| 1. |
- Agüero-Torres, Hedda, et al.
(författare)
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Institutionalization in the elderly : The role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study
- 2001
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Ingår i: Journal of Clinical Epidemiology. - : Elsevier. - 0895-4356 .- 1878-5921. ; 54:8, s. 795-801
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Tidskriftsartikel (refereegranskat)abstract
- A population-based study of 1810 persons, aged 75+, was investigated to evaluate the role of dementia and other chronic diseases as determinants of institutionalization in the elderly. The study population was examined at baseline and after a 3-year interval. After adjustment for sociodemographic characteristics, functional dependence, dementia, cerebrovascular disease and hip fracture were associated with living in an institution at baseline. Additionally, functional dependence, hip fracture and dementia were also associated with moving to an institution during the 3-year follow-up. In a similar analysis, including only nondemented subjects, the Mini-Mental State Examination emerged as one of the strongest determinants. The population attributable risk percentage of institutionalization during the 3-year follow-up due to dementia was 61%. This study confirms that dementia and cognitive impairment are the main contributors to institutionalization in the elderly, independently of their sociodemographic status, social network, or functional status.
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| 2. |
- Angleman, Sara B., et al.
(författare)
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Temporal Trends of Functional Dependence and Survival Among Older Adults From 1991 to 2010 in Sweden : Toward a Healthier Aging
- 2015
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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. ; 70:6, s. 746-752
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Tidskriftsartikel (refereegranskat)abstract
- Background. Declines in functional dependence among older adults were observed before the 1990s, but there is uncertainty about subsequent trends. Our study aimed to verify the temporal trends in disability during 1991-2010 in an older Swedish population and to estimate the associated changes in survival. Methods. Functional status in octogenarians and nonagenarians was assessed at seven occasions with intervals of 2-3 years. Sample size varied at each assessment with an average of 646 (range 212-1096). Disability was defined as difficulty in one or more of personal activities of daily living. We compared prevalence and incidence, as well as mortality, and survival associated with disability over the 20-year period. Results. Sex-standardized prevalence of disability remained steady over time with a tendency toward a gradual decline, and a statistically significant decrease was present among nonagenarians. Sex-standardized cumulative incidence also remained steady. The proportion of people with prevalent disability who died <3 years remained stable, as did the survival time of people with incident disability. In contrast, among nondisabled persons, 3-year mortality decreased significantly, and for octogenarians median survival time was 1.3 years longer at the more recent assessment than a decade earlier. Conclusions. Both prevalence and incidence of disability remained stable over the last two decades in this urban Swedish population, with a trend toward a slow decline. Mortality remained steady among disabled persons but decreased among persons without disability, suggesting that increased life expectancy during the last two decades may be essentially driven by longer lives of functionally independent people.
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| 3. |
- Fratiglioni, Laura, et al.
(författare)
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Multisjuklighet och demens : Vad kan förebyggas?
- 2006
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Andelen äldre ökar i hela världen. Det återspeglar en förbättrad hälsa och en starkare samhällsekonomi. Samtidigt innebär det att allt fler drabbas av åldersrelaterade sjukdomar. Denna rapport är ett led i Statens folkhälsoinstituts arbete med att generellt öka kunskapen om vikten av förebyggande insatser bland äldre. Här belyses i vilken utsträckning multisjuklighet och demenssjukdomar kan förebyggas. Rapporten vänder sig till politiker och tjänstemän i kommuner och landsting samt företrädare för pensionärsorganisationer som arbetar med folkhälsoarbete bland äldre. Multisjuklighet är det vanligaste sjukdomspanoramat hos äldre. Kvinnor och personer med låg utbildning är mest drabbade. I dag vet man inte hur multisjuklighet kan förebyggas, men effekterna av multisjuklighet kan underlättas med mer samordnade insatser av samhället.Demens tillhör våra vanligaste folksjukdomar, men är ovanligt före 60 års ålder. Vid 95 års ålder har 50 procent av befolkningen en demenssjukdom. Demens förkortar livet och orsakar funktionellt beroende och flytt till särskilt boende. I nuläget finns det två möjliga strategier för att minska risken för demens. Vi vet att det är viktigt med god kontroll av blodtrycket både i medelåldern och vid högre åldrar. Vi vet också att det är värdefullt med ett mentalt aktivt och socialt integrerat liv i ålderdomen.Rapporten har skrivits av professor Laura Fratiglioni och docent Eva von Strauss på Aging Research Center, Karolinska Institutet, och Stiftelsen Stockholms Läns Äldrecentrum på uppdrag av Statens folkhälsoinstitut.
