| 1. |
- Sundell, Anna Lena, 1970-
(författare)
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Children with orofacial clefts : dental caries and health-related quality of life
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background. The current understanding on caries and enamel developmental defects prevalence and frequency, caries risk, health-related quality life (HRQoL) and stress response in young children with cleft lip and/or palate (CL/P) are sparse. In this thesis these aspects were investigated in 5- and 10- year-old children with CL/P in comparison to non-cleft children in the same ages.Design. The studies in this thesis have a cross-sectional case-control design. Participants. The study group consisted of 139 children with CL/P (80 children aged 5 years and 59 aged 10 years) and 313 non-cleft controls (144 children aged 5 years and 169 aged 10 years).Method. Caries was scored according to International Caries Detection and Assessment System (ICDAS II) and developmental enamel defects were measured as presence and frequency of hypoplasia and hypomineralization. Oral hygiene was assessed using Quigley-Hein plaque index. Stimulated saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rates. Information regarding children’s oral hygiene routines, dietary habits and fluoride exposure were collected with questionnaires. Caries risk was evaluated with algorithm-based software, Cariogram while HRQoL was perceived with KIDSCREEN-52. Stress response was analyzed with cortisol concentration in saliva at three different time points using a commercial competitive radioimmunoassay.Results. Caries prevalence (36% versus 18%) and caries frequency (1.2 dmfs versus 0.9 dmfs) was significantly higher in 5-year-old children with CL/P in comparison to non-cleft controls. In 10-yearolds no significant difference was found between children with CL/P and non-cleft controls in caries prevalence (47% versus 38%) or in caries frequency (0.7 DMFS versus 0.5 DMFS). Children with CL/P had significantly higher prevalence of enamel defects, higher counts of salivary lactobacilli and less good oral hygiene. The odds of being categorized with high caries risk were elevated in children with CL/P. Children with CL/P had similar HRQoL and salivary cortisol concentrations as non-cleft controls. However, 10-year-old boys with CL/P had significantly higher cortisol concentrations in the evening than non-cleft boys.Conclusions. Preschool children with CL/P seem to have more caries in the primary dentition than non-cleft controls. Children with CL/P had increased odds of being categorized as high caries risk individuals compared to controls. Some of the contributing factors seem to be higher prevalence of enamel defects, impaired oral hygiene and elevated salivary lactobacilli. Furthermore, as measured with the help of cortisol concentrations in saliva, children with CL/P were not more stressed than noncleft controls and their HRQoL was comparable to a European norm population. It appears that regular comprehensive preventive oral care in children with CL/P is effective in preventing caries development in permanent teeth. However, children with CL/P are at risk of caries development and preventive oral care should be implemented and started earlier than today.
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| 2. |
- Wagner, Ryan G, 1984-
(författare)
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The Burden of Epilepsy : using population-based data to define the burden and model a cost-effective intervention for the treatment of epilepsy in rural South Africa
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rationale Epilepsy is a common, chronic, neurological condition that disproportionately affects individuals living in low- and middle- income countries, including much of sub-Saharan Africa. Epilepsy is treatable, with the majority of individuals who take anti-epileptic drugs experiencing a reduction, or elimination, of seizures. Yet the number of individuals taking and adhering to medication in Africa is low and interventions aimed at improving treatment are lacking.Aims To define the epidemiology of convulsive epilepsy in rural South Africa in terms of incidence, mortality and disability-adjusted life years; to determine outpatient, out-of-pocket costs resulting from epilepsy treatment; to establish the level of adherence to anti-epileptic drugs amongst people with epilepsy; and, to determine whether the introduction of routine visits to people with epilepsy by community health workers is a cost-effective intervention for improving adherence to anti-epileptic drugs.Methods Nested within the Agincourt Health and Demographic Surveillance System, this work utilized a cohort of individuals diagnosed with convulsive epilepsy in 2008 to determine health care utilization and out-of-pocket costs due to care sought for epilepsy. Additionally, using blood samples from the cohort, anti-epileptic drug adherence was measured and, following the cohort, mortality rates were determined. Using these collected epidemiological parameters, disability-adjusted life years due to convulsive epilepsy were determined. Finally, combining the epidemiological and cost parameters, a community health worker intervention was modeled to determine its incremental cost-effectiveness ratio.Key Findings The burden of convulsive epilepsy is lower in rural South Africa than other parts of Africa, likely due to lower levels of known risk factors. Yet the burden, especially in terms of mortality, remains high, as does the treatment gap and health care utilization. Findings from the economic evaluation found the introduction of a community health worker to be highly cost-effective and would likely lower the burden of epilepsy in rural South Africa.Implications Epilepsy contributes to the burden of disease in rural South Africa, with high levels of mortality and a substantial treatment gap. The introduction of a community-health worker is likely to be one cost-effective, community based intervention that would lower the burden of epilepsy by improving adherence to anti-epileptic drugs. Implementing this intervention, based on these findings, is a justified and important next step.
