| 1. |
- Grande, Giulia, et al.
(författare)
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Co-occurrence of cognitive impairment and physical frailty, and incidence of dementia : Systematic review and meta-analysis
- 2019
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Ingår i: Neuroscience and Biobehavioral Reviews. - : Elsevier BV. - 0149-7634 .- 1873-7528. ; 107, s. 96-103
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Cognitive impairment and frailty are important health determinants, independently associated with increased dementia risk. In this meta-analysis we aimed to quantify the association of the co-occurrence of cognitive impairment no dementia (CIND) and physical frailty with incident dementia. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used when reporting this review. We performed a systematic search on PubMed, Web of Science, and Embase databases for relevant articles. Longitudinal studies enrolling individuals with both CIND and physical frailty and reporting dementia incidence were eligible. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Results: Out of 3684 articles, five (14302 participants) were included in the meta-analysis. In comparison to participants free from frailty and CIND, the pooled hazard ratio for dementia was 3.83 (95% confidence interval (CI]: 2.64-5.56) for isolated CIND, 1.47 (95%CI: 0.89-2.40) for isolated physical frailty, and 5.36 (95%CI: 3.26-8.81) for their co-occurrence. Discussion: The co-occurrence of cognitive impairment and physical frailty is a clinical marker of incident dementia.
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| 2. |
- Calderón-Larrañaga, Amaia, et al.
(författare)
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Assessing and Measuring Chronic Multimorbidity in the Older Population : A Proposal for Its Operationalization
- 2017
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Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1079-5006 .- 1758-535X. ; 72:10, s. 1417-1423
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAlthough the definition of multimorbidity as the simultaneous presence of two or more chronic diseases is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity. MethodsBased on a consensus definition of chronic disease, all four-digit level codes from the International Classification of Diseases, 10th revision (ICD-10) were classified as chronic or not by an international and multidisciplinary team. Chronic ICD-10 codes were subsequently grouped into broader categories according to clinical criteria. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) using also inpatient data from the Swedish National Patient Register.ResultsA disease or condition was considered to be chronic if it had a prolonged duration and either (a) left residual disability or worsening quality of life or (b) required a long period of care, treatment, or rehabilitation. After applying this definition in relation to populations of older adults, 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had >= 2 of these 60 disease categories, 73.2% had >= 3, and 55.8% had >= 4.ConclusionsThis operational measure of multimorbidity, which can be implemented using either or both clinical and administrative data, may facilitate its monitoring and international comparison. Once validated, it may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care.
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| 3. |
- Calderón-Larrañaga, Amaia, et al.
(författare)
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Rapidly developing multimorbidity and disability in older adults : does social background matter?
- 2018
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 283:5, s. 489-499
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Tidskriftsartikel (refereegranskat)abstract
- Background. Multimorbidity is among the most disabling geriatric conditions. In this study, we explored whether a rapid development of multi morbidity potentiates its impact on the functional independence of older adults, and whether different sociodemographic factors play a role beyond the rate of chronic disease accumulation. Methods. A random sample of persons aged >= 60 years (n = 2387) from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) was followed over 6 years. The speed of multimorbidity development was estimated as the rate of chronic disease accumulation (linear mixed models) and further dichotomized into the upper versus the three lower rate quartiles. Binomial negative mixed models were used to analyse the association between speed of multimorbidity development and disability (impaired basic and instrumental activities of daily living), expressed as the incidence rate ratio (IRR). The effect of sociodemographic factors, including sex, education, occupation and social network, was investigated. Results. The risk of new activity impairment was higher among participants who developed multi morbidity faster (IRR 2.4, 95% Cl 1.9-3.1) compared with those who accumulated diseases more slowly overtime, even after considering the baseline number of chronic conditions. Only female sex (IRR for women vs. men 1.6, 95% Cl 1.2-2.0) and social network (IRR for poor vs. rich social network 1.7, 95% Cl 1.3-2.2) showed an effect on disability beyond the rate of chronic disease accumulation. Conclusions. Rapidly developing multimorbidity is a negative prognostic factor for disability. However, sociodemographic factors such as sex and social network may determine older adults' reserves of functional ability, helping them to live independently despite the rapid accumulation of chronic conditions.
