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  • 1.
    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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  • 2.
    Boström, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    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, Physiotherapy. 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, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    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.
    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.
    Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial2016In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 31, no 8, p. 868-878Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia.

    METHODS: Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini-Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45 min every other weekday for 4 months. The 15-item Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7 months.

    RESULTS: No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7 months. Among participants with GDS scores ≥ 5, reductions in GDS score were observed in the exercise and control groups at 4 months (-1.58, P = 0.001 and -1.54, P = 0.004) and 7 months (-1.25, P = 0.01 and -1.45, P = 0.007). Among participants with MADRS scores ≥ 7, a reduction in MADRS score was observed at 4 months in the control group (-2.80, P = 0.009) and at 7 months in the exercise and control groups (-3.17, P = 0.003 and -3.34, P = 0.002).

    CONCLUSIONS: A 4-month high-intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non-exercise group activities may reduce high levels of depressive symptoms.

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  • 3.
    Boström, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    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, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    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.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Functional capacity and dependency in transfer and dressing are associated with depressive symptoms in older people2014In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 9, p. 249-257Article in journal (Refereed)
    Abstract [en]

    Background: This study examined associations between depressive symptoms and functional capacity, overall dependency in personal activities of daily living (ADLs), and dependency in individual ADL tasks, respectively, in people with a high mean age, large range of functional capacity, and wide spectrum of dependency in ADLs. Methods: Cross-sectional data from three studies were used. A total of 392 individuals living in community and residential care facilities were included. Mean age was 86.2 years, 72% were women, 75% were dependent in ADLs, 42% had depression, and 39% had dementia. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15), functional capacity with the Berg Balance Scale (BBS), and ADLs with the Barthel ADL Index. Multiple linear regression analyses with comprehensive adjustments were performed between GDS-15 and BBS, GDS-15 and Barthel ADL Index, and GDS-15 and each individual ADL task, separately. Results: GDS-15 score was associated with BBS score (unstandardized b=-0.03, P=0.008), but not with Barthel ADL Index score (unstandardized b=-0.07, P=0.068). No significant interaction effects of sex, dementia, or living conditions were found in these associations. Among individual ADL tasks, dependency in transfer (unstandardized b=-1.03, P=0.007) and dressing (unstandardized b=-0.70, P=0.035) were associated with depressive symptoms. Conclusion: Functional capacity seems to be independently associated with depressive symptoms in older people living in community and residential care facilities, whereas overall ADL performance may not be associated. Dependency in the individual ADL tasks of transfer and dressing appear to be independently associated with depressive symptoms and may be an important focus of future interdisciplinary multifactorial intervention studies.

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  • 4.
    Boström, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Brännström, Jon
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Allard, Per
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    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.
    Antidepressant use and mortality in very old people2016In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 28, no 7, p. 1201-1210Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Antidepressant treatment may increase the risk of death. The association between antidepressants and mortality has been evaluated in community-dwelling older people, but not in representative samples of very old people, among whom dementia, multimorbidity, and disability are common.

    METHODS: Umeå 85+/GERDA study participants (n = 992) aged 85, 90, and ≥95 years were followed for up to five years. Cox proportional hazard regression models were used to analyze mortality risk associated with baseline antidepressant treatment, adjusted for potential confounders.

    RESULTS: Mean age was 89 years; 27% of participants had dementia, 20% had stroke histories, 29% had heart failure, and 16% used antidepressants. In age- and sex-adjusted analyses, antidepressant use was associated with a 76% increased mortality risk (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.41-2.19). Adding adjustment for Geriatric Depression Scale score, HR was 1.62 (95% CI, 1.29-2.03). The association was not significant when adjusting for additional confounding factors (HR = 1.08; 95% CI, 0.85-1.38). Interaction analyses in the fully adjusted model revealed a significant interaction between sex and antidepressant use (HR: 1.76; 95% CI, 1.05-2.94). Among male and female antidepressant users, the HRs for death were 0.76 (95% CI, 0.47-1.24) and 1.28 (95% CI, 0.97-1.70), respectively.

    CONCLUSION: Among very old people, baseline antidepressant treatment does not seem to be independently associated with increased mortality risk. However, the risk may be different in men and women. This difference and the potential risk of initial treatment require further investigation in future cohort studies of very old people.

  • 5.
    Brännström, Jon
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    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, Physiotherapy.
    Nordström, Peter
    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.
    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.
    Psychotropic drug use and mortality in old people with dementia: investigating sex differences2017In: BMC Pharmacology & Toxicology, E-ISSN 2050-6511, Vol. 18, article id 36Article in journal (Refereed)
    Abstract [en]

    Background: Psychotropic drugs are common among old people with dementia, and have been associated with increased mortality. Previous studies have not investigated sex differences in this risk. This study was conducted to analyse associations between the use of antipsychotics, antidepressants, and benzodiazepines and 2-year mortality in old people with dementia, and to investigate sex differences therein.

    Methods: In total, 1037 participants (74% women; mean age, 89 years) with dementia were included from four cohort studies and followed for 2 years. Data were collected through home visits and medical records. Cox proportional hazard regression models were used to analyse associations between ongoing baseline drug use and mortality. Multiple possible confounders were evaluated and adjusted for.

    Results: In fully adjusted models including data from the whole population, no association between baseline psychotropic drug use and increased 2-year mortality was seen. Significant sex differences were found in mortality associated with antidepressant use, which was protective in men, but not in women (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40–0.92 and HR 1.09, 95% CI 0.87–1.38, respectively). The interaction term for sex was significant in analyses of benzodiazepine use, with a higher mortality risk among men than among women.

    Conclusions: Among old people with dementia, ongoing psychotropic drug use at baseline was not associated with increased mortality in analyses adjusted for multiple confounders. Sex differences in mortality risk associated with antidepressant and benzodiazepine use were seen, highlighting the need for further investigation of the impact of sex.

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  • 6.
    Carlsson, Maine
    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.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    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.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial2011In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 15, no 7, p. 554-560Article in journal (Refereed)
    Abstract [en]

    Background  Loss of muscle mass is common among old people living in institutions but trials that evaluate interventions aimed at increasing the muscle mass are lacking.

    Objective, participants and intervention  This randomized controlled trial was performed to evaluate the effect of a high-intensity functional exercise program and a timed protein-enriched drink on muscle mass in 177 people aged 65 to 99 with severe physical or cognitive impairments, and living in residential care facilities.

    Design  Three-month high-intensity exercise was compared with a control activity and a protein-enriched drink was compared with a placebo drink. A bioelectrical impedance spectrometer (BIS) was used in the evaluation. The amount of muscle mass and body weight (BW) were followed-up at three and six months and analyzed in a 2 × 2 factorial ANCOVA, using the intention to treat principle, and controlling for baseline values.

    Results  At 3-month follow-up there were no differences in muscle mass and BW between the exercise and the control group or between the protein and the placebo group. No interaction effects were seen between the exercise and nutritional intervention. Long-term negative effects on muscle mass and BW was seen in the exercise group at the 6-month follow-up.

    Conclusion  A three month high-intensity functional exercise program did not increase the amount of muscle mass and an intake of a protein-enriched drink immediately after the exercise did not induce any additional effect on muscle mass. There were negative long-term effects on muscle mass and BW, indicating that it is probably necessary to compensate for an increased energy demand when offering a high-intensity exercise program.

  • 7.
    Conradsson, M
    et al.
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Malmqvist, L
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    The Berg balance scale: Intra-rater reliability in older people dependent in ADL living residential care facilities2007Conference paper (Other academic)
  • 8.
    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?
  • 9.
    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, 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, Physiotherapy.
    Is a change in physical capacity or dependence in ADL associated with a change in mental health among older people living in residential care facilities?Manuscript (preprint) (Other academic)
  • 10.
    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.
    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, Physiotherapy.
    Effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people living in residential care facilities: a cluster-randomized controlled trial2010In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 14, no 5, p. 565-576Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people dependent in activities of daily living (ADL) and living in residential care facilities.

