| 61. |
- Gustafson, Deborah, 1966, et al.
(författare)
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Adiposity indicators and dementia over 32 years in Sweden
- 2009
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Ingår i: Neurology. - 1526-632X. ; 73:19, s. 1559-66
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: High midlife and late-life adiposity may increase risk for dementia. Late-life decrease in body mass index (BMI) or body weight within several years of a dementia diagnosis has also been reported. Differences in study designs and analyses may provide different pictures of this relationship. METHODS: Thirty-two years of longitudinal body weight, BMI, waist circumference, and waist-to-hip ratio (WHR) data, from the Prospective Population Study of Women in Sweden, were related to dementia. A representative sample of 1,462 nondemented women was followed from 1968 at ages 38-60 years, and subsequently in 1974, 1980, 1992, and 2000, using neuropsychiatric, anthropometric, clinical, and other measurements. Cox proportional hazards regression models estimated incident dementia risk by baseline factors. Logistic regression models including measures at each examination were related to dementia among surviving participants 32 years later. RESULTS: While Cox models showed no association between baseline anthropometric factors and dementia risk, logistic models showed that a midlife WHR greater than 0.80 increased risk for dementia approximately twofold (odds ratio 2.22, 95% confidence interval 1.00-4.94, p = 0.049) among surviving participants. Evidence for reverse causality was observed for body weight, BMI, and waist circumference in years preceding dementia diagnosis. CONCLUSIONS: Among survivors to age 70, high midlife waist-to-hip ratio may increase odds of dementia. Traditional Cox models do not evidence this relationship. Changing anthropometric parameters in years preceding dementia onset indicate the dynamic nature of this seemingly simple relationship. There are midlife and late-life implications for dementia prevention, and analytical considerations related to identifying risk factors for dementia.
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| 62. |
- Gustafson, Deborah, 1966, et al.
(författare)
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Leptin and dementia over 32 years-The Prospective Population Study of Women
- 2012
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Ingår i: Alzheimers & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 8:4, s. 272-277
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Tidskriftsartikel (refereegranskat)abstract
- Background: We have shown that high mid-life central adiposity may increase the risk for dementia after 32 years. Leptin, an adipose tissue hormone, is correlated with adiposity measures and may contribute to a better etiological understanding of the relationship between high adiposity and dementia. We explored the relationship between serum leptin in mid-life and dementia, which is a late-life outcome. Methods: A longitudinal cohort study, the Prospective Population Study of Women, in Gothenburg, Sweden, includes a representative sample of 1462 women followed from mid-life ages of 38 to 60 years to late-life ages of 70 to 92 years. Women were examined in 1968, 1974, 1980, 1992, and 2000 using neuropsychiatric, anthropometric, clinical, and other measurements. Serum leptin was measured on samples collected at the 1968 baseline examination, after storage at -20 degrees C for 29 years. Cox proportional hazards regression models estimated incident dementia risk by baseline leptin. Logistic regression models related leptin levels to dementia among surviving participants 32 years later. All models were adjusted for multiple potential confounders. Results: Mid-life leptin was not related to dementia risk using Cox or logistic regression models. This was observed despite positive baseline correlations between leptin and adiposity measures, and given our previous report of high mid-life waist-to-hip ratio being related to a twofold higher dementia risk. Conclusions: Leptin is not a mid-life marker of late-life dementia risk in this population sample of Swedish women born between 1908 and 1930. (C) 2012 The Alzheimer's Association. All rights reserved.
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| 63. |
- Gustafsson, Susanne, 1963, et al.
