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Sökning: L773:1176 9092 OR L773:1178 1998

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1.
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2.
  • Andersson, Pia, 1955-, et al. (författare)
  • Impaired oral health in older orthopaedic in-care patients : The influence of medication and morbidity
  • 2021
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 16, s. 1691-1702
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication.Material and Methods: The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy.Results: Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy.Conclusion: The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.
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3.
  • Andersson, Pia, et al. (författare)
  • Impaired oral health in older orthopaedic in-care patients : The influence of medication and morbidity
  • 2021
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press Ltd.. - 1176-9092 .- 1178-1998. ; 16, s. 1691-1702
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication. Material and Methods: The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy. Results: Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy. Conclusion: The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.
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4.
  • Arkkukangas, Marina (författare)
  • Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention
  • 2023
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press Ltd. - 1176-9092 .- 1178-1998. ; 18, s. 2165-2170
  • Tidskriftsartikel (refereegranskat)abstract
    • Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a “train-The-trainer” approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative approach should be used in the natural environment, before social and healthcare services are required.
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5.
  • Ballin, Marcel, et al. (författare)
  • Effects of interval training on quality of life and cardiometabolic risk markers in older adults : a randomized controlled trial
  • 2019
  • Ingår i: Clinical Interventions in Aging. - : Dove Press. - 1176-9092 .- 1178-1998. ; 14, s. 1589-1599
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To explore the effects of 10 weeks of progressive vigorous interval training as a single intervention on health-related quality of life (HRQoL) and cardiometabolic risk markers in centrally obese 70-year-old individuals.Participants and methods: A randomized controlled trial (ClinicalTrials.gov registration no. NCT03450655) including seventy-seven community-dwelling 70-year-old men and women with central obesity defined as > 1 kg visceral adipose tissue for women and > 2 kg for men. Participants randomized to the intervention group were offered a 10-week progressive vigorous interval training program performed three times per week. Control subjects were asked to maintain their daily living and routines throughout the trial. All participants in both groups had received tailored lifestyle recommendations focused on diet and physical activity at one occasion within 12 months prior to trial initiation. Prespecified outcome measures included: changes in HRQoL using the Short Form Health Survey Questionnaire (SF-36), blood pressure; resting heart rate (HR) and blood lipids. All analyses were conducted on an intention-to-treat basis.Results: The intervention resulted in significant effects on the SF-36 mental component summary (MCS) score and the mental health (MH) subscale (P< 0.05 for both), when compared to the control group. Specifically, the intervention group increased their MCS score by 6.3 points (95% confidence interval [CI] = 0.3–12.3) and their MH score by 6.0 points (95% CI = 1.7–10.4) compared to the control group. Moreover, significant effects were seen on resting HR, total cholesterol and LDL-cholesterol (P<0.05 for all).Conclusion: It was shown that 10 weeks of vigorous interval training as a single intervention was sufficient to improve mental aspects of HRQoL in older individuals with central obesity, which is a critical aspect of healthy ageing. Positive effects were seen also on cardiometabolic risk markers.
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6.
  • Boström, Gustaf, et al. (författare)
  • Functional capacity and dependency in transfer and dressing are associated with depressive symptoms in older people
  • 2014
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press Ltd.. - 1176-9092 .- 1178-1998. ; 9, s. 249-257
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: This study examined associations between depressive symptoms and functional capacity, overall dependency in personal activities of daily living (ADLs), and dependency in individual ADL tasks, respectively, in people with a high mean age, large range of functional capacity, and wide spectrum of dependency in ADLs. Methods: Cross-sectional data from three studies were used. A total of 392 individuals living in community and residential care facilities were included. Mean age was 86.2 years, 72% were women, 75% were dependent in ADLs, 42% had depression, and 39% had dementia. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15), functional capacity with the Berg Balance Scale (BBS), and ADLs with the Barthel ADL Index. Multiple linear regression analyses with comprehensive adjustments were performed between GDS-15 and BBS, GDS-15 and Barthel ADL Index, and GDS-15 and each individual ADL task, separately. Results: GDS-15 score was associated with BBS score (unstandardized b=-0.03, P=0.008), but not with Barthel ADL Index score (unstandardized b=-0.07, P=0.068). No significant interaction effects of sex, dementia, or living conditions were found in these associations. Among individual ADL tasks, dependency in transfer (unstandardized b=-1.03, P=0.007) and dressing (unstandardized b=-0.70, P=0.035) were associated with depressive symptoms. Conclusion: Functional capacity seems to be independently associated with depressive symptoms in older people living in community and residential care facilities, whereas overall ADL performance may not be associated. Dependency in the individual ADL tasks of transfer and dressing appear to be independently associated with depressive symptoms and may be an important focus of future interdisciplinary multifactorial intervention studies.