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| 4. |
- Fratiglioni, Laura, et al.
(författare)
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Prevention of Alzheimer's disease and dementia : Major findings from the Kungsholmen Project
- 2007
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Ingår i: Physiology and Behavior. - : Elsevier. - 0031-9384 .- 1873-507X. ; 92:1-2, s. 98-104
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Tidskriftsartikel (refereegranskat)abstract
- The aging of the population is a worldwide phenomenon, and studying age-related diseases has become a relevant issue from both a scientific and a public health perspective. This review summarises the major findings concerning prevention of Alzheimer's disease (AD) and other dementias from a population-based study, the Kungsholmen Project. The study addresses risk- and protective factors for AD and dementia from a lifetime perspective: at birth, during childhood, in adult life, and in old age. Although many aspects of the dementias are still unclear, some risk factors have been identified and interesting hypotheses have been suggested for other putative risk or protective factors. At the moment it is also possible to delineate some preventative strategies for dementia.
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| 5. |
- Fratiglioni, Laura, et al.
(författare)
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Åldrandets epidemiologi med fokus på fysisk och mental funktionsförmåga
- 2001
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Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 98:6, s. 552-558
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Tidskriftsartikel (refereegranskat)abstract
- In the past decades, the »graying« of the population has emerged as a world-wide phenomenon, leading to an increased interest in research on aging. Many population-based studies have been initiated in several countries, such as the Kungsholmen Project in Stockholm, Sweden. These studies have shown that older adults can be recruited to participate in intensive physiological and clinical evaluations, and that longitudinal surveys are well accepted by the elderly. Comorbidity and physical and mental functioning have emerged as important variables for describing health status and identifying risk factors. Dementia arose as one of the most common diseases in the very old, as dementia prevalence nearly doubles every fifth year. Some risk factors for Alzheimer’s disease have been identified and interesting working hypotheses have been suggested. The natural history of the dementias have been sufficiently outlined for allocating medical and social resources, and for counseling patients and relatives.
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| 6. |
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| 7. |
- Huang, Wenyong, et al.
(författare)
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APOE Genotype, Family History of Dementia, and Alzheimer Disease Risk : A 6-Year Follow-up Study
- 2004
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Ingår i: Archives of Neurology. - : American Medical Association. - 0003-9942 .- 1538-3687. ; 61:12, s. 1930-1934
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Tidskriftsartikel (refereegranskat)abstract
- Background Both family aggregation and apolipoprotein E (APOE) ε4 allele are well-known risk factors for dementia, but the relation between these two factors remains unclear.Objective To explore whether the risk of dementia and Alzheimer disease (AD) due to a positive family history is explained by APOE genotypes.Design Community-based cohort study.Setting The Kungsholmen district of Stockholm, Sweden.Participants A total of 907 nondemented people 75 years or older, followed up for 6 years to detect incident dementia and AD cases according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition.Main Outcome Measures Risk of dementia and AD by Cox proportional hazards models after controlling for several potential confounders.Results Subjects who had at least 2 siblings with dementia were at an increased risk of AD. Individuals with both APOE ε4 allele and at least 2 affected first-degree relatives had a higher risk of dementia and AD compared with those without these 2 factors. Similar results were obtained for history of dementia separately in parents or siblings. Among the ε4 allele carriers, subjects with 2 or more first-degree demented relatives had increased risk of dementia and AD, whereas no increased risk was detected among non–ε4 carriers.Conclusions Family history of dementia was associated with an increased risk of dementia and AD in this very old population, but only among APOE ε4 carriers. This suggests the existence of other genetic or environmental risk factors that may be active in the presence of the APOE ε4 allele.The role of both family history of dementia and the apolipoprotein E (APOE) gene in the development of Alzheimer disease (AD) has been extensively investigated. There is strong evidence to suggest that APOE ε4 allele carriers, as well as subjects with a family history of dementia, have an increased risk of AD.Familial aggregation and genetic risk factors appear to be most influential in AD at relatively early ages.However, there are reports supporting an effect of both familial aggregation and APOE ε4 even in late-onset AD,although a lower effect in comparison with early-onset cases has been detected.It is hypothesized that APOE ε4 allele might explain the association between family history of dementia and AD. Previous studies have tried to evaluate this hypothesis, but to what extent familial aggregation is due to the association between the ε4 allele and AD remains equivocal. Some studies indicated that ε4-positive patients with AD tended to have a higher rate of family history of dementia than ε4-negative patients. Conversely, patients with family history of AD are also more likely to carry the ε4 allele than patients without family history.Other studies, however, showed that the APOE ε4 allele was not related to familial aggregation of AD.Most previous analyses have been hospital-based case-control studies. Because of ascertainment bias and severe truncation of data, these studies might overestimate the effects of family history and APOE ε4 allele, especially in very old people. Only a small-scale prospective study has examined both family history of dementia and APOE ε4 allele in relation to AD risk among people 75 years or older.In a previous study within the Kungsholmen Project, a strong familial aggregation was detected among prevalent cases of late-onset AD, but the contribution of the APOE ε4 allele was not considered. In the present study, we examined the 6-year follow-up data from the same project to explore whether the risk of dementia and AD due to a positive family history is explained by APOE genotypes.
