| 1. |
- Edvardsson, Maria, et al.
(författare)
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Classification of ≥80-year-old individuals into healthy, moderately healthy, and frail based on different frailty scores affects the interpretation of laboratory results
- 2022
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Ingår i: Asian Journal of Medical Sciences. - : Nepal Journals Online (NepJOL). - 2467-9100 .- 2091-0576. ; 13:9, s. 63-71
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Tidskriftsartikel (refereegranskat)abstract
- Background: Interpretation laboratory analyses are crucial when assessing the patient’s condition. Reference intervals from apparently healthy and disease-free individuals may cause problems when outcomes from elderly patients with chronic diseases and on medications are being interpreted. Elderly individuals are a heterogeneous group ranging from individuals managing their daily life independently to individuals with diseases and impairment, in need of nursing care around the clock, that is, frail; a term widely used although there is no consensus on the definition.Aims and Objectives: The aim of the study was to study the effect of classification of elderly into healthy, moderately healthy, and frail, based on activities of daily living (ADL) and Mini-Mental State Examination (MMSE) or frailty index (FI), on the interpretation of outcomes regarding: Albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, and gamma-glutamyltransferase (γ-GT) levels.Materials and Methods: Individuals ≥80 years (n=568) were classified either on ADL and MMSE or number of deficits, (FI).Results: Individuals classified as frail based on FI had lower mean levels for ALT, creatinine and γ-GT than individuals classified based on ADL and MMSE (P<0.05).Conclusion: The model to define health status to some extent affected laboratory analyte levels in ≥80 years old, classified as healthy, moderately healthy, and frail based on ADL and MMSE versus FI.
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| 2. |
- Edvardsson, Maria, et al.
(författare)
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Differences in levels of albumin, ALT, AST, gamma-GT and creatinine in frail, moderately healthy and healthy elderly individuals
- 2018
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Ingår i: Clinical Chemistry and Laboratory Medicine. - : WALTER DE GRUYTER GMBH. - 1434-6621 .- 1437-4331. ; 56:3, s. 471-478
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reference intervals are widely used as decision tools, providing the physician with information about whether the analyte values indicate ongoing disease process. Reference intervals are generally based on individuals without diagnosed diseases or use of medication, which often excludes elderly. The aim of the study was to assess levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine and gamma-glutamyl transferase (gamma-GT) in frail, moderately healthy and healthy elderly indivuduals. Methods: Blood samples were collected from individuals amp;gt; 80 years old, nursing home residents, in the Elderly in Linkoping Screening Assessment and Nordic Reference Interval Project, a total of 569 individuals. They were divided into three cohorts: frail, moderately healthy and healthy, depending on cognitive and physical function. Albumin, ALT, AST, creatinine and gamma-GT were analyzed using routine methods. Results: Linear regression predicted factors for 34% of the variance in albumin were activities of daily living (ADL), gender, stroke and cancer. ADLs, gender and weight explained 15% of changes in ALT. For AST levels, ADLs, cancer and analgesics explained 5% of changes. Kidney disease, gender, Mini Mental State Examination (MMSE) and chronic obstructive pulmonary disease explained 25% of the variation in creatinine levels and MMSE explained three per cent of gamma-GT variation. Conclusions: Because a group of people are at the same age, they should not be assessed the same way. To interpret results of laboratory tests in elderly is a complex task, where reference intervals are one part, but far from the only one, to take into consideration.
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| 3. |
- Andersson, Lena B., et al.
(författare)
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Health-related quality of life and activities of daily living in 85-year-olds in sweden
- 2014
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Ingår i: Health and Social Care in the Community. - : John Wiley & Sons. - 0966-0410 .- 1365-2524. ; 22:4, s. 368-374
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Tidskriftsartikel (refereegranskat)abstract
- Few studies have examined health-related quality of life (HRQoL) with respect to daily living and health factors for relatively healthy elderly individuals. To this end, this study examines 85-year-olds’ reported HRQoL in relation to social support, perceived health, chronic diseases, health care use and instrumental activities of daily living. Data were collected from 360 participants (55% response rate) between March 2007 and March 2008 using a postal questionnaire and a home visit interview. HRQoL was assessed using the EQ-5D-3L. For the items in the EQ-5D-3L, more problems were related to lower HRQoL. Restricted mobility and occurrence of pain/discomfort was common. Lower HRQoL was associated with increased risk for depression, increased use of medication, increased number of chronic diseases, and more problems with instrumental activities of daily living (IADL). Health care use and health care costs was correlated to lower HRQoL. HRQoL is of importance to health care providers and must be considered together with IADL in the elderly population when planning interventions. These should take into account the specific needs and resources of the older individuals.
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| 4. |
- Classon, Elisabet, et al.