(författare)
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A Cross-Cultural Adaptation of the ICECAP-O: Reliability and Validity in Swedish 70-Year-Old Persons
- 2017
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Ingår i: 21st International Association of Gerontology and Geriatrics (IAGG) World Congress, July 23-27, 2017 San Francisco, California. Innovation in Aging, 1 (S1), s. 752. - : Oxford University Press (OUP). - 2399-5300.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Few Quality of Life (QoL) measures tap into the concept of capability, i.e. genuine opportunities to 'do' and 'be' the things that a person deems important in life. The ICECAP-O is one such instrument. This presentation includes test-retest reliability, item relevance, face- and content validity, and accessibility of the ICECAP-O in a Swedish context. Thirty-nine 70-year-olds who took part in a population-based study completed the Swedish version of the ICECAP-O on two occasions, and another 18 partook in cognitive interviews. Test-retest reliability was analyzed for the index and separate items, and participants rated item relevance on a Visual Analogue Scale. A standardized classification scheme was used to quantify any identified response problems, and a thematic analysis was applied to capture participants’ experiences of completing the measure and perceptions of included attributes. Test-retest showed that the index score had good stability, ICC of 0.80 (95 % CI 0.62-0.90). However, Kappa was low for each separate item, and ranged from 0.18 (Control) to 0.41 (Role). Participants gave their highest relevance rating to Attachment and the lowest to Enjoyment. In the cognitive interviews, three participants (18%) had problems completing ICECAP-O, and out of 80 question segments, judged problems occurred for five (6%). Most participants perceived the attributes as understandable even though the meaning of Control brought some uncertainty. ICECAP-O has potential for becoming a valuable addition to the supply of QoL measures in research and health and social care in Sweden. However, we recommend further research on more diverse groups of older person.
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| 64. |
- Haglund, A., et al.
(författare)
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Interpersonal violence and the prediction of short-term risk of repeat suicide attempt
- 2016
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- In this multi-center cohort study, suicide attempters presenting to hospital (N = 355, 63% women) were interviewed using the Karolinska Interpersonal Violence Scale (KIVS) and followed-up by medical record review. Main outcome was non-fatal or fatal repeat suicide attempt within six months. Also, repeat attempt using a violent method was used as an additional outcome in separate analyses. Data were analyzed for the total group and for men and women separately. Repeat attempts were observed within six months in 78 persons (22%) and 21 (6%) of these used a violent method. KIVS total score of 6 or more was associated with repeat suicide attempt within six months (OR = 1.81, CI 1.08-3.02) and predicted new attempts with a sensitivity of 62% and a specificity of 53%. A three-fold increase in odds ratio was observed for repeat attempt using a violent method (OR = 3.40, CI 1.22-9.49). An association between exposure to violence in adulthood and violent reattempt was seen in women (OR = 1.38, CI 1.06-1.82). The overall conclusions are that information about interpersonal violence may help predict short-term risk for repeat suicide attempt, and that structured assessment of interpersonal violence may be of value in risk assessment after attempted suicide.
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| 65. |
- Hed, Sara, et al.
(författare)
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Depressive symptoms across the retirement transition in men and women: associations with emotion regulation, adjustment difficulties and work centrality
- 2024
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Ingår i: BMC GERIATRICS. - 1471-2318. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundRetirement is a major life event and factors driving depression in the retirement transition might differ in men and women. The aim was to prospectively study depressive symptoms across the retirement transition in men and women and to test associations with emotion regulation strategies (suppression and reappraisal), adjustment difficulties, and work centrality.MethodsThe sample included 527 individuals from the population-based Health, Aging and Retirement Transitions in Sweden (HEARTS) study who were working at baseline and retired during one of the following four annual measurement waves. Participants contributed with a total of 2635 observations across five measurement waves. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D); total score was modelled as a function of time to and from retirement. Changes over the retirement transition were analyzed with multilevel growth curve models. Gender differences in associations with emotion regulation, adjustment difficulties and work centrality were examined by including interaction effects with sex.ResultsWe observed a general reduction of depressive symptoms in the early years of retirement in both men and women. Higher suppression was related to higher depression scores while higher cognitive reappraisal was related to lower levels of depressive symptoms. Women more often used cognitive reappraisal, and men more often suppression, but no significant gender interaction in associations with depressive symptoms could be shown. Retirement adjustment difficulties and greater importance of work for self-esteem were related to higher depression scores. Greater meaning of work, on the other hand, was related to lower levels of depressive symptoms, and this association was stronger in men.ConclusionsThere was a general reduction of depression scores in the early years of retirement in both women and men. Findings suggest that basing one's self-esteem on workplace performance was related to higher levels of depressive symptoms after retirement, while perceiving one's job as important and meaningful may facilitate better adjustment in terms of lower depression symptom levels, especially in men.