    Method: Cluster-randomized controlled study. Participants were 191 older people, aged 65–100, dependent in ADL and with Mini Mental State Examination scores between 10 and 30. One-hundred (52%) of the participants had a diagnosed dementia disorder. A high-intensity functional weight-bearing exercise programme and a control activity were performed in groups. Sessions were held five times over each two week period for three months, a total of 29 times. The outcome measures, Geriatric Depression Scale (GDS-15) and Philadelphia Geriatric Center Morale Scale (PGCMS) were blindly assessed at baseline, three and six months.

    Results: At baseline, mean ± SD (range) for GDS was 4.4 ± 3.2 (0–14), and for PGCMS 11.0 ± 3.5 (2–17). There were no significant differences in GDS or PGCMS between the exercise and the control group at the three and six month follow-ups in the total sample. Among people with dementia, there was a between-group difference at three months in PGCMS scores in favour of the exercise group.

    Conclusion: A high-intensity functional exercise programme seems generally not to influence depressive symptoms or psychological well-being among older people dependent in ADL and living in residential care facilities. An individualized and multifactorial intervention may be needed in this group. However, an exercise programme as a single intervention may have a short-term effect on well-being among people with dementia.

  • 11.
    Conradsson, Mia
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillernor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    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.
    Malmqvist, Lisa
    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
    Physiotherapy Unit, Department of Health Sciences, Luleå University of Technology.
    Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities2007In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 87, no 9, p. 1155-1163Article in journal (Refereed)
    Abstract [en]

    Background and Purpose: The Berg Balance Scale (BBS) is frequently used to assess balance in older people, but knowledge is lacking about the absolute reliability of BBS scores. The aim of this study was to investigate the absolute and relative intrarater test-retest reliability of data obtained with the BBS when it is used among older people who are dependent in activities of daily living and living in residential care facilities.

    Subjects: The participants were 45 older people (36 women and 9 men) who were living in 3 residential care facilities. Their mean age was 82.3 years (SD=6.6, range=68-96), and their mean score on the Mini Mental State Examination was 17.5 (SD=6.3, range=4-30).

    Methods: The BBS was assessed twice by the same assessor. The intrarater test-retest reliability assessments were made at approximately the same time of day and with 1 to 3 days in between assessments. Absolute reliability was calculated using an analysis of variance with a 95% confidence level, as suggested by Bland and Altman. Relative reliability was calculated using the intraclass correlation coefficient (ICC). Results The mean score was 30.1 points (SD=15.9, range=3-53) for the first BBS test and 30.6 points (SD=15.6, range=4-54) for the retest. The mean absolute difference between the 2 tests was 2.8 points (SD=2.7, range=0-11). The absolute reliability was calculated as being 7.7 points, and the ICC was calculated to .97.

    Discussion and Conclusion: Despite a high ICC value, the absolute reliability showed that a change of 8 BBS points is required to reveal a genuine change in function among older people who are dependent in activities of daily living and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time in this group of older people.

  • 12.
    Conradsson, Mia
    et al.
    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, Physiotherapy. 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, Physiotherapy. 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.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment2013In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 17, no 5, p. 81p. 638-645Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this population-based study was to investigate the usefulness of the Geriatric Depression Scale 15-item version (GDS-15) to assess depressive symptoms among very old people with differing levels of cognitive function.

    Methods: The 834 participants were aged 85 and over. Feasibility of GDS-15 was evaluated as the proportion of people who completed the scale. Concurrent criterion validity was evaluated by calculating correlations between GDS-15 and Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS measures psychological wellbeing which is closely related with depressive symptoms. Correlations were calculated within groups according to cognitive function assessed with Mini-Mental State Examination (MMSE); 0-4, 5-9, 10-14, 15-19, 20-24, 25-27, and 28-30, using Pearson's two-sided correlation and compared using Fisher r-to-z transformation. Internal consistency of the GDS-15 was evaluated by calculating Cronbach's in each group.

    Results: In total, 651 (78%) of the 834 participants completed the GDS-15. For the two MMSE-groups with scores of <10, the proportion who completed GDS-15 were 1% and 42%, respectively, compared to 65-95% in the MMSE-groups with scores of 10. Cronbach's in each MMSE-group ranged from 0.636 (MMSE 28-30) to 0.821 (MMSE 5-9). The level of correlation between GDS-15 and PGCMS did not significantly differ between MMSE-groups with scores of 5-27 compared to the MMSE-group with scores of 28-30.

    Conclusions: The GDS-15 seems to have an overall usefulness to assess depressive symptoms among very old people with an MMSE score of 10 or more. More studies are needed to strengthen the validity of GDS-15 among older people with MMSE scores of 10-14. For older people with MMSE scores lower than 10, there is a need to develop and validate other measurements.

  • 13.
    Englund, Undis
    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.
    Sondell, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Bucht, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Pettersson, Ulrika
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology.
    The beneficial effects of exercise on BMC are lost after cessation: a 5-year follow-up in older post-menopausal women2009In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 3, p. 381-388Article in journal (Refereed)
    Abstract [en]

    This study investigates whether the positive effects on bone mineral density (BMD, g/cm2) and neuromuscular function following a combined weight-bearing program are sustained in older women, a longer period after cessation of training. Thirty-four women (18 exercisers and 16 controls) aged 73–88 years, who completed a 12-month randomized-controlled trial, were invited to a 5-year follow-up assessment of BMD and neuromuscular function. Both groups sustained significant losses in BMD of the femoral neck, trochanter, and Ward's triangle during the follow-up period. Significant losses were also seen in all neuromuscular function tests. The inter-group change was, however, significant only for maximal walking speed where the exercise group had a significantly greater loss. In conclusion, this study suggests that gains in bone density and neuromuscular functions achieved by training are lost after cessation of training. Continuous high-intensity weight-loading physical activity is probably necessary to preserve bone density and neuromuscular function in older women.

  • 14.
    Englund, Undis
    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.
    Sondell, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Pettersson, Ulrika
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology.
    Bucht, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women2005In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 16, no 9, p. 1117-1123Article in journal (Refereed)
    Abstract [en]

    Forty-eight community living women 66–87 years old volunteered to participate in a 12-month prospective, randomized, controlled, trial. The aim was to determine if a combined weight-bearing training program twice a week would be beneficial to bone mineral density and neuromuscular function. The participants were pairwise age-matched and randomly assigned to either an exercise group (n=24) or a control group (n=24). Twenty-one subjects in the intervention group and 19 in the control group completed the study. The exercise program lasted for 50 min and consisted of a combination of strengthening, aerobic, balance and coordination exercises. The mean percentage of scheduled sessions attended for the exercise group was 67%. At the completion of the study, the intervention group showed significant increments in bone mineral density of the Wards triangle (8.4%, P<0.01) as well as improvement in maximum walking speed (11.4%, P<0.001) and isometric grip strength (9.9%, P<0.05), as compared to the control group. The conclusion was that a combined weight-bearing training program might reduce fracture risk factors by improving bone density as well as muscle strength and walking ability. This program could be suitable for older community living women in general, and might, therefore, have important implications for fracture prevention.

  • 15.
    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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  • 16.
    Hörnsten, Carl
    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.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    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.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    High blood pressure as a risk factor for incident stroke among very old people: a population-based cohort study2016In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 34, no 10, p. 2059-2065Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: High blood pressure (BP) increases the risk of stroke, but there is limited evidence from studies including very old people. The aim was to investigate risk factors for incident stroke among very old people.