(författare)
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A quick test of cognitive speed (AQT) : regression-based norms for cognitively healthy 80 to 94-year olds
- 2022
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Ingår i: Aging, Neuropsychology and Cognition. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 1382-5585 .- 1744-4128. ; 29:5, s. 820-839
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Tidskriftsartikel (refereegranskat)abstract
- Slowed processing speed is part of normal aging but also a symptom of many diseases, including dementia. A Quick Test of Cognitive Speed (AQT) consists of three conditions: color naming (AQT1), form naming (AQT2) and dual color-form naming (AQT3) and offers a user-friendly assessment of processing speed that is used internationally to identify cognitive impairment in elderly patients. Appropriate age-norms have however been lacking. This study provides regression-based norms derived from a Swedish sample of 158 cognitively healthy 80 to 94-year olds. The results show age effects in all three conditions, a non-linear education effect in AQT1, and age by gender interactions in AQT2 and AQT3: men performed worse with increasing age, but women remained on a par. However, irrespective of age and gender, AQT2 and AQT3 mean raw and predicted scores were slower than the hitherto recommended cutoff criteria for suspected cognitive impairment.
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| 5. |
- Classon, Elisabet, et al.
(författare)
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Relations between Concurrent Longitudinal Changes in Cognition, Depressive Symptoms, Self-Rated Health and Everyday Function in Normally Aging Octogenarians
- 2016
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 11:8, s. e0160742-
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Tidskriftsartikel (refereegranskat)abstract
- Ability to predict and prevent incipient functional decline in older adults may help prolong independence. Cognition is related to everyday function and easily administered, sensitive cognitive tests may help identify at-risk individuals. Factors like depressive symptoms and self-rated health are also associated with functional ability and may be as important as cognition. The purpose of this study was to investigate the relationship between concurrent longitudinal changes in cognition, depression, self-rated health and everyday function in a well-defined cohort of healthy 85 year olds that were followed-up at the age of 90 in the Elderly in Linkoping Screening Assessment 85 study. Regression analyses were used to determine if cognitive decline as assessed by global (the Mini-Mental State Examination) and domain specific (the Cognitive Assessment Battery, CAB) cognitive tests predicted functional decline in the context of changes in depressive symptoms and self-rated health. Results showed deterioration in most variables and as many as 83% of these community-dwelling elders experienced functional difficulties at the age of 90. Slowing-down of processing speed as assessed by the Symbol Digits Modality Test (included in the CAB) accounted for 14% of the variance in functional decline. Worsening self-rated health accounted for an additional 6%, but no other variables reached significance. These results are discussed with an eye to possible preventive interventions that may prolong independence for the steadily growing number of normally aging old-old citizens.
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| 6. |
- Dannapfel, Petra, 1978-, et al.
(författare)
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Education to Increase Skills in Research Methods among Clinicians in Health Care
- 2017
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Ingår i: Journal of Health & Medical Informatics. - Los Angeles, United States : Omics Publishing Group. - 2157-7420. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe aim of this study was to evaluate participants’ and managers’ experience of the design and content of an education programme. The Knowledge to Action (KTA) framework was applied to identify the steps of knowledge creation and action in the education programme.MethodsData were collected from 18 participants representing two groups: participants in the intervention and supervisors and managers. Two focus groups took place: two with participants in the intervention (4 and 3 in each) and one with eleven managers.ResultsAll steps in the KTA framework were identified and discussed from several aspects. The importance of selecting projects that were relevant and added value in their clinics was mentioned by all participants. The participants also mentioned that after the education, they had further understanding and increased skills in how to be active and perform continuous improvement projects. The step in the KTA process regarding how to adapt knowledge to local context was not discussed explicitly by the participants or managers.DiscussionEducation in research methods and performing improvement projects to develop the clinic creates a more positive attitude to working with continuous improvement. The participant’s self-esteem and knowledge increased regarding how to work with improvements. It is important to have the manager’s support to perform a project. Emphasis was on knowledge inquiry and synthesis and presenting the results with or without possible solutions. The participants and managers talked about barriers and knowledge use more generally and at an organizational level. This means that the participants did not gain the last bit of nowledge needed to put the action into practice. This implies that the problem regarding lack of implementation skills in health care might remain.
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| 7. |
- Dong, Huan-Ji, et al.
