| 1. |
- Hörnsten, Carl, et al.
(författare)
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High blood pressure as a risk factor for incident stroke among very old people : a population-based cohort study
- 2016
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Ingår i: Journal of Hypertension. - 0263-6352 .- 1473-5598. ; 34:10, s. 2059-2065
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 2. |
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| 3. |
- Hörnsten, Carl, et al.
(författare)
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Measurement error of the Mini-Mental State Examination among individuals with dementia that reside in nursing homes
- 2021
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Ingår i: European Journal of Ageing. - : Springer. - 1613-9372 .- 1613-9380. ; 18:1, s. 109-115
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 4. |
- Hörnsten, Carl, 1985-
(författare)
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Stroke and depression in very old age
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background The prevalence and incidence of stroke are known to increase with age, which, combined with demographic change, means that very old patients with stroke are a growing patient group. Risk factors for incident stroke among very old people have not been widely investigated. The impact of depression on mortality in very old people who have had a stroke also remains unclear. The aim of this thesis was to investigate the risk factors for incident stroke, the epidemiology of stroke and depression, and the consequences of having had a stroke regarding the risk of depression and mortality among very old people.Methods A randomly selected half of 85-, all 90-, and all ≥95-year-olds in certain municipalities in Västerbotten County, Sweden, and Pohjanmaa County, Finland were targeted in a population-based cohort study from 2000-2012. The 65-, 70-, 75-, and 80-year-olds in all the rural and random samples from the urban municipalities in the same counties were furthermore targeted in a survey in 2010.In the cohort study patients were assessed in their homes, by means of the 15-item Geriatric Depression Scale (GDS-15) and other assessment scales, as well as blood pressure measurements, several physical tests, and a review of medical diagnoses appearing in the medical charts. Incident stroke data were collected from medical charts guided by hospital registry records, cause of death records, and reassessments after 5 years. Depression was defined as a GDS-15 score ≥5. A clinical definition of all depressive disorders, based on assessment scale scores and review of medical charts was also used. A specialist in geriatric medicine evaluated the diagnoses. The survey included yes/no questions about stroke and depression status, and the 4-item Geriatric Depression Scale. Associations with mortality and incident stroke were tested using Cox proportional-hazard models. Results In the ≥85-year-olds examined in 2005-2007 (n=601), the stroke prevalence was 21.5%, the prevalence of all depressive disorders was 37.8% and stroke was independently associated with depressive disorders (odds ratio 1.644, p=0.038). The prevalence of depression according to GDS-15 scores was 43.2% in people with stroke compared with 25.0% in people without stroke (p=0.001). However, in ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, depression was not independently associated with incident stroke. In ≥65-year-olds who responded to a survey in 2010 (n=6098), the stroke prevalence rose with age from 4.7% among the 65- to 11.6% among the 80-year-olds (p<0.001). The prevalence of depression rose from 11.0% among the 65- to 18.1% among the 80-year-olds (p<0.001). In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year, while in the non-stroke group, depression was independently associated with several additional demographic, social and health factors.In ≥85-year-olds examined in 2005-2007 with valid GDS-15 tests (n=452), having had a stroke was associated with increased 5-year mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.15-2.03]. Having had a stroke and depression was associated with increased 5-year mortality compared with having only stroke (HR 1.90, 95% CI 1.15-3.13), having only depression (HR 1.59, 95% CI 1.03-2.45), and compared with having neither stroke nor depression (HR 2.50, 95% CI 1.69-3.69). Having only stroke without a depression did not increase mortality compared with having neither stroke nor depression.In ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, the stroke incidence was 33.8/1000 person-years during a mean follow-up period of about three years. In a comprehensive multivariate model, atrial fibrillation (HR 1.85, 95% CI 1.07–3.19) and higher systolic blood pressure (SBP; HR 1.19, 95% CI 1.08–1.30 per 10-mmHg increase) were associated with incident stroke overall. In additional multivariate models, diastolic blood pressure (DBP) ≥90 mmHg (HR 2.45, 95% CI 1.47–4.08) and SBP ≥160 mmHg (v. <140 mmHg; HR 2.80, 95% CI 1.53–5.14) were associated with incident stroke.Conclusion The prevalence of both stroke and depression increased with age, and rates were especially high among very old people. Having had a stroke was independently associated with a higher prevalence of depression among very old people, however, depression was not independently associated with a higher incidence of stroke. Having had a stroke was associated with increased all-cause mortality among very old people, but only among those who were also depressed. High SBP (≥160 mmHg), DBP (≥90 mmHg) and atrial fibrillation were the only consistent independent risk factors for incident stroke among very old people.