    METHODS: A prospective population-based cohort study was performed among participants aged at least 85 years in northern Sweden. The 955 participants were tested at their homes. BP was measured manually after 5-min supine rest. Incident stroke data were collected from medical charts guided by hospital registry, death records, and 5-year reassessments. Cox proportional hazards models were used.

    RESULTS: The stroke incidence was 33.8/1000 person-years (94 stroke events) during a mean follow-up period of 2.9 years. In a comprehensive multivariate model, atrial fibrillation [hazard ratio 1.85, 95% confidence interval (CI) 1.07-3.19] and higher SBP (hazard ratio 1.19, 95% CI 1.08-1.30 per 10-mmHg increase) were associated with incident stroke overall. However, higher SBP was not associated with incident stroke in participants with SBP less than 140 mmHg (hazard ratio 0.90, 95% CI 0.53-1.53 per 10-mmHg increase). In additional multivariate models, DBP at least 90 mmHg (hazard ratio 2.45, 95% CI 1.47-4.08) and SBP at least 160 mmHg (vs. <140 mmHg; hazard ratio 2.80, 95% CI 1.53-5.14) were associated with incident stroke. The association between BP and incident stroke was not affected by interactions related to sex, dependence in activities of daily living, or cognitive impairment.

    CONCLUSION: High SBP (≥160 mmHg) and DBP (≥90 mmHg) and atrial fibrillation appeared to be risk factors for incident stroke among very old people.

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  • 17.
    Johansson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. 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, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Cognitive function and walking velocity in people with dementia: a comparison of backward and forward walking2017In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 58, p. 481-486Article in journal (Refereed)
    Abstract [en]

    How forward and backward walking, both central to everyday life, relate to cognition are relatively unexplored in people with dementia. This study aimed to investigate if forward and backward walking velocity respectively, associated with global cognition and executive function in people with dementia, and whether the association differed according to walking aid use or dementia type. Using a cross-sectional design, 161 participants (77% women), a mean Mini-Mental State Examination (MMSE) score of 15, and mean age of 85.5 years and living in nursing homes were included. Self-paced forward walking (FW) and backward walking (BW) velocity over 2.4 m was measured. Global cognitive outcome measurements included MMSE and Alzheimer Disease Assessment Scale - Cognitive subscale (ADAS-Cog). Executive function was measured using Verbal Fluency (VF). In comprehensively adjusted multivariate linear regression analyses, FW was independently associated with VF (p = 0.001), but not MMSE (p = 0.126) or ADAS-Cog (p = 0.818). BW was independently associated with VF (p = 0.043) and MMSE (p = 0.022), but not ADAS-Cog (p = 0.519). Interaction analyses showed that the association between BW velocity and executive function were stronger in participants who walked without a walking aid. No associations differed according to dementia type. In conclusion, executive function appears important to walking velocity, both forward and backward, in people with dementia with mild to moderately severe cognitive impairment. Global cognitive function was associated with backward walking only, perhaps due to it being more challenging. The association between BW velocity and executive function differed according to use of walking aids, which appeared to attenuate the association.

  • 18.
    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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  • 19.
    Lindelof, Nina
    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.
    Lindström, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nyberg, Lars
    Weighted Belt Exercise for Frail Older Women Following Hip Fracture - A Single Subject Design2002In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 4, no 2, p. 54-64Article in journal (Refereed)
  • 20.
    Lindelöf, Nina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy. School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Littbrand, Håkan
    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.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    A focus groups study of staff team experiences of providing interdisciplinary rehabilitation for people with dementia and their caregivers: a co-creative journey2023In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, no 1, article id 572Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 21.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Physical exercise for older people: focusing on people living in residential care facilities and people with dementia2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The main purposes of this thesis were to evaluate a high-intensity functional weight-bearing exercise pro­gramme, regarding its applicability (attendance, achieved intensity, adverse events) as well as its effect on physical functions and activities of daily living (ADL) among older people living in residential care facilities, with a special focus on people with dementia. Furthermore, a main purpose was to systematically review the applicability and effects of physical exercise on physical functions, cognitive functions, and ADL among people with dementia.

    A high-intensity functional weight-bearing exercise programme that includes lower-limb strength and balance exercises in standing and walking, was evaluated in a randomised controlled trial among 191 older people, dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ten or more. One hundred (52.4%) of the participants had dementia. Participants were randomised to an exercise programme or a control activity, consisting of 29 supervised sessions over 3 months, as well as to an intake of a protein-enriched energy supplement or a placebo drink immediately after each session. The effect on physical functions was evaluated using the Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in a leg press machine measuring lower-limb strength. The effect on ADL was evaluated using the Barthel Index. These outcome measures were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle.

    The evaluation of the applicability of the high-intensity functional weight-bearing exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and all except two adverse events were assessed as minor or temporary and none led to manifest injury or disease. No statistically significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, the applicability of the programme was not associated with the participants’ cognitive function. Significant long-term effects of the exercise programme were seen regarding functional balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. Age, sex, depression, dementia disorder, nutritional status, and level of functional balance capacity did not influence the effect on functional balance of the high-intensity functional weight-bearing exercise programme. There were no significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a significantly smaller proportion of participants in the exercise group had deteriorated regarding indoor mobility at 3 and 6 months. For people with dementia, there was a significant difference in overall ADL performance in favour of the exercise group at 3 months, but not at 6 months.

    In a systematic review, randomised controlled trials, evaluating the effects of physical exercise among people with dementia, were identified according to pre-defined inclusion criteria. Two reviewers independently extracted predetermined data and assessed methodological quality. Ten studies were included in the review and the majority of the participants were older people with Alzheimer’s disease living in residential care facilities. Four studies reached “moderate” methodological quality and six “low”. The results showed that among older people with Alzheimer’s disease in residential care facilities, combined functional weight-bearing exercise over 12 months at an intended moderate intensity seems applicable for use regarding attendance and adverse events and there is some evidence that the exercise improves walking performance and reduces ADL decline. Furthermore, there is some evidence that walking exercise over 16 weeks performed individually, where the participant walks as far as possible during the session, reduces decline in walking performance, but adverse events need to be evaluated.

    In conclusion, among older people who are dependent in ADL, living in residential care facilities, and have an MMSE score of 10 or more, a high-intensity functional weight-bearing exercise programme is applicable for use and has positive long-term effects on functional balance, gait ability, and lower-limb strength and seems to reduce ADL decline related to indoor mobility. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. In people with dementia, the exercise programme may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect. The positive results regarding applicability and effects of combined functional weight-bearing exercise among people with dementia is confirmed when the scientific literature is systematically reviewed. It seems to be important that exercise interventions among people with dementia last for at least a few months and that the exercises are task-specific and intended to challenge the individual’s physical capacity. Whether physical exercise can improve cognitive functions among people with dementia remains unclear. There is a need for more exercise studies of high methodological quality among people with dementia disorders.

     

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  • 22.
    Littbrand, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlsson, Maine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family 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.
    Effect of a high-intensity functional exercise program on functional balance: preplanned subgroup analyses of a randomized controlled trial in residential care facilities2011In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 59, no 7, p. 1274-1282Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate whether age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity influences the effect of a high-intensity functional weight-bearing exercise program on functional balance.

    DESIGN: Preplanned subgroup analyses of a randomized controlled trial.

    SETTING: Nine residential care facilities.

    PARTICIPANTS: One hundred ninety-one people aged 65 to 100 dependent in activities of daily living and with Mini-Mental State Examination scores of 10 or greater.

    INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity, each comprising 29 sessions over 3 months.