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| 3. |
- Moradi, Shahram
(författare)
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Time is of the essence in speech perception! : Get it fast, or think about it
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present thesis examined the extent to which background noise influences the isolation point (IP, the shortest time from the onset of speech stimulus required for correct identification of that speech stimulus) and accuracy in identification of different types of speech stimuli (consonants, words, and final words in high-predictable [HP] and low-predictable [LP] sentences). These speech stimuli were presented in different modalities of presentation (auditory, visual, and audiovisual) to young normal-hearing listeners (Papers 1, 2, and 5). In addition, the present thesis studied under what conditions cognitive resources were explicitly demanded in identification of different types of speech stimuli (Papers 1 and 2). Further, elderly hearing-aid (EHA) users and elderly normal-hearing (ENH) listeners were compared with regard to the IPs, accuracy, and under what conditions explicit cognitive resources were demanded in identification of auditory speech stimuli in silence (Paper 3). The results showed that background noise resulted in later IPs and reduced the accuracy for the identification of different types of speech stimuli in both modalities of speech presentation. Explicit cognitive resources were demanded in identification of speech stimuli in the auditory-only modality, under the noisy condition, and in the absence of a prior semantic context. In addition, audiovisual presentation of speech stimuli resulted in earlier IPs and more accurate identification of speech stimuli than auditory presentation. Furthermore, a pre-exposure to audiovisual speech stimuli resulted in better auditory speech-in-noise identification than an exposure to auditory-only speech stimuli (Papers 2 and 4). When comparing EHA users and ENH individuals, the EHA users showed inferior performance in the identification of consonants, words, and final words in LP sentences (in terms of IP). In terms of accuracy, the EHA users demonstrated inferior performance only in the identification of consonants and words. Only the identification of consonants and words demanded explicit cognitive resources in the EHA users. Theoretical predictions and clinical implications were discussed.