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| 66. |
- Hed, Sara, et al.
(författare)
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Gender differences in resources related to depressive symptoms during the early years of retirement: A Swedish population-based study
- 2020
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 35:11, s. 1301-1308
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd Objectives: To examine levels of depressive symptoms during the early years of retirement in men and women and to investigate potential gender differences in associations with self-reported health, financial insecurity, social network and psychological resources. Methods: Data was drawn from the first wave in the Health, Aging and Retirement Transitions in Sweden-study (HEARTS) including a total sample of 1148 retirees, aged 60 to 66. Level of depressive symptoms and associations with health, financial insecurity, social network and psychological resources were investigated in regression analyses in the total sample and in bivariate correlation analyses in the subgroup at risk of depression as defined by a cut-off ≥9 on the Center for Epidemiologic Studies Depression Scale (CES-D). Results: Mean CES-D scores were similar in men and women in the entire sample. The CES-D identified 144 individuals at risk of depression (men 14%, women 11%, n.s.). Although the pattern of related resources was similar in men and women, a greater proportion of the variance was explained in the male group (51% vs 37%). Health, quality of social network, social support and competence satisfaction were all correlated with depressive symptoms in men in the high risk group, but no associations were seen in women. Conclusions: Similar levels of depressive symptoms were observed in women and men in the retirement transition. However, the relevance of the selected resources may be greater in men. Research on the management of depressive symptoms in the transition between midlife and aging needs to take gender into consideration.
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| 67. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Antidepressant Use and Suicide Rates in Adults Aged 75 and Above: A Swedish Nationwide Cohort Study
- 2021
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Ingår i: Frontiers in Public Health. - : Frontiers Media SA. - 2296-2565. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: The treatment of depression is a main strategy for suicide prevention in older adults. We aimed to calculate suicide rates by antidepressant prescription patterns in persons aged >= 75 years. A further aim was to estimate the contribution of antidepressants to the change in suicide rates over time. Methods: Swedish residents aged >= 75 years (N = 1,401,349) were followed between 2007 and 2014 in a national register-based retrospective cohort study. Biannual suicide rates were calculated for those with selective serotonin reuptake inhibitor (SSRI) single use, mirtazapine single use, single use of other antidepressants and use of >= 2 antidepressants. The contribution of antidepressants to the change in biannual suicide rates was analyzed by decomposition analysis. Results: There were 1,277 suicides. About one third of these were on an antidepressant during their last 3 months of life. In the total cohort, the average biannual suicide rate in non-users of antidepressants was 13 per 100,000 person-years. The corresponding figure in users of antidepressants was 34 per 100,000 person-years. These rates were 25, 42 and 65 per 100,000 person-years in users of SSRI, mirtazapine and >= 2 antidepressants, respectively. In the total cohort, antidepressant users contributed by 26% to the estimated increase of 7 per 100,000 in biannual suicide rates. In men, biannual suicide rates increased by 11 suicides per 100,000 over the study period; antidepressant users contributed by 25% of the change. In women, those on antidepressant therapy accounted for 29% of the estimated increase of 4.4 per 100,000. Conclusion: Only one third of the oldest Swedish population who died by suicide filled an antidepressant prescription in their last 3 months of life. Higher suicide rates were observed in mirtazapine users compared to those on SSRIs. Users of antidepressants accounted for only one quarter of the increase in the suicide rate. The identification and treatment of suicidal older adults remains an area for prevention efforts.