    MEASUREMENTS: Functional balance capacity was assessed blindly using the Berg Balance Scale (BBS) at baseline, 3 months, and 6 months. The BBS consists of 14 tasks, common in everyday life, such as standing up from sitting and, while standing, reaching forward or turning 360°. Interactions between allocation to activity group and each subgroup were evaluated according to the intention-to-treat principle.

    RESULTS: The subgroup analyses revealed no statistically significant interaction for age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity at 3 (P=.65,.65,.51,.78,.09,.67, respectively) or 6 (P=.69,.62,.20,.94,.48,.85, respectively) months. In addition, at 3 and 6 months there was no significant interaction for cognitive level (P=.28,.47, respectively) or number of depressive symptoms (P=.85,.49, respectively).

    CONCLUSION: Older age, female sex, depression, mild to moderate dementia syndrome, malnutrition, and severe physical impairment do not seem to have a negative effect on functional balance from a high-intensity functional weight-bearing exercise program. Consequently, people with these characteristics in residential care facilities should not be excluded from offers of rehabilitation including high-intensity exercises.

  • 23.
    Littbrand, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    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.
    The effect of a high-intensity functional exercise program on activities of daily living: a randomized controlled trial in residential care facilities2009In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 57, no 10, p. 1741-1749Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia. DESIGN: Randomized, controlled trial.

    SETTING: Nine residential care facilities.

    PARTICIPANTS: One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia.

    INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months.

    MEASUREMENTS: The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses.

    RESULTS: There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months.

    CONCLUSION: A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect.

  • 24.
    Littbrand, Håkan
    et al.
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Physiotherapy.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    The effect on ADL of a high-intensity functional exercise program among older people dependent in ADL: a randomized controlled trial2007Conference paper (Other academic)
  • 25.
    Littbrand, Håkan
    et al.
    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, Physiotherapy. 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.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nyberg, Lars
    Department of Health Sciences, Physiotherapy Unit, Luleå University of Technology.
    A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function2006In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 86, no 4, p. 489-498Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program.

    SUBJECTS: The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29).

    METHODS: A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program.

    RESULTS: The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score.

    DISCUSSION AND CONCLUSION: The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.

  • 26.
    Littbrand, Håkan
    et al.
    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.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review2011In: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 90, no 6, p. 495-518Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: : The aim of this study was to systematically review the applicability (attendance, achieved intensity, adverse events) and effects of physical exercise on physical functions, cognitive functions, and activities of daily living among people with dementia.

    DESIGN: : Randomized controlled trials were identified in PubMed, the Cumulative Index to Nursing and Allied Health, the Allied and Complementary Medicine Database, and the Cochrane Library on August 30 and September 1, 2010, according to predefined inclusion criteria. Two reviewers independently extracted predetermined data and assessed methodologic quality.

    RESULTS: : A qualitative analysis was performed, including ten studies. Most participants were people with Alzheimer disease in residential care facilities. Four studies reached "moderate" methodologic quality, and six reached "low." The studies of moderate quality evaluated the effects of combined functional weight-bearing exercise, combined functional and nonfunctional exercise, and walking exercise.

    CONCLUSIONS: : Among older people with Alzheimer disease in residential care facilities, combined functional weight-bearing exercise seems applicable for use regarding attendance and adverse events, and there is some evidence that exercise improves walking performance and reduces the decline in activities of daily living. Furthermore, there is some evidence that walking exercise performed individually reduces decline in walking performance, but adverse events need to be evaluated. Among older people with various types of dementia disorders who are staying in a hospital, there is some evidence that combined functional and nonfunctional exercise over 2 wks has no effect on mobility. It seems important that the interventions last for at least a few months and that the exercises are task-specific and are intended to challenge the individual's physical capacity. Among older people with unspecified dementia disorders in residential care facilities, there is some evidence that walking exercise performed at a self-selected speed has no effect on cognitive functions. Whether physical exercise can improve cognitive functions among people with dementia remains unclear because studies evaluating this have either been of low methodologic quality or used an intervention of presumably insufficient intensity. There is a need for more studies of high methodologic quality, especially among people with dementia disorders other than Alzheimer disease.

  • 27.
    Rosendahl, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Yifter-Lindgren, Elinor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nyberg, Lars
    High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial2006In: Australian Journal of Physiotherapy, ISSN 0004-9514, Vol. 52, no 2, p. 105-113Article in journal (Refereed)
    Abstract [en]

    The aims of this randomised controlled trial were to determine if a high-intensity functional exercise program improves balance, gait ability, and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training. One hundred and ninety-one older persons dependent in activities of daily living, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ? 10 participated. They were randomised to a high-intensity functional exercise program or a control activity, which included 29 sessions over 3 months, as well as to protein-enriched energy supplement or placebo. Berg Balance Scale, self-paced and maximum gait speed, and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA, using the intention-to-treat principle. At three months, the exercise group had improved significantly in self-paced gait speed compared with the control group (mean difference 0.04 m/s, p = 0.02). At six months, there were significant improvements favouring the exercise group for Berg Balance Scale (1.9 points, p = 0.05), self-paced gait speed (0.05 m/s, p = 0.009), and lower-limb strength (10.8 kg, p = 0.03). No interaction effects were seen between the exercise and nutrition interventions. In conclusion, a high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older persons dependent in activities of daily living. An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training.

  • 28.
    Rosendahl, Erik
    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, Physiotherapy.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Demenssjukdomar: motorik, fysisk aktivitet och fysisk träning2012In: Äldres hälsa: ett sjukgymnastiskt perspektiv / [ed] Elisabeth Rydwik, Lund: Studentlitteratur, 2012, 1, p. 235-247Chapter in book (Other (popular science, discussion, etc.))
  • 29.
    Sefastsson, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Marklund, Ingela
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    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.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Langhammer, Birgitta
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Improved balance, leg strength, and dual-task ability after lower extremity constraint-induced movement therapy in stroke patients: a longitudinal cohort studyManuscript (preprint) (Other academic)
  • 30.
    Sondell, Anna
    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 Physiotherapy.
    Lampinen, Josefine
    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.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Englund, Undis
    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.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program2021In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, no 1, article id 341Article in journal (Refereed)
    Abstract [en]

    Background: There is great need for development of feasible rehabilitation for older people with dementia. Increased understanding of this population’s experiences of rehabilitation participation is therefore important. The aim of this study was to explore the experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program.

    Methods: Sixteen older people with dementia were interviewed about their experiences of participation in a person-centred multidimensional interdisciplinary rehabilitation program. The program comprised assessments by a comprehensive team of rehabilitation professionals followed by a rehabilitation period of 16 weeks, including interventions based on individualized rehabilitation goals conducted with the support of the rehabilitation team. The rehabilitation was performed in the participants’ homes, in the community and at an outpatient clinic, including exercise with social interaction in small groups offered twice a week to all participants. The interviews were conducted at the end of the rehabilitation period and analysed with qualitative content analysis.

    Results: The analysis resulted in one overarching theme: Empowered through participation and togetherness and four sub-themes: Being strengthened through challenges; Gaining insights, motives, and raising concerns about the future; Being seen makes participation worthwhile; and Feelings of togetherness in prosperity and adversity. The participants increased their self-esteem by daring and coping in the rehabilitation. The insights about themselves and their condition motivated them to continue with their prioritized activities, but also raised concerns about how the future would play out. Collaboration in the group and being seen and acknowledged by staff strengthened their own motivation and self-efficacy.

    Conclusion: According to community-dwelling older people with dementia, a person-centred multidimensional interdisciplinary rehabilitation program was experienced as viable and beneficial. The participants seemed empowered through the rehabilitation and expressed mostly positive experiences and perceived improvements. Providers of interdisciplinary rehabilitation programs for this group should consider aspects raised by the participants e.g. the positive experience of being challenged in both exercise and daily activities; the importance of being seen and feeling secure; the benefits and challenges of collaboration with others in the same situation; and the generation of new perspectives of current and future situation.