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| 4. |
- Junuzovic, Mensura, 1970-
(författare)
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Firearm deaths in Sweden : epidemiology with emphasis on accidental deaths and prevention
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Prevention of firearm deaths and injuries is an important public health issue that may save human lives. The aim of this thesis was to investigate the epidemiology and attributes of accidental firearm fatalities in Sweden, and to provide a basis for further preventive measures. Data were obtained from the database of the National Board of Forensic Medicine, the National Patient Register, the Prescribed Drug Register, the Firearm Register, and from questionnaire responses.All 48 accidental firearm fatalities that involved hunting in 1983-2008 were investigated (Paper I). The victims’ mean age was 50 years, 96% were males. During moose hunting, most victims were mistaken for game (41%), whereas during small game hunting, fatalities were mostly related to falls (31%) and improper weapon handling (15%). Hunters’ habits and attitudes towards preventive measures and their experience of firearm incidents were investigated through a questionnaire, which was sent to 1,000 hunters (Paper II). The response rate was approximately 50%. The mean age of the respondents was 54 years and females accounted for 5%. One quarter of the respondents stated that they had witnessed a firearm incident caused by another hunter, of which more than half suggested that improper handling of the weapon and inappropriate hunting strategies were the main causes of these events.All 43 accidental non-hunting firearm deaths in Sweden 1983-2012 were investigated (Paper III). In 56% of cases, the fatality was caused by another person. Victims were mostly young males (mean age 25 years). The main cause of the incidents was human error. The majority of cases (63%) involved legal firearm. Most victims killed by illegal firearm (85%) were under the influence of alcohol and/or drugs at the time of death. Both the risk of being killed as a result of hunting (Paper I) and non-hunting accidental firearm injury (Paper III) decreased after the introduction of the mandatory hunter’s exam in 1985 (p < 0.001).Firearm deaths in Sweden including 52 accidental fatalities and 3 cases with undetermined manner of death in 1987-2013, as well as 213 suicides and 23 solved homicides in 2012-2013, were studied (Paper IV). The number of firearm suicides was positively correlated to the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in firearm homicides. The majority of the shooters in accidental deaths and suicides had no registered visits to inpatient care or specialized outpatient care. Less than half (42%) of all suicide victims had had a health care contact due to mental health problems. Physician’s mandatory reporting to the police of patients deemed unsuitable for possessing a firearm license did not include any of the suicide victims and the shooters in accidental deaths.This thesis confirmed that accidental firearm deaths are rare, and indicates that the firearm law changes in 1985 contributed to a decline of such fatalities. Human error was the main “cause” of the fatalities and future prevention measures should target improper weapon handling. Physician’s mandatory reporting to the police was suboptimal and barely contributed to the decline of accidental firearm deaths. If streamlined it may, however, represent an important prevention strategy in firearm suicides, claiming most lives among firearm deaths. A significant fraction of non-hunting fatalities, firearm suicides and homicides was associated with illegal firearm use, a fact calling for prevention issues targeting such firearm use.
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| 5. |
- Dahl, Anna, 1975-
(författare)
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Body mass index, cognitive ability, and dementia : prospective associations and methodological issues in late life
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of the present study were to investigate the association between overweight and cognitive ability and dementia, and to evaluate the usefulness of self-reported body mass index (BMI) in late life and various data sources commonly used in epidemiological studies to identify persons with dementia. Data were drawn from three population-based studies: the Swedish Adoption/Twin Study of Aging (SATSA), Aging in Women and Men: A Longitudinal Study of Gender Differences in Health Behaviour and Health among Elderly (the Gender Study), and the Finnish Lieto Study. In Study I, the agreement between self-reported and measured BMI over time was evaluated among 774 men and women, ages 40 to 88 years at baseline (mean age 63.9) participating in both the questionnaire phase and in-person testing of SATSA. Latent growth curve (LGC) modeling showed a small but significant increase between self-reported and measured BMI (0.02 kg/m2/y) over time, which would probably not affect the results if self-reported BMI were used as a continuous variable in longitudinal research. In Study II, the agreement between dementia diagnoses from various sources and dementia diagnoses set at a consensus conference was evaluated. Among the 498 elderly people ages 70 to 81 at baseline (mean age 74.5) enrolled in the Gender Study, 87 were diagnosed with dementia during an eight-year period. Review of medical records and nurse evaluations yielded the highest sensitivity (0.83 and 0.80, respectively) and a high specificity (0.98 and 0.96), indicating that these sources might be good proxies of dementia, while data extraction from the Swedish Inpatient Discharge Registry underestimated the prevalence of dementia (sensitivity 0.26). In Study III, the association between being overweight in midlife and cognitive ability in late life was examined in SATSA. The 781 participants ages 25 to 63 at baseline (mean age 41.6) in 1963 or 1973 self-reported their height and weight. From 1986 until 2002, they were assessed five times using a cognitive test battery. LGC models showed that people with higher midlife BMI scores had significantly lower cognitive ability and a significantly steeper decline than their thinner counterparts, an association that persisted when those who developed dementia during the study period were excluded from the analysis. This finding indicates that being overweight might affect cognitive ability independently of dementia. In Study IV, the association between BMI and dementia risk in older persons was described among 605 persons without dementia and ages 65 to 92 at baseline (mean age 70.8) in the Lieto Study. Among these, 86 persons were diagnosed with dementia during eight years of follow-up. Cox regression analyses indicated that for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio = 0.92, 95% confidence interval = 0.87–0.97) and the association remained significant when individuals who developed dementia during the first four years of follow-up were excluded from the analyses. This result suggests that low BMI scores are present almost a decade before clinical dementia onset.