(författare)
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Health Consequences Associated with Being Overweight or Obese: A Swedish Population-Based Study of 85-Year-Olds
- 2012
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Ingår i: Journal of The American Geriatrics Society. - : Wiley-Blackwell. - 0002-8614 .- 1532-5415. ; 60:2, s. 243-250
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine whether being overweight or obese is associated with significant health outcomes in an 85-year-old population. less thanbrgreater than less thanbrgreater thanDESIGN: A cross-sectional population-based study. less thanbrgreater than less thanbrgreater thanSETTING: Linkoping, Sweden. less thanbrgreater than less thanbrgreater thanPARTICIPANTS: Three hundred thirty-eight people born in 1922 were identified using the local authoritys register. less thanbrgreater than less thanbrgreater thanMEASUREMENTS: Data related to sociodemographic characteristics, health-related quality of life (HRQoL), assistance use, and the presence of diseases were collected using a postal questionnaire. Anthropometry and functional status were assessed during home and geriatric clinic visits. Diseases were double-checked in the electronic medical records, and information about health service consumption was obtained from the local healthcare register. less thanbrgreater than less thanbrgreater thanRESULTS: Overweight (body mass index (BMI) 25.0-29.9 kg/m(2)) and obese (BMI andgt;= 30.0 kg/m(2)) participants perceived more difficulty performing instrumental activities of daily living (IADLs) and had more comorbidity than their normal-weight counterparts (BMI 18.5-24.9 kg/m(2)), but their overall HRQoL and health service costs did not differ from those of normal-weight participants. After controlling for sociodemographic factors, being overweight did not influence IADLs or any comorbidity, but obese participants were more likely to perceive greater difficulty in performing outdoor activities (odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.1-4) and cleaning (OR = 2.2, 95% CI = 1.2-4.2) than their normal-weight counterparts. Although obesity was also associated with multimorbidity (OR = 3, 95% CI = 1.2-8), the health service cost of each case of multimorbidity (n = 251) was highest in normalweight participants and nearly three times as much as in obese participants (ratio: 2.9, 95% CI = 1.1-8.1). less thanbrgreater than less thanbrgreater thanCONCLUSION: For 85-year-olds, being obese, as opposed to overweight, is associated with self-reported activity limitations and comorbidities. Overweight older adults living in their own homes in this population had well-being similar to that of those with normal weight.
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| 8. |
- Dong, Huan-Ji, 1981-
(författare)
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Health Maintenance in Very Old Age : Medical Conditions, Functional Outcome and Nutritional Status
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to provide better understanding of the underlying factors related to health maintenance in very old people, with a focus on medical conditions, functional outcome and nutritional status. Data were gathered from the ELSA 85 project (Elderly in Linköping Screening Assessment). The ELSA 85 project was started in 2007 with a population-based survey of 85-year-old individuals (n = 650) residing in Linköping municipality, Sweden. During the study period from 2007 to 2010, we conducted surveys by postal questionnaire, home visits, geriatric clinic visits, and reviews of electronic medical records as well as the database of health service consumption. A series of cross-sectional analyses were performed on multimorbidity, health service consumption, activities of daily living (ADLs), physical functioning and nutritional status.Of 650 eligible individuals, 496 (78% of those alive) completed the questionnaire (Paper I). Despite the prevalence of multimorbidity (68%) and frequent use of assistive technology for mobility (40%), the majority managed self-care (85%), usual activities (74%) and had high self-rated health (>60/100, visual analogue scale). Factors associated with in-patient care were an increased number of general practitioner visits, more use of assistive technology, community assistance, multimorbidity (≥2 chronic diseases) and/or heart failure and arrhythmia.Cluster analyses (n = 496, Paper II) revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic–mental (only for men), mental disease (only for women), and three other clusters related to ageing (one for men and two for women). Heart failure in men (odds ratio [OR], 2.4; 95% confidence interval [CI], 1–5.7) and women (OR, 3; 95% CI, 1.3–6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency room visits. Men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.7) and women’s cardiopulmonary cluster (OR, 1.7; 95% CI, 1.2–2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.4) and one of the women’s ageing clusters (OR, 0.5; 95% CI, 0.3–0.8) showed interaction effects on hospitalization.In Paper III, overweight (body mass index [BMI], 25–29.9 kg/m2) and obese (BMI, ≥30 kg/m2) individuals (n = 333) perceived more difficulty performing instrumental ADL (IADL) and had more comorbidities than their normal weight counterparts (BMI, 18.5–24.9 kg/m2). After controlling for socio-demographic factors, obese but not overweight individuals were more likely to perceive increased difficulty in performing outdoor activities (OR, 2.1; 95% CI, 1.1–4) and cleaning (OR, 2.2; 95% CI, 1.2–4.2) than their normal weight counterparts. Although obesity was also associated with multimorbidity (OR, 3; 95% CI, 1.2–8), the health service cost of each case of multimorbidity (n = 251) was highest in individuals of normal weight and nearly three times as much as in obese individuals (ratio, 2.9; 95% CI, 1.1–8.1).In Paper IV, 88-year-old obese women (n = 83) had greater absolute waist circumference, fat mass (FM) and fat-free mass (FFM), and lower handgrip strength (HS) corrected for FFM and HS-based ratios (HS/weight (Wt), HS/BMI, HS/FFM and HS/FM) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, the HS-based ratios explained more variance in physical functioning in Short Form-36 (R2, 0.52–0.54) than other single anthropometric or body composition parameters (R2, 0.45–0.51). Waist circumference, HS, and two HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty.In conclusion, the ELSA 85 population showed a fairly positive image of healthy perception, good functional ability as well as low use of health care among the majority of participants. Patterns of cardiac and pulmonary conditions were better associated than any single morbidity with hospitalization. Heart failure as a single morbidity was better associated than multimorbidity patterns with emergency room visits. For 85-year-olds, being obese, as opposed to overweight, was associated with self-reported activity limitations and comorbidities. Overweight elderly living in their own homes in this population had similar well-being to those of normal weight. In the cohort of 88-year-olds, obese women had high waist circumference, but their HS was relatively low in relation to their Wt and FFM. These parameters were better than BMI for predicting physical function and independent daily living.