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  • 31.
    Sondell, Anna
    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 Physiotherapy.
    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.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation Among Older People with Dementia in Nursing Homes?2019In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 23, no 10, p. 1011-1020Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: Exercise can be an important way of maintaining balance function in people with dementia, but further investigation is needed to determine the optimal way of exercising. The objective was to evaluate whether exercise applicability (i.e., attendance, exercise intensity, and adverse events) and motivation were associated with the effect on functional balance of a high-intensity functional exercise program for older people with dementia in nursing homes.

    Design, Setting and Participants: Exercise intervention participants (n = 81; 60 women, 21 men) from a randomized controlled trial (UMDEX) were included. Their mean age was 84 and mean Mini-Mental State Examination score was 15.

    Intervention: Groups of 3–8 participants participated in the High-Intensity Functional Exercise (HIFE) Program, with 5 sessions per 2-week period, for 4 months (total, 40 sessions).

    Measurements: Outcome was the Berg Balance Scale (BBS), assessed at baseline and follow up, and the score difference, dichotomized to classify participants into two groups: responders (≥5-point increase) and non-responders (<5-point increase). Target variables were measures of applicability and motivation. Associations between each target variable and the outcome were analyzed using multivariable logistic regression. Baseline characteristics and new medical conditions developing during the intervention period were compared between responders and non-responders and included in the analyses when p < 0.10.

    Results: The BBS score was 28.6 ± 14.3 at baseline and 31.2 ± 15.3 at follow up, with the difference between follow-up and baseline scores ranging from −35 to 24. Twenty-nine (35.8%) participants were responders. The multivariable models showed no significant association between responders vs. non-responders and any target variable.

    Conclusion: Participation in a 4-month high-intensity functional exercise program can improve balance in many individuals with dementia in nursing homes, despite the progressiveness of dementia disorders and several co-existing medical conditions. Predicting balance exercise response based on applicability and motivation seem not to be possible, which lends no support for excluding this group from functional exercise, even when exercise intensity or motivation is not high.

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  • 32.
    Sondell, Anna
    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 Physiotherapy.
    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.
    Gustafson, Yngve
    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. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    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.
    The Applicability of a High-Intensity Functional Exercise Program among Older People with Dementia living in Nursing Homes2019In: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 42, no 4, p. E16-E24Article in journal (Refereed)
    Abstract [en]

    Background and Purpose: Exercise programs for people with dementia need to be optimized. We therefore evaluated the applicability of a high-intensity functional exercise program among people with dementia in nursing homes with regard to attendance, achieved exercise intensity, adverse events, a focus on dementia type, and whether symptoms of dementia or other medical conditions common in this population were associated with program applicability.

    Methods: The Umeå Dementia and Exercise study, a cluster-randomized controlled trial set in 16 nursing homes in Umeå, Sweden. Ninety-three people with dementia (mean [SD] Mini-Mental State Examination score of 15.4 [3.4]) were randomized to the exercise intervention. Thirty-four participants had Alzheimer's disease (AD) and 59 non-Alzheimer's dementia (non-AD). High-Intensity Functional Exercise (HIFE) program was conducted in groups of 3 to 8 participants. Two physiotherapists led 5 sessions (45 minutes each) per fortnight for 4 months (total 40 sessions).

    Results: Median attendance rate was 82.5%. Lower limb strength exercises were performed at high or medium intensity at a median interquartile range of 94.7% (77.8%-100%) of attended sessions. Participants with non-AD performed more sessions with high intensity in strength exercises than participants with AD (median interquartile range, 53.8% [25.7%-80%] vs 34.9% [2.02%-62.9%]; P = .035). Balance exercises were performed at high intensity at a median interquartile range of 75% (33.3%-88.6%). Adverse events (all minor and temporary, mostly musculoskeletal) occurred during the exercise sessions in 16% of attended sessions. Low motivation was the most common barrier for attendance. Buildup period, low motivation, and pain were common barriers for achieving high intensity in balance and strength exercises, and fear was a barrier in balance exercises. Of medical conditions, only behavioral and psychological symptoms of dementia, including apathy, were negatively associated with applicability.

    Conclusion: A group-based, supervised, and individualized high-intensity functional exercise program seems to be applicable with regard to attendance, achieved intensity, and adverse events during the exercise sessions, in people with mild to moderate dementia in nursing homes. Effective strategies to enhance motivation to participate in exercise, as well as prevention and treatment of pain and behavioral and psychological symptoms of dementia, are important when promoting exercise participation in this population.

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  • 33.
    Sondell, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. 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, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Motivation to participate in high-intensity functional exercise compared with a social activity in older people with dementia in nursing homes2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 11, article id e0206899Article in journal (Refereed)
    Abstract [en]

    Background: Motivation to participate in exercise among people with dementia has not been well studied. The symptoms of dementia, including apathy, may lead to low motivation to participate in exercise. The aim of this study was to evaluate the motivation of older people with dementia to participate in a high-intensity exercise program compared with motivation of those participating in a social group activity.

    Methods: The Umeå Dementia and Exercise Study (UMDEX) was a cluster-randomized controlled intervention trial including 186 people (mean age; 85, 75% female) with dementia in nursing homes. Participants were randomized to participate in the High-Intensity Functional Exercise (HIFE) Program (n = 93) or a seated social group activity (n = 93). The activities were conducted in groups of 3–8 participants for 45 minutes, five times per two-week period, for 4 months (40 sessions in total). Participants’ motivation to go to and during activity sessions were assessed by the activity leaders and nursing homes staff using a five-point Likert scale. Data were analyzed using cumulative link mixed models.

    Results: Motivation was high or very high during 61.0% of attended sessions in the exercise group and 62.6% in the social activity group. No overall significant difference between groups was observed, but motivation increased over time in the exercise group and decreased in the social activity group (p < 0.05). Motivation during the sessions was significantly higher than motivation to go to the sessions, especially in the exercise group [OR 2.39 (95% CI 2.38–2.40) and 1.50 (95% CI 1.32–1.70), respectively].

    Conclusions: Among older people with dementia in nursing homes, motivation to participate in a high-intensity functional exercise program seems to be high, comparable to motivation to participate in a social activity, and increase over time. Since motivation during activity sessions was higher than motivation to go to sessions the promotion of strategies to encourage people with dementia to join exercise groups is of great importance.

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  • 34.
    Toots, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. 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, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Boström, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    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.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Effects of exercise on cognitive function in older people with dementia: a randomized controlled trial2017In: Journal of alzheimers disease, ISSN 1387-2877, Vol. 60, no 1, p. 323-332Article in journal (Refereed)
    Abstract [en]

    Background: Although physical exercise has been suggested to influence cognitive function, previous exercise studies show inconsistent results in people with dementia. Objectives: To investigate effects of exercise on cognitive function in people with dementia. Method: The Umea a Dementia and Exercise (UMDEX) study, a cluster-randomized controlled trial, was set in 16 nursing homes in Umea, Sweden. One hundred-and-forty-one women and 45 men with dementia; mean age of 85 y and mean MiniMental State Examination (MMSE) score of 15, were randomized to a High-Intensity Functional Exercise program or a seated attention control activity. Blinded assessors measured global cognitive function using the MMSE and the Alzheimer's disease Assessment Scale -Cognitive subscale (ADAS-Cog), and executive function using Verbal fluency (VF) at baseline and 4 months (directly after intervention completion), and MMSE and VF at 7 months. Results: Linear mixed models showed no between-group effects in mean difference from baseline (95% confidence intervals, CI) at 4 months in MMSE (-0.27; 95% CI -1.4 to 0.87, p = 0.644), ADAS-Cog (-1.04, 95% CI -4 to 1.92, p = 0.491), or VF (-0.53, 95% CI -1.42 to 0.35, p = 0.241) or at 7 months in MMSE (-1.15, 95% CI -2.32 to 0.03, p = 0.056) or VF (-0.18, 95% CI -1.09 to 0.74, p = 0.707). Conclusion: A 4-month, high-intensity functional exercise program had no superior effects on global cognition or executive function in people with dementia living in nursing homes when compared with an attention control activity.