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| 6. |
- Eckerblad, Jeanette, 1966-
(författare)
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Symptom burden among people with chronic disease
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief.Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease.Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT.Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III).Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider.
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| 7. |
- Hasselgren, Caroline, 1987
(författare)
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Inequity in mind. On the Social and Genetic Risk Factors of Dementia and Their Interactions
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present thesis seeks to further explain the occurrence of Alzheimer’s disease and other dementias by studying the long-term impact of class- and gender-based inequities as well as the extent to which they potentially moderate genetic risk. Central to this endeavour is the recognition of social inequity as multifaceted, and of potential intersections between different drivers of structural (dis)advantage in relation to individual health prospects. The main point of departure is that even though the causes of dementia are heterogeneous and cannot be reduced to either genetic or environmental factors, dementia is, just like many of its potential risk/protective factors, unevenly distributed in the population. Nevertheless, our knowledge of whether and how systems of structural inequity intersect and interact with individual genetic endowments in the development of disease is still scarce. The thesis encompasses four empirical studies, all of which should be considered examples of interdisciplinary efforts to incorporate theory and expertise from different fields in order to create a more holistic understanding of dementia aetiology. The analyses are based on data derived from the longitudinal Gothenburg H70 Birth Cohort Study (H70) and the Prospective Populations Study on Women (PPSW) from Gothenburg, Sweden. The baseline sample (N =1019) was first examined in 2000 and followed up in 2005 and 2009. Study I lays the foundation upon which the other studies rest. It does so by asking whether socio- economic status (SES) could in fact moderate the increased risk of dementia that carrying one or more copies of the APOE (apolipoprotein E) ε4 allele implies. Having identified that high SES seems to buffer the effect of APOE ε4 among men but not among women, Study II and III set out to explore two mechanisms that could possibly shed further light on the link between socio-economic (dis)advantage and dementia risk as well as on the previously identified sex difference: work environment exposures and access to social networks. The findings of Study II suggest that work control is the most influential aspect of the work environment, with respect to moderation of genetic endowments, but that it is only protective among men. While no significant gene-social network interactions were revealed in Study III, the results indicate that there might be important differences between men and women in the impact of social networks on dementia risk. Finally, Study IV tests the assumption that the higher lifetime risk of dementia among women could, at least in part, be the result of differences in educational attainment and/or in experiences of general psychological distress. The results confirm that education ought to be considered a ‘gendered’ dementia risk factor and propose that psychological distress constitutes a potential, and hitherto rarely acknowledged, pathway between dementia and female sex, on the one hand, and dementia and low educational attainment, on the other. In light of the findings presented in this thesis, it is evident that dementia is an emergent phenomenon that must not be reduced to the sum of its parts, especially considering the results suggesting that genetic endowments can actually be moderated by externally imposed factors. Additionally, all four studies underline that the risk/protective factors that are more proximate to the individual, such as work environment exposures, social networks or distress, must not be studied as if they were distinct from the social structures that ‘put people at risk of risks’. Consequently, I argue, class and sex/gender must be attended to as fundamental, and intersecting, causes of dementia if we are to better understand why some individuals develop the disease, while others do not.