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7.
  • Cederbom, Sara, et al. (författare)
  • A behavioral medicine intervention for older women living alone with chronic pain - a feasibility study
  • 2014
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 9, s. 1383-1397
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: To be an older woman, live alone, have chronic pain, and be dependent on support are all factors that may have an impact on daily life. One way to promote ability in everyday activities in people with pain-related conditions is to use individualized, integrated behavioral medicine in physical therapy interventions. How this kind of intervention works for older women living alone at home, with chronic pain, and dependent on formal care to manage their everyday lives has not been studied. The aim was to explore the feasibility of a study and to evaluate an individually tailored integrated behavioral medicine in physical therapy intervention for the target group of women. Materials and methods: The study was a 12-week randomized trial with two-group design. Primary effect outcomes were pain-related disability and morale. Secondary effect outcomes focused on pain-related beliefs, self-efficacy for exercise, concerns of falling, physical activity, and physical performance. Results: In total, 23 women agreed to participate in the study and 16 women completed the intervention. The results showed that the behavioral medicine in physical therapy intervention was feasible. No effects were seen on the primary effect outcomes. The experimental intervention seemed to improve the level of physical activity and self-efficacy for exercise. Some of the participants in both groups perceived that they could manage their everyday life in a better way after participation in the study. Conclusion: Results from this study are encouraging, but the study procedure and interventions have to be refined and tested in a larger feasibility study to be able to evaluate the effects of these kinds of interventions on pain-related disability, pain-related beliefs, self-efficacy in everyday activities, and morale in the target group. Further research is also needed to refine and evaluate effects from individualized reminder routines, support to collect self-report data, safety procedures for balance training, and training of personnel to enhance self-efficacy.
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8.
  • Cederbom, Sara, 1973-, et al. (författare)
  • Effects of a behavioral medicine intervention on pain, health, and behavior among community-dwelling older adults : a randomized controlled trial
  • 2019
  • Ingår i: Clinical Interventions in Aging. - : Informa UK Limited. - 1176-9092 .- 1178-1998. ; 14, s. 1207-1220
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The aim of the study was to evaluate the effects of an intervention, based on a behavioral medicine approach in physical therapy (BMPI), on pain-related disability and physical performance as well as on pain severity, pain catastrophizing, physical activity levels, falls efficacy, and health-related quality of life (HRQL) by comparing the effects to standard care.Patients and methods: The study was a pragmatic randomized controlled trial with a two-group design and included measurements preintervention and postintervention and a 12-week follow-up. In total, 105 older adults, aged >75 years with chronic musculoskeletal pain living alone at home and dependent on formal care to manage their everyday lives, were included in the study. All statistical analyses were performed using an intention to treat approach.Results: The intervention, based on a behavioral medicine approach, compared to usual care, had a positive effect on pain-related disability, pain severity, level of physical activity, HRQL, management of everyday life, and self-efficacy.Conclusion: BMPI can be a suitable evidence-based intervention for community-dwelling older adults, even for those who are very old and frail. BMPI can support and promote an active aging and "age in place" for the target population, which is currently the main goal of all interventions in this field.
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9.