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| 4. |
- Grande, Giulia, et al.
(författare)
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Cognitive and physical markers of prodromal dementia : A 12-year-long population study
- 2020
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 16:1, s. 153-161
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim is to test whether adding a simple physical test such as walking speed (WS) to the neuropsychological assessment increases the predictive ability to detect dementia.Methods: The 2546 dementia-free people from the SNAC-K study were grouped into four profiles: (1) healthy profile; (2) isolated cognitive impairment, no dementia (CIND, scoring 1.5 standard deviation below age-specific means on >= 1 cognitive domains); (3) isolated slow WS (<0.8 m/s); (4) CIND+ slow WS. The hazard of dementia (Cox regression), the positive and negative predictive values (PPV, NPV), and the area under the curve (AUC) were estimated.Results: Participants with CIND +slow WS demonstrated the highest hazard of dementia (3.4; 95% confidence interval [CI]: 2.5-4.8). The AUC increased from 0.69 for isolated CIND to 0.83 for CIND+ slow WS. Such an increase was due to the improvement of the PPV, the NPV remaining optimal.Discussion: Adding WS to the cognitive assessment dramatically increases the diagnostic accuracy of prodromal dementia.
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| 5. |
- Grande, Giulia, et al.
(författare)
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Disability trajectories and mortality in older adults with different cognitive and physical profiles
- 2020
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Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32:6, s. 1007-1016
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Tidskriftsartikel (refereegranskat)abstract
- Background Cognitive and physical deficits independently raise the risk for negative events in older adults. Less is known about whether their co-occurrence constitutes a distinct risk profile. This study quantifies the association between cognitive impairment, no dementia (CIND), slow walking speed (WS) and their combination and disability and mortality.Methods We examined 2546 dementia-free people aged >= 60 years, part of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) up to 12 years. The following four profiles were created: (1) healthy profile; (2) isolated CIND (scoring 1.5 SD below age-specific means on at least one cognitive domain); (3) isolated slow WS (< 0.8 m/s); (4) CIND+ slow WS. Disability was defined as the sum of impaired activities of daily living and trajectories of disability were derived from mixed-effect linear regression models. Piecewise proportional hazard models were used to estimate mortality rate [hazard ratios (HRs)]. Population attributable risks of death were calculated.Results Participants with both CIND and slow WS had the worst prognosis, especially in the short-term period. They experienced the steepest increase in disability and five times the mortality rate (HR 5.1; 95% CI 3.5-7.4) of participants free from these conditions. Similar but attenuated results were observed for longer follow-ups. Co-occurring CIND and slow WS accounted for 30% of short-term deaths.Conclusions Co-occurring cognitive and physical limitations constitute a distinct risk profile in older people, and account for a large proportion of short-term deaths. Assessing cognitive and physical function could enable early identification of people at high risk for adverse events.
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| 6. |
- Grande, Giulia, et al.
(författare)
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Measuring gait speed to better identify prodromal dementia
- 2019
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Ingår i: Experimental Gerontology. - : Elsevier BV. - 0531-5565 .- 1873-6815. ; 124
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Forskningsöversikt (refereegranskat)abstract
- Slow gait speed has been shown to predict incident dementia and cognitive decline in older individuals. We aimed to summarize the evidence concerning the association of slow gait speed with cognitive decline and dementia, and discuss the possible shared pathways leading to cognitive and motor impairments, under the unifying hypothesis that body and mind are intimately connected. This is a scoping review supported by a systematic search of the literature, performed on PubMed and Web of Science. Longitudinal studies providing information on the role of gait speed in the prediction of cognitive decline and dementia in cognitively intact people and in those with initial cognitive impairment were eligible. Of 39 studies selected, including overall 57,456 participants, 33 reported a significant association between gait speed and cognitive outcomes, including dementia. Neurodegenerative pathology and cerebrovascular burden may damage cerebral areas involved in both cognitive functions and motor control. At the same time, systemic conditions, characterized by higher cardiorespiratory, and metabolic and inflammatory burden, can affect a number of organs and systems involved in motor functions, including the brain, having ultimately an impact on cognition. The interplay of body and mind seems relevant during the development of cognitive decline and dementia. The measurement of gait speed may improve the detection of prodromal dementia and cognitive impairment in individuals with and without initial cognitive deficits. The potential applicability of such a measure in both clinical and research settings points at the importance of expanding our knowledge about the common underlying mechanisms of cognitive and motor decline.