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| 68. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Antidepressants and suicidal behaviour in late life: a prospective population-based study of use patterns in new users aged 75 and above.
- 2018
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Ingår i: European journal of clinical pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 74, s. 201-208
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Tidskriftsartikel (refereegranskat)abstract
- To investigate associations between antidepressant use patterns and risk of fatal and non-fatal suicidal behaviours in older adults who initiated antidepressant therapy.A national population-based cohort study conducted among Swedish residents aged ≥75years who initiated antidepressant treatment. Patients who filled antidepressant prescriptions between January 1, 2007 and December 31, 2013 (N=185,225) were followed until December 31, 2014. Sub-hazard ratios of suicides and suicide attempts associated with use patterns of antidepressants, adjusting for potential confounders such as serious depression were calculated using the Fine and Gray regression models.During follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) were increased for both outcomes in those who switched to another antidepressant (aSHR for suicide 2.42, 95% confidence interval 1.65 to 3.55, and for attempt 1.76, 1.32 to 2.34). Elevated suicide risks were also observed in those who concomitantly filled anxiolytics (1.54, 1.20 to 1.96) and hypnotics (2.20, 1.69 to 2.85). Similar patterns were observed for the outcome suicide attempt. Decreased risk of attempt was observed among those with concomitant use of anti-dementia drugs (0.40, 0.27 to 0.59).Switching antidepressants, as well as concomitant use of anxiolytics or hypnotics, may constitute markers of increased risk of suicidal behaviours in those who initiate antidepressant treatment in very late life. Future research should consider indication biases and the clinical characteristics of patients initiating antidepressant therapy.
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| 69. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Determinants of suicidal behavior in dementia: A Swedish national register-based study
- 2023
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Ingår i: International Psychogeriatrics. - 1041-6102.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:To examine predictors of suicidal behavior (SB) in adults aged 75 years and above with dementia.Design:Longitudinal national register-based study.Participants and setting:Swedish residents aged & GE;75 years with dementia identified in the Swedish Dementia Registry (SveDem) between 1 January 2007 and 31 December 2017 (N = 59 042) and followed until 31 December 2018. Data were linked with numerous national registers using personal identity numbers.Measurements:Outcomes were nonfatal self-harm and suicide. Fine and Gray regression models were used to investigate demographics, comorbidities, and psychoactive medications associated with fatal and nonfatal SB.Results:Suicidal behavior was observed in 160 persons after dementia diagnosis; 29 of these died by suicide. Adjusted sub-hazard ratio (aSHRs) for SB was increased in those who had a previous episode of self-harm (aSHR = 14.42; 95% confidence interval [CI] = 7.06-29.46), those with serious depression (aSHR = 4.33, 95%CI = 2.94-6.4), and in those born outside Sweden (aSHR = 1.53; 95% CI = 1.03-2.27). Use of hypnotics or anxiolytics was also associated with a higher risk of SB; use of antidepressants was not. Milder dementia and higher frailty score also increased risk of SB. Risk was decreased in those who received home care (aSHR = 0.52; 95%CI = 0.38-0.71) and in the oldest group (aSHR = 0.35; 95%CI = 0.25-0.49).Conclusion:In addition to established targets for suicidal behavior prevention (improved identification and treatment of depression and previous self-harm), several new risk factors were suggested. There is a need for innovative public health strategies to meet the needs of older dementia patients with a foreign background. Home care may have a potential positive effect to prevent SB in people with dementia, but this needs to be further explored.
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| 70. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Healthcare visits for mental disorders and use of psychotropic medications before and after self-harm in a cohort aged 75
- 2023
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Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 27:10, s. 2052-2060
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesNon-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode.MethodLongitudinal population-based study in adults aged >= 75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode.ResultsThere were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care.ConclusionThe use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.
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