  • Cederbom, Sara, et al. (författare)
  • Impact of the fall prevention Otago Exercise Programme on pain among community-dwelling older adults : a short- and long-term follow-up study
  • 2019
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 14, s. 721-726
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Pain is a major public health issue among community-dwelling older adults, with a prevalence of 45-80%. In addition to being strongly associated with reduced physical function, loss of independence, psychological distress, lower quality of life, and risk of earlier death. Recent research has also found that pain in older adults is associated with a higher risk of falls, which itself is another major health concern. Long-term and high-intensity pain are predictors of chronic pain and pain-related disability. Therefore, establishing an evidence-based intervention that can reduce both pain and falls in older adults is of high importance.Purpose: This study aimed to investigate whether a home-based fall-preventive exercise-program can reduce pain in the target population over both the short and long term.Patients and methods: This was a quasi-experimental study with a 1-group pretest-posttest design. We included 119 participants who had participated in a recent 2-year fall prevention intervention in a randomized controlled trial. The intervention included exercises based on the Otago Exercise Programme (OEP), an individually tailored and prescribed program that involves home-based exercises supervised by a physiotherapist. Pain was measured using an item from the EuroQol-5D questionnaire.Results: Pain was significantly reduced from baseline (n=119) at 3 (n=105, p=0.003), 12 (n=96, p=0.041), and 24 (n=80, p=0.028) months following the commencement of OEP-based exercises.Conclusions: These results indicate that the OEP could be a suitable evidence-based program for both pain management and fall prevention among community-dwelling older people who live with pain and are at a higher risk of falling. Our study highlights an effective technique for better pain management and fall prevention in older adults.
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10.
  • Cheng, Yingzhe, et al. (författare)
  • Genetic Effects of NDUFAF6 rs6982393 and APOE on Alzheimer’s Disease in Chinese Rural Elderly : A Cross-Sectional Population-Based Study
  • 2022
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 17, s. 185-194
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To investigate the associations of genotypes of NDUFAF6 rs6982393 and APOE and their combined genotypes with the risk of Alzheimer’s disease (AD) and mild cognitive impairment (MCI) in Chinese rural elderly.Methods: This cross-sectional population-based study included 5096 older adults (age ≥ 60 years, 57.1% female). Genotypes of NDUFAF6 rs6982393 and APOE were detected using the multiple-polymerase chain reaction amplification. We diagnosed AD following the criteria of Diagnostic and Statistical Manual of Mental Disorders, the fourth edition and diagnosed MCI following the Petersen’s criteria MCI. Data were analyzed using the logistic regression model.Results: The overall prevalence of AD and MCI was 3.57% (95% confidence interval [CI]: 0.040, 0.053) and 22.65% (95% CI: 0.223, 0.247), separately. The TT versus CC/CT genotype of NDUFAF6 rs6982393 was related to a higher risk of AD with the multi-adjusted odds ratio (95% CI) being 1.61 (1.02, 2.54) in the total sample, 3.36 (1.48, 7.60) in those aged 60– 69, and 1.24 (0.71, 2.17) in those aged 70 years and above. The interaction between genotype of NDUFAF6 rs6982393 with age groups (60– 69 versus ≥ 70 years) was significant on the risk of AD. The presence of APOE ϵ4 was not significantly associated with the risk of AD. Carrying both NDUFAF6 TT and APOE ϵ4 was related to a higher risk of AD with the multi-adjusted odds ratio (95% CI) being 2.69 (1.10, 2.56). In addition, there was no significant association between the above genotypes and MCI.Conclusion: In Chinese rural elderly, the TT versus CT/CC genotype of NDUFAF6 rs6982393 was associated with an increased likelihood of AD; such an association only existed among young-old adults. Carrying both NDUFAF6 rs6982393-TT and APOE ϵ4 was related to a higher risk of AD. This finding highlights the importance of considering age and combined genotype in studying the genetic profiles of AD.
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11.
  • Conradsson, Mia, et al. (författare)
  • Is a change in functional capacity or dependency in activities of daily living associated with a change in mental health among older people living in residential care facilities?