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| 7. |
- Saadeh, Marguerita, et al.
(författare)
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Associations of pre-pandemic levels of physical function and physical activity with COVID-19-like symptoms during the outbreak
- 2022
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Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 34:1, s. 235-247
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Tidskriftsartikel (refereegranskat)abstract
- Background One’s physical function and physical activity levels can predispose or protect from the development of respiratory infections. We aimed to explore the associations between pre-pandemic levels of physical function and physical activity and the development of COVID-19-like symptoms in Swedish older adults.Methods We analyzed data from 904 individuals aged ≥ 68 years from the population-based Swedish National study on Aging and Care in Kungsholmen. COVID-19-like symptoms were assessed by phone interview (March–June 2020) and included fever, cough, sore throat and/or a cold, headache, pain in muscles, legs and joints, loss of taste and/or odor, breathing difficulties, chest pain, gastrointestinal symptoms, and eye inflammation. Muscle strength, mobility, and physical activity were examined in 2016–2018 by objective testing. Data were analyzed using logistic regression models in the total sample and stratifying by age.Results During the first outbreak of the pandemic, 325 (36%) individuals from our sample developed COVID-19-like symptoms. Those with slower performance in the chair stand test had an odds ratio (OR) of 1.5 (95% confidence interval [CI] 1.1–2.1) for presenting with COVID-19-like symptoms compared to better performers, after adjusting for potential confounders. The association was even higher among people aged ≥ 80 years (OR 2.6; 95% CI 1.5–4.7). No significant associations were found between walking speed or engagement in moderate-to-vigorous physical activity and the likelihood to develop COVID-19-like symptoms.Conclusion Poor muscle strength, a possible indicator of frailty, may predispose older adults to higher odds of developing COVID-19-like symptoms, especially among the oldest-old.
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| 8. |
- Saadeh, Marguerita, et al.
(författare)
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Mobility and muscle strength trajectories in old age : the beneficial effect of Mediterranean diet in combination with physical activity and social support
- 2021
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Ingår i: International Journal of Behavioral Nutrition and Physical Activity. - : Springer Science and Business Media LLC. - 1479-5868. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Decline in physical function varies substantially across older individuals due to several extrinsic modifiable factors such as dietary patterns, physical activity and social support. We aimed to determine the association of these factors and their interaction with mobility and muscle strength decline.Methods: We analyzed data from 1686 functionally healthy individuals aged 60 + from the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K). The Mediterranean Diet Score (MDS) was calculated based on a validated food frequency questionnaire. Self-reported physical activity was categorized based on current recommendations, and social support was measured according to participants' perceived material and psychological support from relatives and friends. Participants' physical function was assessed over 12 years through changes in walking speed (m/s) and chair stand time (s). Linear mixed models adjusted for socio-demographic and clinical factors were used. In order to explore the combined effect of the different exposures, two indicator variables were created by cross-classifying individuals' levels of Mediterranean diet adherence and social support or physical activity.Results: Participants with a high adherence to Mediterranean diet were primarily < 78 years (82.3%), women (56.1%), married (61.1%), with university education (52.8%), high levels of social support (39.3%) and health-enhancing levels of physical activity (51.5%). A one-point increase in MDS (score range 0-9) was associated with less annual deterioration in walking speed (beta*time[year] = 0.001; p = 0.024) and chair-stand time (beta*time[year] = -0.014; p = 0.008). The potential protective effect of Mediterranean diet was highest among participants reporting high social support (beta*time[year] = -0.065, p = 0.026 for chair stands) and high physical activity (beta*time[year] = 0.010, p = 0.001 for walking speed), beyond the effect of each exposure individually.Conclusion: A higher adherence to Mediterranean diet, especially in combination with recommended levels of physical activity and high social support, may contribute to delay the decline in physical function observed with aging.