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| 9. |
- Dong, Huan-Ji, et al.
(författare)
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Multimorbidity patterns of and use of health services by Swedish 85-year-olds: an exploratory study
- 2013
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 13:120
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAs life expectancy continues to rise, more elderly are reaching advanced ages (≥80 years). The increasing prevalence of multimorbidity places additional demands on health-care resources for the elderly. Previous studies noted the impact of multimorbidity on the use of health services, but the effects of multimorbidity patterns on health-service use have not been well studied, especially for very old people. This study determines patterns of multimorbidity associated with emergency-room visits and hospitalization in an 85-year-old population.MethodsHealth and living conditions were reported via postal questionnaire by 496 Linköping residents aged 85 years (189 men and 307 women). Diagnoses of morbidity were reviewed in patients’ case reports, and the local health-care register provided information on the use of health services. Hierarchical cluster analysis was applied to evaluate patterns of multimorbidity with gender stratification. Factors associated with emergency-room visits and hospitalization were analyzed using logistic regression models.ResultsCluster analyses revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic–mental (only for men), mental disease (only for women), and three other clusters related to aging (one for men and two for women). Heart failure in men (OR = 2.4, 95% CI = 1–5.7) and women (OR = 3, 95% CI = 1.3–6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency-room visits. Men's cardiac cluster (OR = 1.6; 95% CI = 1–2.7) and women's cardiopulmonary cluster (OR = 1.7, 95% CI = 1.2–2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men’s cardiac cluster (OR = 1.6, 95% CI = 1–2.4) and one of the women’s aging clusters (OR = 0.5, 95% CI = 0.3–0.8) showed interaction effects on hospitalization.ConclusionIn this 85-year-old population, patterns of cardiac and pulmonary conditions were better than a single morbidity in explaining hospitalization. Heart failure was superior to multimorbidity patterns in explaining emergency-room visits. A holistic approach to examining the patterns of multimorbidity and their relationships with the use of health services will contribute to both local health care policy and geriatric practice.
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| 10. |
- Dong, Huan-Ji, et al.
(författare)
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Obese very old women have low relative handgrip strength, poor physical function, and difficulty in daily living
- 2015
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Ingår i: The Journal of Nutrition, Health & Aging. - : Springer. - 1279-7707 .- 1760-4788. ; 19:1, s. 20-25
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate how anthropometric and body composition variables, and handgrip strength (HS) affect physical function and independent daily living in 88-year-old Swedish women.Participants: A cross-sectional analysis of 83 community-dwelling women, who were 88 years old with normal weight (n=30), overweight (n=29), and obesity (n=24) in Linköping, Sweden, was performed.Measures: Assessments of body weight (Wt), height, waist circumference (WC), and arm circumference were performed by using an electronic scale and measuring tape. Tricep skinfold thickness was measured by a skinfold calliper. Fat mass (FM) and fat-free mass (FFM) were measured by bioelectrical impedance analysis, and HS was recorded with an electronic grip force instrument. Linear regression was used to determine the contributions of parameters as a single predictor or as a ratio with HS to physical function (Short Form-36, SF-36PF) and instrumental activities of daily living (IADL).Results: Obese women had greater absolute FM and FFM, and lower HS corrected for FFM and HS-based ratios (i.e., HS/Wt, HS/body mass index [BMI]) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, HS-based ratios explained more variance in SF-36PF scoring (R2: 0.52–0.54) than single anthropometric and body composition variables (R2: 0.45–0.51). WC, HS, and HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty.Conclusion: Obese very old women have a high WC, but their HS is relatively low in relation to their Wt and FFM. These parameters are better than BMI for predicting physical function and independent daily living.
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