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  • 35.
    Toots, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. 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, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    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, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Walking aids moderate exercise effects on gait speed in people with dementia: a randomized controlled trial2017In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 18, no 3, p. 227-233Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the effects of exercise on gait speed, when tested using walking aids and without, and whether effects differed according to amount of support in the test.

    DESIGN: A cluster-randomized controlled trial.

    SETTING: The Umeå Dementia and Exercise (UMDEX) study was set in 16 nursing homes in Umeå, Sweden.

    PARTICIPANTS: One hundred forty-one women and 45 men (mean age 85 years) with dementia, of whom 145 (78%) habitually used walking aids.

    INTERVENTION: Participants were randomized to the high-intensity functional exercise program or a seated attention control activity.

    MEASUREMENTS: Blinded assessors measured 4-m usual gait speed with walking aids if any gait speed (GS), and without walking aids and with minimum amount of support, at baseline, 4 months (on intervention completion), and 7 months.

    RESULTS: Linear mixed models showed no between-group effect in either gait speed test at 4 or 7 months. In interaction analyses exercise effects differed significantly between participants who walked unsupported compared with when walking aids or minimum support was used. Positive between-group exercise effects on gait speed (m/s) were found in subgroups that walked unsupported at 4 and 7 months (GS: 0.07, P = .009 and 0.13, P < .001; and GS test without walking aids: 0.05, P = .011 and 0.07, P = .029, respectively).

    CONCLUSIONS: In people with dementia living in nursing homes exercise had positive effects on gait when tested unsupported compared with when walking aids or minimum support was used. The study suggests that the use of walking aids in gait speed tests may conceal exercise effects.

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  • 36.
    Toots, Annika
    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, Physiotherapy.
    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.
    Lindelöf, Nina
    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.
    Wiklund, Robert
    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.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    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.
    Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia2016In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 64, no 1, p. 55-64Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the effects of a high-intensity functional exercise program on independence in activities of  daily living (ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types.

    DESIGN: Cluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study.

    SETTING: Residential care facilities, Umeå, Sweden.

    PARTICIPANTS: Individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N = 186).

    INTERVENTION: Ninety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity.

    MEASUREMENTS: Blinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months.

    RESULTS: Linear mixed models showed no between-group effect on ADL independence at 4 (FIM=1.3, 95% confidence interval (CI)=-1.6-4.3; BI=0.6, 95% CI=-0.2-1.4) or 7 (FIM=0.8, 95% CI=-2.2-3.8; BI=0.6, 95% CI=-0.3-1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8-6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months.

    CONCLUSION: In older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia.

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  • 37.
    Toots, Annika
    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, Physiotherapy.
    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.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, 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.
    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.
    Usual gait speed independently predicts mortality in very old people: a population-based study2013In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 14, no 7, p. 529.e1-529.e6Article in journal (Refereed)
    Abstract [en]

    Objectives: In older people, usual gait speed has been shown to independently predict mortality; however, less is known about whether usual gait speed is as informative in very old populations, in which prevalence of multimorbidity and disability is high. The aim of this study was to investigate if usual gait speed can independently predict all-cause mortality in very old people, and whether the prediction is influenced by dementia disorder, dependency in activities of daily living (ADL), or use of walking aids in the gait speed test.

    Design: Prospective cohort study. Setting: Population-based study in northern Sweden and Finland (the Umea 85+/GERDA Study).

    Participants: A total of 772 participants with a mean age of 89.6 years, 70% women, 33% with dementia disorders, 54% with ADL dependency, and 39% living in residential care facilities.

    Measurements: Usual gait speed assessed over 2.4 meters and mortality followed-up for 5 years. Results: The mean +/- SD gait speed was 0.52 +/- 0.21 m/s for the 620 (80%) participants able to complete the gait speed test. Cox proportional hazard regression analyses adjusted for potential confounders were performed. Compared with the fastest gait speed group (>= 0.64 m/s), the hazard ratio for mortality was for the following groups: unable = 2.27 (P < .001), <= 0.36 m/s = 1.97 (P = .001), 0.37 to 0.49 m/s = 1.99 (P < .001), 0.50 to 0.63 m/s = 1.11 (P = .604). No interaction effects were found between gait speed and age, sex, dementia disorder, dependency in ADLs, or use of walking aids.

    Conclusion: Among people aged 85 or older, including people dependent in ADLs and with dementia disorders, usual gait speed was an independent predictor of 5-year all-cause mortality. Inability to complete the gait test or gait speeds slower than 0.5 m/s appears to be associated with higher mortality risk. Gait speed might be a useful clinical indicator of health status among very old people.

  • 38.
    Toots, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Wiklund, Robert
    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.
    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.
    Nordin, Ellinor
    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.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    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, Section of Physiotherapy.
    The Effects of Exercise on Falls in Older People With Dementia Living in Nursing Homes: A Randomized Controlled Trial2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 7, p. 835-842Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate exercise effects on falls in people with dementia living in nursing homes, and whether effects were dependent on sex, dementia type, or improvement in balance. A further aim was to describe the occurrence of fall-related injuries.

    DESIGN: A cluster-randomized controlled trial.

    SETTING AND PARTICIPANTS: The Umeå Dementia and Exercise study was set in 16 nursing homes in Umeå, Sweden and included 141 women and 45 men, a mean age of 85 years, and with a mean Mini-Mental State Examination score of 15.

    INTERVENTION: Participants were randomized to the high-intensity functional exercise program or a seated attention control activity; each conducted 2-3 times per week for 4 months.

    MEASURES: Falls and fall-related injuries were followed for 12 months (after intervention completion) by blinded review of medical records. Injuries were classified according to severity.

    RESULTS: During follow-up, 118(67%) of the participants fell 473 times in total. At the interim 6-month follow-up, the incidence rate was 2.7 and 2.8 falls per person-year in exercise and control group, respectively, and at 12-month follow-up 3.0 and 3.2 falls per person-year, respectively. Negative binomial regression analyses indicated no difference in fall rate between groups at 6 or 12 months (incidence rate ratio 0.9, 95% confidence interval (CI) 0.5-1.7, P = .838 and incidence rate ratio 0.9, 95% CI 0.5-1.6, P = .782, respectively). No differences in exercise effects were found according to sex, dementia type, or improvement in balance. Participants in the exercise group were less likely to sustain moderate/serious fall-related injuries at 12-month follow-up (odds ratio 0.31, 95% CI 0.10-0.94, P = .039).

    CONCLUSIONS/IMPLICATIONS: In older people with dementia living in nursing homes, a high-intensity functional exercise program alone did not prevent falls when compared with an attention control group. In high-risk populations, in which multimorbidity and polypharmacy are common, a multifactorial fall-prevention approach may be required. Encouraging effects on fall-related injuries were observed, which merits future investigations.