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| 8. |
- Lagergren, Mårten, et al.
(författare)
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Horizontal and vertical targeting : a population-based comparison of public eldercare services in urban and rural areas of Sweden
- 2016
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Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 28:1, s. 147-158
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Tidskriftsartikel (refereegranskat)abstract
- The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001-2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70-90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40-50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern-it was almost 100 % in all areas for IADL dependency, but only 50-60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.
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| 9. |
- Qiu, Chengxuan, et al.
(författare)
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Decline in blood pressure over time and risk of dementia : a longitudinal study from the Kungsholmen project
- 2004
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Ingår i: Stroke. - : American Stroke Association. - 0039-2499 .- 1524-4628. ; 35:8, s. 1810-1815
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose—Low blood pressure has been related to an increased risk of dementia. We sought to verify blood pressure variations before and after a dementia diagnosis and to relate blood pressure decline to subsequent Alzheimer disease and dementia.Methods—A community dementia-free cohort aged _75 years (n_947) underwent follow-up examinations twice over a period of 6 years to detect dementia cases (Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised [DSM-III-R] criteria, n_304). Blood pressure variation before and after dementia diagnosis was verified with linear mixed-effects models. Using the dementia-free cohort identified at first follow-up (n_719), the association between blood pressure decline from baseline to first follow-up and subsequent risk of dementia was examined.Results—Blood pressure markedly decreased over 3 years before dementia diagnosis and afterward, whereas no substantial decline was present 3 to 6 years before the diagnosis. However, among subjects with baseline systolic pressure _160 mm Hg, systolic pressure decline _15 mm Hg occurring 3 to 6 years before diagnosis was associated with relative risks (95% CI) of 3.1 (1.3 to 7.0) for Alzheimer disease and 3.1 (1.5 to 6.3) for dementia. There was a dose–response relationship between systolic pressure decline and dementia risk in subjects with vascular disease.Conclusions—Blood pressure starts to decrease only 3 years before dementia diagnosis and continues to decline afterward. A greater decline in systolic pressure occurring 3 to 6 years before diagnosis is associated with an increased risk of dementia only in older people with already low blood pressure or affected by vascular disorders.
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| 10. |
- Qiu, Chengxuan, et al.
(författare)
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Lifetime principal occupation and risk of Alzheimer's disease in the Kungsholmen project
- 2003
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Ingår i: American Journal of Industrial Medicine. - : Wiley. - 0271-3586 .- 1097-0274. ; 43:2, s. 204-211
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSome studies suggest that manual work is associated with dementia. This study is aimed at identifying the specific occupational categories that may be related to dementia.MethodsA cohort of 913 non-demented subjects aged 75 + years was longitudinally examined twice over 6 years to detect incident dementia using the DSM-III-R diagnostic criteria. The lifetime longest occupations of all subjects were divided into different categories according to the occupation-based classification system. Data were analyzed with Cox models.ResultsDuring the follow-up period, 260 subjects were diagnosed with dementia (197 with Alzheimer's disease). Manual work was associated with an increased risk of dementia, and the association was dependent on educational level. Compared with non-manual work, manual work involving goods production had a multi-adjusted relative risk (95% CI) of 1.6 (1.0–2.5, P = 0.046) for Alzheimer's disease and 1.4 (0.9–2.1) for dementia.ConclusionsAn association between goods production, manual work and Alzheimer's disease found in this study suggests that factors in the mid-twentieth century goods production environment may be involved in the development of Alzheimer's disease.
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