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| 8. |
- Kiwi, Mahin, 1954-
(författare)
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Dementia across cultural borders : Reflections and thought patterns of elderly Iranians with dementia in Sweden, their relatives and staff at a culturally profiled nursing home
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Today’s multicultural society has resulted in major changes, with healthcare undergoing significant modifications. Healthcare workers and patients are increasingly confronted with “cultural” backgrounds other than their own. The world’s population is ageing, and the number of people with dementia is growing, resulting in a growing number of older people with a foreign background whose care needs have increased at different rates. Migration does not only mean moving from one place to another; it also involves the transition of an individual’s lifestyle, life views, social and economic adjustments that may lead to certain changes. These transitions from the “old” to the “new” way of life and from a life without dementia to a life with dementia involve making sense of life’s changes.Aim: The aim of study I was to explore the experiences and perceptions of dementia among Iranian staff working in a culturally profiled nursing home (CPNH). The aim of studies II and III was to explore relatives’ decisions to end caregiving at home, and Iranian families’ and relatives’ attitudes towards CPNHs in Sweden. The aim of study (IV) was to explore how the residents with dementia at the CPNH expressed the feeling of “home”.Method: This thesis is based on more than one year’s fieldwork. The empirical material is based on interviews and observations. Three groups of participants were interviewed and observed: 10 people with dementia (IV), 20 family caregivers and relatives (II and III, respectively) and 34 staff members (I). The interviews were conducted in Persian/Farsi, Azerbaijani, English and Swedish. The choice of language was always up to the participants. All the interviews were audio-recorded, transcribed verbatim in the respective languages and then translated later into Swedish. The analysis of the material was based on content analysis blended with ethnography.Results: Study I shows that people from different culturally and linguistically diverse backgrounds could have different perceptions of what dementia entails. A lack of knowledge concerning dementia affects how staff approach these people.Study II shows that the CPNH is crucial when deciding to cease caregiving at home. It is important to ensure that relatives with dementia are cared for by someone who speaks the same mother tongue. The results indicate that positive feelings of relief or comfort are dominant responses among the participants, some of whom even feel pride in the high standard of care provided by the home.In Study III, most participants based their views on a comparison between the CPNH and Iranian nursing homes after the Islamic Revolution. Negative views of the nursing home were evaluated alongside what the respondents considered to be typically Iranian. In Study IV, the results show that people with dementia’s personal experiences of home played a great role, and although none of the participants felt at home, all of them stated that the CPNH was a place to live in.Conclusion: Perceptions of dementia can be based on cultural and traditional understanding, although this can shift through transition and knowledge accumulation. A lack of knowledge concerning dementia and residents’ sociocultural background, generational differences and incoherence, aligned with staff members’ different sociocultural backgrounds, created many challenges. The staff wanted to learn more about dementia, to be able to manage daily communication with the residents. On another point, the staff admitted that only being able to speak a person’s native language was not enough to claim that they were actually communicating. Family caregivers’ decisions to end caregiving at home involve mutuality, capability and management, but decision-making sometimes has nothing to do with violating a person’s autonomy and is more about protecting the person. The family caregivers do care for frail elderly family members. What has changed due to a transition is the structure and construction of family caregiving. The consequences of communication difficulties between staff and the residents have led to a small degree of social involvement, which in turn affects residents’ daily social state. Overall, many family members stated that the CPNH resembled Iran too much, which disturbed them.The residents thought of home as a geographical location, but also connected it with both positive and negative feelings. Furthermore, the CPNH reminded some of the residents of the nicer side of life back home in Iran, while for others it brought back sad experiences and memories from the past. Nevertheless, the nursing home, due to memories and experiences of life in Iran, “home”, was a place to be and to live.
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| 9. |
- Larsson, Caroline
(författare)
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Chronic pain and kinesiophobia among older adults. Prevalence, characteristics and impact on physical activity.