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  • 39. Von Heideken Wågert, Petra
    et al.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Johansson, Annette
    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.
    Jumping exercises with and without raloxifene treatment in healthy elderly women.2002In: Journal of Bone and Mineral Metabolism, ISSN 0914-8779, E-ISSN 1435-5604, Vol. 20, no 6, p. 376-82Article in journal (Refereed)
    Abstract [en]

    Several meta-analyses confirm that physical exercise can slow down postmenopausal bone loss, but it is not clear whether physical exercise alone can increase bone mass. Our intent was to evaluate high-impact exercises (including jumping) and combined balance and leg-strength training, with and without raloxifene treatment, in three healthy elderly women, age 68-71 years. The 40-week study period consisted of two 17-week exercise periods with a 6-week rest period in between. The jumping exercises were performed both vertically and in different directions. Effects were measured in bone mineral density (BMD), balance, maximal gait speed, and leg extensor strength. BMD (g/cm(2)) was measured with dual-energy X-ray photon absorptiometry (DXA) at the proximal femur, lumbar spine, and total body. After the first exercise period, large losses of trochanteric BMD (8.1%-10.8%) were seen in all subjects. After both 6 weeks of rest and the second exercise period, which included both exercise and raloxifene, BMD increased in all subjects. During both exercise periods, the balance, gait speed, and leg extensor strength increased in all subjects. The results show that this kind of high-impact exercise had limited effects on BMD, but had large positive effects on balance, gait speed, and leg extensor strength. In conclusion, high-impact exercise in elderly women improves their fall risk factors, but, at least without raloxifene treatment, the trochanteric fracture risk might even increase because of reduction in the regional bone mass.

  • 40.
    Weidung, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Boström, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Toots, Annika
    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.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, 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. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Blood Pressure, Gait Speed, and Mortality in Very Old Individuals: A Population-Based Cohort Study2015In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 16, no 3, p. 208-214Article in journal (Refereed)
    Abstract [en]

    Objectives: Clinical trials and observational studies have produced contradictory results regarding the association of blood pressure (BP) and mortality in people aged 80 years or older. Gait speed at usual pace has been shown to moderate this association in a population of noninstitutionalized people aged 65 years or older. The aims of this study were to investigate the association of BP with all-cause mortality in a representative sample of people aged 85 years or older and to assess whether gait speed moderates this association.

    Design, Setting, and Participants: A total of 806 participants in the population-based prospective Umeå 85+/GERDA study aged 85, 90, and 95 years or older.

    Measurements: Gait speed at usual pace was measured over 2.4 m. The main outcome was hazard ratios (HRs) for all-cause mortality according to systolic and diastolic BP categories in the total sample and in faster-walking (≥0.5 m/s, n = 312) and slower-walking (<0.5 m/s, n = 433) subcohorts; the latter also included habitually nonwalking participants. Comprehensive adjustments were made for sociodemographic and clinical characteristics associated with death.

    Results: Mean age and baseline systolic and diastolic BP were 89.6 ± 4.6 years, 146.8 ± 23.9 mm Hg, and 74.8 ± 11.1 mm Hg, respectively. Most (n = 561 [69%]) participants were women, 315 (39%) were care facility residents, and 566 (70%) were prescribed BP-lowering drugs. Within 5 years, 490 (61%) participants died. In the total sample and slower-walking subcohort, systolic BP appeared to be inversely associated with mortality, although not independent of adjustments. Among faster-walking participants, mortality risk after adjustment was more than 2 times higher in those with systolic BP of 140 to 149 mm Hg (HR = 2.25, 95% confidence interval [CI] = 1.03–4.94) and 165 mm Hg or higher (HR = 2.13, 95% CI = 1.01–4.49), compared with systolic BP of 126 to 139 mm Hg. Mortality risk was also independently higher in faster-walking participants with diastolic BP higher than 80 mm Hg, compared with diastolic BP of 75 to 80 mm Hg (HR = 1.76, 95% CI = 1.07–2.90).

    Conclusion: The gait speed threshold of 0.5 m/s may be clinically useful for the distinction of very old people with and without increased all-cause mortality risk due to elevated systolic and diastolic BP.

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  • 41.
    Weidung, Bodil
    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.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    The association between SBP and mortality risk differs with level of cognitive function in very old individuals2016In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 34, no 4, p. 745-752Article in journal (Refereed)
    Abstract [en]

    Objective:Cognitive impairment and dementia are highly prevalent in very old populations. Cardiovascular disease is a common cause of death in people with dementia.This study investigated whether the association of blood pressure (BP) with mortality differed with respect to mini-mental state examination (MMSE) score in a representative sample of very old individuals.Methods:The sample consisted of 1115 participants aged 85, 90, and at least 95 years from the Umea85+/GErontological Regional DAtabase cohort study. The main outcome was all-cause mortality within 2 years according to BP and MMSE score, using Cox proportional-hazard regression models adjusted for sociodemographic and clinical characteristics associated with death.Results:Mean age, MMSE score, and SBP and DBP were 89.44.6 years, 21.1 +/- 7.6, 146.1 +/- 23.4mmHg, and 74.1 +/- 11.7mmHg, respectively. Within 2 years, 293 (26%) participants died. BP was not associated independently with mortality risk, except among participants with MMSE scores of 0-10 among whom mortality risk was increased in association with SBP at least 165mmHg and 125mmHg or less, compared with 126-139mmHg (adjusted hazard ratio 4.54, 95% confidence interval=1.52-13.60 and hazard ratio 2.23, 95% confidence interval=1.12-4.45, respectively). In age and sex-adjusted analyses, SBP 125mmHg or less was associated with increased mortality risk in participants with MMSE scores at least 18.Conclusion:In people aged at least 85 years, the association of SBP with mortality appears to differ with respect to MMSE score. Very old individuals with very severe cognitive impairment and low or high BP may have increased mortality risk.

  • 42.
    Weidung, Bodil
    et al.
    Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden.
    Lövheim, Hugo
    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.
    Wahlin, Johanna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    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.
    Temporal dementia and cognitive impairment trends in the very old in the 21st century2023In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 93, no 1, p. 61-74Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Long-increasing dementia incidence and prevalence trends may be shifting. Whether such shifts have reached the very old is unknown.

    OBJECTIVE: To investigate temporal trends in the incidence of dementia and cognitive impairment and prevalence of dementia, cognitive impairment, Alzheimer's disease, vascular dementia, and unclassified dementia among 85-, 90-, and ≥ 95-year-olds in Sweden during 2000-2017.

    METHODS: This study was conducted with Umeå 85 + /Gerontological Regional Database data from 2182 85-, 90-, and ≥ 95-year-olds in Sweden collected in 2000-2017. Using logistic regression, trends in the cumulative 5-year incidences of dementia and cognitive impairment; prevalences of dementia, cognitive impairment, Alzheimer's disease, and vascular dementia; and Mini-Mental State Examination thresholds for dementia diagnosis were estimated.

    RESULTS: Dementia and cognitive impairment incidences decreased in younger groups, which generally showed more-positive temporal trends. The prevalences of overall dementia, cognitive impairment, and Alzheimer's disease were stable or increasing; longer disease durations and increasing dementia subtype classification success may mask positive changes in incidences. Vascular dementia increased while unclassified dementia generally decreased. CONCLUSION: The cognitive health of the very old may be changing in the 21st century, possibly indicating a trend break.

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  • 43.
    Wiklund, Robert
    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, Physiotherapy.
    Toots, Annika
    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.
    Conradsson, Mia
    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.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. 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. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Risk factors for hip fracture in very old people: a population-based study2016In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, no 3, p. 923-931Article in journal (Refereed)
    Abstract [en]

    Knowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson's disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development.

    INTRODUCTION: The purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people.

    METHODS: In total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression.

