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| 2. |
- Kelfve, Susanne, et al.
(författare)
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Educational differences in long-term care use in Sweden during the last two years of life
- 2023
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:4, s. 579-586
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Tidskriftsartikel (refereegranskat)abstract
- Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p<0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8–17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8–16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden’s publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.
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| 3. |
- Kelfve, Susanne, et al.
(författare)
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Length of the period with late life dependency : Does the age of onset make a difference?
- 2023
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Ingår i: European Journal of Ageing. - : SPRINGER. - 1613-9372 .- 1613-9380. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- There is a gap in knowledge about factors associated with the duration of late life dependency. In this study, we measured how the age at onset of late life dependency relates to the time spent with late life dependency. Using Swedish register data, we identified people 70 + who entered the period of late life dependency (measured by entering long-term care for help with PADLs) between June and December 2008. We followed this cohort (n = 17,515) for 7 years, or until death. We used Laplace regression models to estimate the median number of months with late life dependency by age group, gender, level of education and country of birth. We also calculated the crude percentiles (p10, p25, p50, p75 and p90) of month with late life dependency, by age group, gender and cohabitation status. Results show that the majority spent a rather long period with dependency, the median number of months were 40.0 (3.3 years) for women and 22.6 (1.9 year) for men. A higher age at entry was associated with a shorter duration of dependency, an association that was robust to adjustment for cohabiting at baseline, gender, education and country of birth. Our results suggest that older adults who postpone the start of dependency also compress the time with dependency, this lends support to the ambitions of public health initiatives and interventions targeting maintained independence in older adults.
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| 4. |
- Kelfve, Susanne, et al.
(författare)
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Length of the period with late life dependency: Does the age of onset make a difference?
- 2023
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Ingår i: European Journal of Ageing. - : SPRINGER. - 1613-9372 .- 1613-9380. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- There is a gap in knowledge about factors associated with the duration of late life dependency. In this study, we measured how the age at onset of late life dependency relates to the time spent with late life dependency. Using Swedish register data, we identified people 70 + who entered the period of late life dependency (measured by entering long-term care for help with PADLs) between June and December 2008. We followed this cohort (n = 17,515) for 7 years, or until death. We used Laplace regression models to estimate the median number of months with late life dependency by age group, gender, level of education and country of birth. We also calculated the crude percentiles (p10, p25, p50, p75 and p90) of month with late life dependency, by age group, gender and cohabitation status. Results show that the majority spent a rather long period with dependency, the median number of months were 40.0 (3.3 years) for women and 22.6 (1.9 year) for men. A higher age at entry was associated with a shorter duration of dependency, an association that was robust to adjustment for cohabiting at baseline, gender, education and country of birth. Our results suggest that older adults who postpone the start of dependency also compress the time with dependency, this lends support to the ambitions of public health initiatives and interventions targeting maintained independence in older adults.
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| 5. |
- Kåreholt, Ingemar, 1960-, et al.
(författare)
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History of Job Strain And Risk of Late-Life Dependency : A Nationwide Swedish Registerbased Study
- 2022
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Ingår i: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 6:Supplement 1, s. 502-503
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Tidskriftsartikel (refereegranskat)abstract
- There is substantial evidence that work plays a significant role in post-retirement health. Yet little is known about its role in when late-life dependency may occur. We examined associations between job strain and the risk of entering late-life dependency. Individually linked nationwide Swedish registers were used to identify people 70+ alive in January 2014, and who did not experience the outcome (late-life dependency) during two months prior to the start of the follow-up. Late-life dependency was operationalized as use of long-term care. Information about job strain was obtained via a job exposure matrice and matched with job titles. Cox regression models with age as time-scale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios (HR) for entering late-life dependency during the 24 months of follow-up (n=993,595). Having an initial high starting point of job strain followed by an increasing trajectory throughout working life implied a 23% higher risk of entering late-life dependency at a younger age, compared with the reference group (low starting point with a decreasing trajectory). High initial starting point followed by a stable trajectory implied a 12% higher risk of entering late-life dependency at a younger age. High initial starting point followed by a decreasing trajectory implied a 10% risk reduction, and a low starting point with a stable trajectory implied a 22% risk reduction, of entering late-life dependency at a younger age. Reducing stressful jobs across working life may contribute to postponing late-life dependency.
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| 6. |
- Marengoni, Alessandra, et al.
(författare)
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Aging with multimorbidity : A systematic review of the literature
- 2011
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Ingår i: Ageing Research Reviews. - : Elsevier BV. - 1568-1637 .- 1872-9649. ; 10:4, s. 430-439
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Forskningsöversikt (refereegranskat)abstract
- A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients.
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| 7. |
- Marengoni, Alessandra, et al.