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| 5. |
- Hörnsten, Carl, et al.
(författare)
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The association between stroke, depression, and 5-year mortality among very old people
- 2013
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Ingår i: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 44:9, s. 2587-2589
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: Depression after stroke has been associated with increased mortality, but little is known about this association among very old people.Methods: A population-based study among people ≥85 years of age was conducted in northern Sweden and Finland, comprising cross-sectional assessments and subsequent survival data. The 452 individuals who had completed the Geriatric Depression Scale-15 assessment were selected. Depression was defined as a score of ≥5 on the geriatric depression scale.Results: Of those with a history of stroke, 38 of 88 (43.2%) people were depressed, and 11 of the 38 (28.9%) were treated with antidepressants, compared with 91 of 364 (25.0%) depressed (P=0.001) and 17 of 91 (18.7%) treated with antidepressants among those without stroke. Having a history of stroke and ongoing depression was associated with increased 5-year mortality compared with having only stroke (hazard ratio, 1.90; confidence interval, 1.15–3.13), having only depression (hazard ratio, 1.59; confidence interval, 1.03–2.45), and compared with having neither stroke nor depression (hazard ratio, 2.50; confidence interval, 1.69–3.69). Having only stroke without depression did not increase mortality compared with having neither stroke nor depression.Conclusions: A history of stroke was associated with increased mortality among very old people but only among those who were also depressed. Depression seemed to be underdiagnosed and undertreated.
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| 6. |
- Hörnsten, Carl, et al.
(författare)
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The prevalence of stroke and depression and factors associated with depression in elderly people with and without stroke
- 2016
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318 .- 1471-2318. ; 16
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Few studies have investigated factors associated with depression among elderly people with and without stroke concurrently, using identical settings, procedures and study variables. The aim was to investigate the prevalence of stroke and depression and to compare the factors associated with depression in people with and without stroke. Methods: A postal mail survey was sent to 65-, 70-, 75- and 80-year-olds in northern Sweden and Finland in 2010 (n = 6098). Stroke was defined as answering "yes" to the question "Have you had a stroke?" Depression was defined as answering "yes" to the question "Are you depressed?" or having a Geriatric Depression Scale-4 score >= 2. Dependence in personal activities of daily living was defined as not showering without human assistance. Associations were tested with log-binomial regression. Results: The overall stroke prevalence was 7.0 +/- 0.3 % and increased from 4.7 +/- 0.4 % among 65-year-olds to 11.6 +/- 1.0 % among 80-year-olds (p < 0.001). The overall depression prevalence was 12.8 +/- 0.4 % and increased from 11.0 +/- 0.6 % among 65-year-olds to 18.1 +/- 1.2 % among 80-year-olds (p < 0.001). Depression was more common among people with stroke (Prevalence Ratio 1.77, 95 % Confidence Interval 1.48-2.12). In the non-stroke group, depression was independently associated with diabetes, dependence in instrumental activities of daily living, living alone, not having someone to talk to, poor finances, pain problems and having a life crisis in the preceding year. In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year. Conclusions: Depression in people without stroke appeared to be independently associated with a broader range of external factors than depression in people with stroke.
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| 7. |
- Niklasson, Johan, et al.
(författare)
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High morale and survival
- 2016
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Ingår i: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 85, s. 75-75
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Niklasson, Johan, et al.