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| 9. |
- Saadeh, Marguerita, et al.
(författare)
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Profiles of behavioral, social and psychological well-being in old age and their association with mobility-limitation-free survival
- 2022
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Ingår i: Aging. - : Impact Journals, LLC. - 1945-4589. ; 14:15, s. 5984-6005
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Successful aging is a multidimensional construct covering behavioral, social, and psychological domains of well-being. We aimed to identify well-being profiles and their association with mobility-limitation-free survival.Methods: A total of 1488 healthy individuals aged 60+ from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed-up for 15 years. Mobility limitation was defined as a walking speed <0.8m/s and vital status information was obtained from the National Cause of Death Register. Well-being profiles were derived from different behavioral, social and psychological indicators using latent class analysis among men and women. Cox and Laplace regression models were applied to examine the association with the incidence of a composite endpoint of mobility limitation or death.Results: At baseline, three well-being profiles (i.e., worst, intermediate, best) were identified, which followed a clear gradient in all behavioral, social and psychological indicators. Compared to those in the worst profile, men and women in the intermediate profile had 27% (HR 0.73; 95% CI 0.56-0.94) and 23% (HR 0.77; 95% CI 0.59-1.00) lower hazard of developing mobility limitation/death. An even greater protective effect was seen among individuals in the best versus worst profile (HR 0.47; 95% CI 0.31-0.70 in men; HR 0.60; 95% CI 0.46-0.78 in women). Men in the intermediate and best profiles survived 1 and 3 years longer without mobility limitation, respectively; these figures were 2 and 3 years for women.Conclusions: Better profiles of behavioral, social and psychological well-being may prolong mobility-limitation-free survival by at least one year among older adults. Our findings strengthen the evidence-base to achieve successful aging through multi-domain interventions.
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| 10. |
- Santoni, Giola, et al.
(författare)
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Geriatric Health Charts for Individual Assessment and Prediction of Care Needs : A Population-Based Prospective Study
- 2020
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Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1079-5006 .- 1758-535X. ; 75:1, s. 131-138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Geriatric health charts that are similar to pediatric growth charts could facilitate monitoring health changes and predicting care needs in older adults. We aimed to validate an existing composite score (Health Assessment Tool [HAT]) and provide provisional age-specific reference curves for the general older population.Methods: Data came from the Swedish National study on Aging and Care in Kungsholmen (N = 3,363 participants aged 60 years and over examined clinically at baseline and 3 years later). HAT was validated by exploring its relationship with health indicators (logistic regression) and comparing its ability to predict care consumption with that of two of its components, morbidity and disability (receiver operating characteristic curve areas). A flowchart was developed to obtain individual-level HAT scores (nominal response method). Sex-specific health charts were derived by graphing seven percentile curves of age-related HAT change (logistic quantile regression).Results: HAT scores above the age- and sex-specific median were related to good performance in chair-stand tests (odds ratio [OR] = 2.62, 95% confidence interval [CI]: 2.07-3.31), balance and grip tests (interaction balance grip test, OR = 1.15, 95% CI: 1.05-1.25), and good self-rated health (OR = 2.19, 95% CI: 1.77-2.71). Receiver operating characteristic curve areas (HAT vs number of chronic disorders) were formal care, 0.76 versus 0.58 (p value < .001); informal care, 0.74 versus 0.59 (p value < .001); hospital admission, 0.70 versus 0.66 (p value < .001); primary care visits, 0.71 versus 0.69 (p value > .05); and specialty care visits, 0.62 versus 0.65 (p value < .001). HAT consistently predicted medical and social care service use better than disability.Conclusions: HAT is a valid tool that predicts care consumption well and could be useful in developing geriatric health charts to better monitor health changes in older populations.
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