    RESULTS: Participants had a mean age of 89.3 ± 4.7 years; 65.8 % were women, 36.8 % lived in residential care facilities, 33.6 % had dementia, and 20.4 % had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1 %) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR] = 8.57; 95 % confidence interval [CI], 1.90-38.71), Parkinson's disease (HR = 5.12; 95 % CI, 1.82-14.44), currently smoking (HR = 4.38; 95 % CI 2.06-9.33), delirium in the previous month (HR = 2.01; 95 % CI, 1.15-3.49), underweight (body mass index <22; HR = 1.74, 95 % CI, 1.09-2.77), and age (HR = 1.09; 95 % CI, 1.04-1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR = 0.37; 95 % CI, 0.15-0.91), but only for those with bilateral hip prostheses.

    CONCLUSIONS: Seven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.

  • 44.
    Öhlin, Jerry
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Ahlgren, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Folkesson, Robert
    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.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    The association between cognition and gait in a representative sample of very old people - the influence of dementia and walking aid use2020In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, article id 34Article in journal (Refereed)
    Abstract [en]

    Background: Cognition has been related with gait speed in older adults; however, studies involving the oldest age group, where many have mobility disability and cognitive impairment, are few. The aim was to investigate the association between global cognitive function and gait speed in a representative sample of very old people, and whether the association was affected by dementia, and walking aid use.

    Method: This cross-sectional study included 1317 participants, mean age 89.4 years, and 68% women, from the Umeå85+/Gerontological Regional Database. Self-paced gait speed was measured over 2.4 m, with or without walking aids, and global cognitive function with the Mini-Mental State Examination (MMSE). The association between cognition and gait speed was analyzed using multiple linear regression and stratified according to dementia. The influence of missing gait speed values was explored using multiple imputation. An interaction analysis was performed to investigate the influence of walking aid use.

    Results: In comprehensively adjusted analyses, MMSE associated with gait speed (unstandardized β (β) 0.011 m/s, 95% Confidence Interval [CI] = 0.009, 0.013, p < 0.001) in the total sample. No association was found in people with dementia (β 0.003 m/s, 95%CI = 0.000, 0.006, p = 0.058), until missing gait speed values were compensated for by multiple imputation (β 0.007 m/s, 95% [CI] = 0.002, 0.011, p = 0.002). In interaction analysis the use of walking aids attenuated the association between cognition and gait speed (β − 0.019 m/s, 95%CI = − 0.024, − 0.013, p < 0.001).

    Conclusion: Global cognitive function appears to associate with gait speed in very old people. However, in people with dementia selection bias was indicated since unless missing gait speed values were accounted for no association was observed. Walking aid use attenuated cognitive load, which may not apply to walking in daily activities, and requires further investigation.

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  • 45.
    Öhlin, Jerry
    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.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Low or declining gait speed is associated with risk of developing dementia over 5 years among people aged 85 years and over2021In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 29, no 4, p. 678-685Article in journal (Refereed)
    Abstract [en]

    Improving dementia screening procedures beyond simple assessment of current cognitive performance is timely given the ongoing phenomenon of population aging. A slow or declining gait speed (GS) is a potential early indicator of cognitive decline scarcely investigated in very old people. Here, we investigated the 5-year associations of baseline GS, change in GS, and cognitive function with subsequent dementia development in people aged 85 years and older (n = 296) without dementia at baseline. Declining and a slow baseline GS were associated with higher odds of dementia development after adjusting for confounders (e.g., age, sex, and dependency in activities of daily living) and missing GS values at follow-up. The GS decline was associated with cognitive decline in participants who developed dementia. The results support the potential of GS tests to predict future cognitive decline among community- and nursing home-dwelling very old people.

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  • 46.
    Öhlin, Jerry
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Dahlin Almevall, Albin
    Department of Development, Region Norrbotten, Luleå, Sweden.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Niklasson, Johan
    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.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Concurrent validity of the International Physical Activity Questionnaire adapted for adults aged ≥ 80 years (IPAQ-E 80 +) - tested with accelerometer data from the SilverMONICA study2022In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 92, p. 135-143Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity and sedentary behavior vary across the life span, and in very old people activity behavior can vary considerably over 24 h. A physical activity questionnaire adapted for this age group is lacking. This study was conducted to validate such a newly developed questionnaire suitable for use in very old people.

    Research question: Is the International Physical Activity Questionnaire adapted for adults aged ≥ 80 years (IPAQ-E 80 +) a valid measure of physical activity in very old people?

    Methods: Seventy-six participants (55.3% women) with a mean age of 84.4 ± 3.8 years wore accelerometers for ≥ 5 consecutive days, and completed the IPAQ-E 80 +. Spearman's rho and Bland-Altman plots were used to analyze the validity of IPAQ-E 80 + against accelerometer measures. Analyses were conducted for the separate items sitting, laying down at daytime and nighttime, walking, moderate to vigorous (MV) walking, and moderate to vigorous physical activity (MVPA), and the summary measures: total inactive time, sedentary time (i.e. lying down at daytime + sitting), total active time, and total MVPA + MV walking.

    Results: The IPAQ-E 80 + correlated with the accelerometer measures of total inactive- (r = 0.55, p < 0.001), sedentary- (r = 0.28, p = 0.015), walking- (r = 0.54 p < 0.001) and total active- (r = 0.60, p < 0.001) times, but not with measures of intensity of walking or physical activity; MV walking (r = 0.06, p = 0.58), MVPA (r = 0.17, p = 0.13).

    Significance: In this study the IPAQ-E 80 + showed fair to substantial correlations with accelerometers, and it therefore seems able to rank very old people according to levels of PA (total inactive-, sedentary-, and total active time, and walking time). The IPAQ-E 80 + seems promising for use in studies investigating associations between activity behavior and health in this population. Further investigation is needed to determine whether the IPAQ-E 80 + can accurately measure PA intensity.

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  • 47.
    Öhlin, Jerry
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Toots, Annika
    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.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family 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.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Niklasson, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Physical activity in late middle- to older-aged people and dementia, cognitive, and physical function two decades later2022In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 51, p. 135-141Article in journal (Refereed)
    Abstract [en]

    Introduction: Low physical activity (PA) is a potential risk factor for dementia and cognitive impairment. However, few studies have focused on very old people (aged ≥80 years), the age group with highest prevalence of dementia. The aim was to investigate if PA associated with subsequent dementia, cognitive function, and gait speed (GS), in very old people.

    Methods: A population-based survey was conducted in 1999 and followed-up between 2016 and 2019 in participants ≥80 years. Altogether 541 individuals (56.2% women), 64.9 ± 4.2 years of age at baseline participated. Self-rated baseline PA was categorized into low, medium, or high. Cognitive function was assessed with the Mini-Mental State Examination (MMSE), executive function with the Frontal Assessment Battery (FAB), and GS (in meters/second) was measured over 2.4 m at follow-up.

    Results: During a mean of 19.0 ± 1.1 years, 175 (32.3%) developed dementia. Low or medium PA compared to high PA did not associate with subsequent dementia, and PA did not associate with future cognitive function (MMSE). PA associated with executive function (FAB) (unstandardized beta [95% confidence interval]) (0.67 [0.07–1.27]), but not after adjustments. PA associated with subsequent GS in the unadjusted model and after adjustment for age, sex, smoking, and education (0.06 [0.02–0.09], and 0.04 [0.01–0.08], respectively), but not after adding adjustment for hypertension, obesity, and glucose intolerance.

    Conclusion: No support was found for the hypothesis that low PA is a potential risk factor for dementia in very high age. However, PA and executive function were associated in unadjusted analyses which indicate that PA may be important for at least one aspect of cognitive function. The association between PA and GS around 2 decades later seems attenuated by cardiometabolic risk factors. Future investigations regarding PA, dementia, and cognitive decline may consider cardiometabolic risk factors such as hypertension, obesity, and glucose intolerance, and include repeated measures of PA over the life course.

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