(författare)
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High morale is associated with increased survival in the very old
- 2015
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Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 44:4, s. 630-636
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: high morale is defined as future-oriented optimism. Previous research suggests that a high morale independently predicts increased survival among old people, though very old people have not been specifically studied.OBJECTIVE: to investigate whether high morale is associated with increased survival among very old people.SUBJECTS: the Umeå 85+/GErontological Regional DAtabase-study (GERDA) recruited participants aged 85 years and older in northern Sweden and western Finland during 2000-02 and 2005-07, of whom 646 were included in this study.METHODS: demographic, functional- and health-related data were collected in this population-based study through structured interviews and assessments carried out during home visits and from reviews of medical records. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale.RESULTS: the 5-year survival rate was 31.9% for participants with low morale, 39.4% for moderate and 55.6% for those with high morale. In an unadjusted Cox model, the relative risk (RR) of mortality was higher among participants with low morale (RR = 1.86, P < 0.001) and moderate morale (RR = 1.59, P < 0.001) compared with participants with high morale. Similar results were found after adjustment for age and gender. In a Cox model adjusted for several demographic, health- and function-related confounders, including age and gender, mortality was higher among participants with low morale (RR = 1.36, P = 0.032) than those with high morale. There was a similar but non-significant pattern towards increased mortality in participants with moderate morale (RR = 1.21, P value = 0.136).CONCLUSION: high morale is independently associated with increased survival among very old people.
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| 9. |
- Niklasson, Johan, et al.
(författare)
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Psychometric properties and feasibility of the Swedish version of the Philadelphia Geriatric Center Morale Scale
- 2015
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Ingår i: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 24:11, s. 2795-2805
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Morale is related to psychological well-being and quality of life in older people. The Philadelphia Geriatric Center Morale Scale (PGCMS) is widely used to assess morale. The purpose of this study was to evaluate the psychometric properties and feasibility of the Swedish version of the 17-item PGCMS among very old people.METHODS: The Umea 85+/GERDA study included Swedish-speaking people aged 85, 90 and 95 years and older, from Sweden and Finland. Participants were interviewed in their own homes using a predefined set of questions. In the main sample, 493 individuals answered all 17 PGCMS items (aged 89.0 +/- 4.3 years). Another 105 answered between 1 and 16 questions (aged 89.6 +/- 4.4 years). A convenience sample was also collected, and 54 individuals answered all 17 PGCMS items twice (aged 84.7 +/- 6.7 years). The same assessor restated the questions within 1 week.RESULTS: Cronbach's alpha was 0.74 among those who answered all 17 questions in the main sample. Confirmatory factor analysis was used to test the construct validity of the most widely used version of the PGCMS, with 17 items and three factors, and showed a generally good fit. Among those answering between 1 and 17 PGCMS questions, 92.6 % (554/598) answered 16 or 17. The convenience sample was used for intra-rater test-retesting, and the intraclass correlation coefficient (ICC) was 0.89. The least significant change between two assessments, with 95 % confidence interval, was 3.53 PGCMS points.CONCLUSION: The Swedish version of the PGCMS seems to have satisfactory psychometric properties and feasibility among very old people.
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| 10. |
- Snellman, Sandra, et al.
(författare)
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Validity and test–retest reliability of the Swedish version of the Geriatric Depression Scale among very old adults
- 2024
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Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Geriatric Depression Scale (GDS) has shown good validity and reliability, but few studies have examined the GDS among very old adults or the Swedish translation.Objectives: Evaluate the validity and reliability of the Swedish version of GDS-15 among very old adults.Methods: In the Umeå85 + /GErontological Regional DAtabase (GERDA) study, 387 participants were assessed with both the GDS-15 and the Montgomery-Åsberg Depression Rating Scale (MADRS). The mean age was 91 years. Concurrent validity between the scales was calculated using Spearman's correlation. We used the Diagnostic and Statistical Manual of Mental Disorders (DSM) V symptom criteria for depression based on MADRS item scores to define depression. We calculated the Area Under the Curve (AUC) and found an optimal cut-off. A convenience sample with 60 individuals was used to calculate test–retest reliability with Cohen’s kappa and Intraclass Correlation Coefficient (ICC).Results: Spearman's correlation coefficients between total scores for GDS-15 and MADRS were 0.60. Cronbach's alpha for the whole scale was 0.73. The AUC was 0.90 for distinguishing major depression, and the recommended cut-off of ≥ 5 showed a sensitivity of 95.2% and specificity of 65.8%. The test–retest showed that Cohen’s kappa was substantial (0.71) and the ICC was excellent (0.95).Conclusions: The Swedish version of the GDS-15 showed good validity and reliability among very old adults. The generally recommended cut-off of ≥ 5 seems reasonable to use with the Swedish version and among very old adults.
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