(författare)
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Coexisting chronic conditions in the older population : Variation by health indicators
- 2016
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Ingår i: European journal of internal medicine. - : Elsevier BV. - 0953-6205 .- 1879-0828. ; 31, s. 29-34
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study analyzes the prevalence and patterns of coexisting chronic conditions in older adults.Design: Cross-sectional.Participant and setting: A sample of 3363 people >= 60 years living in Stockholm were examined from March 2001 through August 2004.Measurements: Chronic conditions were measured with: 1) multimorbidity (>= 2 concurrent chronic diseases); 2) the Cumulative Illness Rating Scale, 3) polypharmacy (>= 5 prescribed drugs), and 4) complex health problems ( chronic diseases and/or symptoms along with cognitive and/or functional limitations).Results: A total of 55.6% of 60-74 year olds and 13.4% of those >= 85 years did not have chronic conditions according to the four indicators. Multimorbidity and polypharmacy were the most prevalent indicators: 38% aged 60-74 and 76% aged >= 85 had multimorbidity; 24.3% aged 60-74 and 59% aged >= 85 had polypharmacy. Prevalence of chronic conditions as indicated by the comorbidity index and complex health problems ranged from 16.5% and 1.5% in the 60-74 year olds to 38% and 36% in the 85 + year olds, respectively. Prevalence of participants with 4 indicators was low, varying from 1.6% in those aged 60-74 to 14.9% in those aged >= 85 years. Older age was associated with higher odds of each of the 4 indicators; being a woman, with all indicators but multimorbidity; and lower educational level, only with complex health problems.Conclusions: Prevalence of coexisting chronic conditions varies greatly by health indicator used. Variation increases when age, sex, and educational level are taken into account. These findings underscore the need of different indicators to capture health complexity in older adults.
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| 8. |
- Meinow, Bettina, 1972-
(författare)
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Capturing health in the elderly population : Complex health problems, mortality, and allocation of home-help services
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.
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| 9. |
- Meinow, Bettina, et al.
(författare)
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Complex health problems among the oldest old in Sweden : increased prevalence rates between 1992 and 2002 and stable rates thereafter
- 2015
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Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 12:4, s. 285-297
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Tidskriftsartikel (refereegranskat)abstract
- Studies of health trends in older populations usually focus on single health indicators. We include multiple medical and functional indicators, which together indicate the broader impact of health problems experienced by individuals and the need for integrated care from several providers of medical and long-term care. The study identified severe problems in three health domains (diseases/symptoms, mobility, and cognition/communication) in three nationally representative samples of the Swedish population aged 77+ in 1992, 2002, and 2011 (n a parts per thousand 1900; response rate > 85 %). Institutionalized people and proxy interviews were included. People with severe problems in two or three domains were considered to have complex health problems. Results showed a significant increase of older adults with complex health problems from 19 % in 1992 to 26 % in 2002 and no change thereafter. Changes over time remained when controlling for age and sex. When stratified by education, complex health problems increased significantly for people with lower education between 1992 and 2002 and did not change significantly between 2002 and 2011. For higher-educated people, there was no significant change over time. Among the people with severe problems in the symptoms/disease domain, about half had no severe problems in the other domains. People with severe mobility problems, on the other hand, were more likely to also have severe problems in other domains. Even stable rates may imply an increasing number of very old people with complex health problems, resulting in a need for improved coordination between providers of medical care and social services.
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| 10. |
- Meinow, Bettina, et al.
(författare)
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Complex health problems and mortality among the oldest old in Sweden : decreased risk for men between 1992 and 2002
- 2010
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Ingår i: European journal of ageing. - : Springer. - 1613-9372 .- 1613-9380. ; 7:2, s. 81-90
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Tidskriftsartikel (refereegranskat)abstract
- Although mortality in older ages generally declined in most countries during the past decades less is known about mortality trends among the most vulnerable subset of the oldest old. The aim of this study was to investigate possible changes between 1992 and 2002 in the relation of complex health problems and mortality in two representative samples of the Swedish population aged 77+ (1992: n = 537; 2002: n = 561). Further, it was examined if trends differed by sex, education, and age. Serious problems in three health domains were identified (diseases/symptoms, mobility, cognition/communication). People with serious problems in two or three domains were considered to have complex health problems. Four-year mortality was analyzed using Cox proportional hazard regressions. Controlled for age, sex, education, and health status mortality risk decreased by 20% during the 10-year period. Complex health problems strongly predicted 4-year mortality in both 1992 and 2002. No single dimension explained the decrease. Men with complex health problems accounted for most of the decrease in mortality risk, so much that the gender difference in mortality risk was almost eliminated among elderly people with complex health problems 2002. A considerable decrease in the mortality risk among men with complex health problems has implications for the individual who may face longer periods of complex health problems and dependency. It will also place increasing demands upon medical and social services as well as informal caregivers.
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