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic pain is common in older adults, yet little is known of its development in old age. Although fear-avoidance beliefs in chronic pain have been explored in younger adults, the relationship between chronic pain, kinesiophobia and physical activity levels has not been investigated in older adults.Objectives: The overall aim was to explore prevalence, development and related factors of chronic pain and kinesiophobia in older adults with a focus on psychosocial and pain related factors and their impact on physical activity among older adults.Methods: The study had a longitudinal design and data were obtained through posted surveys and collected at baseline and after 12 and 24 months during 2011–2013. Participants (N=2000) were selected through simple randomization of the Swedish register of inhabitants using the whole Swedish population aged 65+, as sampling frame. A total of 1141 older adults were included at baseline (aged 65–103 years). Prevalence, incidence rate and cumulative incidence of chronic pain over 2 years in different age strata were estimated. To estimate associations for demographic, psychosocial and pain-related variables as functions of chronic pain (persistence and onset), kinesiophobia and physical activity linear/logistic regression analysis were performed.Results: In paper I, chronic pain was reported by 38.5% of the participants, more common among females and those over 85 years. The incidence was estimated at 5.4%. Being female, having lower BMI, high intensity/severity, long duration and multiple locations of pain were able to predict persistence of chronic pain among older women. Paper II showed that TSK-11 had acceptable construct validity, factor structure and test-retest reliability. In Papers III–IV generally low levels of kinesiophobia were found among those with chronic pain, except among frailer and older adults living in care homes. Despite this, it was found that kinesiophobia was independently associated with levels of physical activity and significantly lower levels of physical activity among those with chronic pain.Conclusions: Even though chronic pain was often highly prevalent and persistent, both onset and recovery occurred over time. The findings highlight the importance of early pain management in prevention of future pain among older adults. It must also be considered that older adults with chronic pain are at higher risk of functional decline and additional chronic diseases, due to significantly lower levels of physical activity compared to older without chronic pain. Kinesiophobia among older adults can be captured by the TSK-11 and plays an important role in predicting future physical activity levels and is hence important to consider. Potential interventions against kinesiophobia among older adults should aim to decrease pain intensity and strengthen health beliefs.
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| 10. |
- Nilsson, Kerstin
(författare)
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To work or not to work in an extended working life? Factors in working and retirement decisions
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In most of the industrialised world, the proportion of older and retired people in the population is continuously increasing. This will have budgetary implications for maintaining the welfare state, because the active working section of the population must fund the non-active and old population. Aim: The overall aim of this thesis was to obtain knowledge about older workers’ work and life situation in association with their planning and decision to retire from working life. Method: The thesis includes one qualitative and three quantitative studies conducted in Sweden. Result: Self-rated health was found to be a better measure than diagnosed disease of whether older workers believed they could work until 65 years or beyond. Health seems not to be a general impediment to working in old age if older workers are satisfied with their work situation and have enough time and opportunities to recover from fatigue. In one of Sweden’s most hazardous work environments, older workers were not injured significantly more often than younger workers. Good mental and physical work environment, moderate working pace and working time, and the right competence and possibility for skills development were factors determining whether older workers believed they can extend their working life. Attitude to older workers in the organisation, motivation and work satisfaction were factors determining whether older workers want to extend working life. Health, personal economic incentives, family/leisure pursuits and attitude to pension in society affected both whether people believed they can and wanted to extend their working life. In their final retirement decision, older workers considered: i) their possibility to balance and adapt functional ageing and health to a sustainable work situation; ii) their economic situation; iii) possibilities for social inclusion and coherence; and iv) possibilities for meaningful activities. Whether these requirements were best fulfilled in or outside working life determined the decision to continue working or to retire. Conclusion: If it is desirable for society that people will to extend their working life, both the “can work” and the “want to work” factors need to be met. It is important to provide a good fit inside working life. This requires a focus not only on older workers, but also on organisations and managers in order to provide incentives that keep older workers in the work force.
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