as active, the interviewees argued strongly in favour of the right to retire. What are often described as opposing retiree subject positions healthy and active vs. vulnerable and dependent were partly transgressed in the interviews. The interviewees performed a solidarity that had the potential of including their future selves as possible objects of solidarity. Another important result was that in comprehending the possibility of an extended working life, morally charged notions of geographic place became central.

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  • 50.
    Lundström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. 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.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Symptom profile of postoperative delirium in patients with and without dementia2012In: Journal of Geriatric Psychiatry and Neurology, ISSN 0891-9887, E-ISSN 1552-5708, Vol. 25, no 3, p. 162-169Article in journal (Refereed)
    Abstract [en]

    This study compares the symptom profile of patients with postoperative delirium after femoral neck fracture surgery in those with and without dementia. In this study, 129 patients of age >= 70 years (mean age +/- SD, 86 +/- 6 yr, 72% women) with postoperative delirium, were included. Delirium and dementia were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Of the 129 patients with delirium, 54 (42%) had a dementia disorder. Patients with delirium superimposed on dementia more often had any hyperactive and pure emotional delirium. Communication difficulties and symptoms such as restlessness/agitation, aggressive behavior, and irritability were more commonly found in the dementia group. In contrast, patients with delirium but without dementia were more often diagnosed with pure hypoactive and any psychotic delirium. The symptom profile of postoperative delirium varies according to whether it occurs in patients with or without dementia. This may indicate that postoperative delirium among patients with hip fracture differs based on the presence or absence of dementia.

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