  • 2013
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 8, s. 1561-1568
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: Functional capacity and dependency in activities of daily living (ADL) could be important mediators for an association between physical exercise and mental health. The aim of this study was to investigate whether a change in functional capacity or dependency in ADL is associated with a change in depressive symptoms and psychological well-being among older people living in residential care facilities, and whether dementia can be a moderating factor for this association.Methods: A prospective cohort study was undertaken. Participants were 206 older people, dependent in ADL, living in residential care facilities, 115 (56%) of whom had diagnosed dementia. Multivariate linear regression, with comprehensive adjustment for potential confounders, was used to investigate associations between differences over 3 months in Berg Balance Scale (BBS) and Geriatric Depression Scale (GDS-15) scores, and in BBS and Philadelphia Geriatric Center Morale Scale (PGCMS) scores. Associations were also investigated between differences in Barthel ADL Index and GDS-15 scores, and in Barthel ADL Index and PGCMS scores.Results: There were no significant associations between changes in scores over 3 months; the unstandardized beta for associations between BBS and GDS-15 was 0.026 (P=0.31), BBS and PGCMS 0.045 (P=0.14), Barthel ADL Index and GDS-15 0.123 (P=0.06), and Barthel ADL Index and PGCMS -0.013 (P=0.86). There were no interaction effects for dementia.Conclusion: A change in functional capacity or dependency in ADL does not appear to be associated with a change in depressive symptoms or psychological well-being among older people living in residential care facilities. These results may offer one possible explanation as to why studies of physical exercise to influence these aspects of mental health have not shown effects in this group of older people.
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12.
  • Ekerstad, Niklas, et al. (författare)
  • Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care
  • 2017
  • Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1176-9092 .- 1178-1998. ; 12, s. 1239-1248
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services. Results: After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052-0.164; P amp;lt; 0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131-0.400; P amp;lt; 0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085-0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395-1.178; P=0.170). Conclusion: Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.
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13.
  • Ekerstad, Niklas, et al. (författare)
  • Hospitalized frail elderly patients - atrial fibrillation, anticoagulation and 12 months outcomes
  • 2018
  • Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1176-9092 .- 1178-1998. ; 13, s. 749-756
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and objective: Multiple chronic conditions and recurring acute illness are frequent among elderly people. One such condition is atrial fibrillation (AF), which increases the risk of stroke up to fivefold. The aim of this study was to investigate the prevalence of AF among hospitalized frail elderly patients, their use of anticoagulation and their 12-month outcomes. Patients and methods: This was a clinical observational study of acutely hospitalized frail patients over the age of 75 years. The CHA2DS2-VASc Score was used to evaluate ischemic stroke risk in patients with AF. Clinically relevant outcomes were the composite of ischemic stroke and/or bleeding within 12 months, which was considered as primary in the analysis, ischemic stroke/transient ischemic attack (TIA), mortality, bleeding and hospital care consumption. Students (test, Fishers exact test, Mann Whitney U test and a Cox proportional hazards model were used for the analyses. Results: The prevalence of AF was 47%, and 63% of them were prescribed an anticoagulant. AF patients without anticoagulation were older, more often females, more often in residential care, and they had worse Mini Nutritional Assessment and activities of daily living scores. Of the patients without anticoagulation, 56% had a documented contraindication. In univariate analysis, there were significantly more events among AF patients without anticoagulation regarding the composite outcome of ischemic stroke and/or bleeding (hazard ratio [1112] 3.65, 95% CI = 1.70-7.86; p amp;lt; 0.001). When adjusting for potential confounders in Cox regression analysis, the difference remained significant (HR 4.54, 95% CI = 1.83-11.25; p = 0.001). Conclusion: The prevalence of AF in a hospitalized frail elderly population was 47%. Of these, 63% were prescribed anticoagulation therapy. Almost half of the patients without stroke pro-phylaxis had no documented contraindication. At 1 year, there were significantly more events in terms of ischemic stroke and/or bleeding among AF patients without anticoagulation therapy than among those with.
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14.
  • Ekerstad, Niklas, 1969-, et al. (författare)
  • Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
  • 2017
  • Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1178-1998 .- 1176-9092. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost.
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15.
  • Ekstam, Annika Kragh, et al. (författare)
  • Oral Health Status Using the Revised Oral Assessment Guide and Mortality in Older Orthopaedic Patients : A Cross-Sectional Study
  • 2023
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press Ltd.. - 1176-9092 .- 1178-1998. ; 18, s. 1103-1113
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose : Orthogeriatric hospitalised patients with fractures of the lower limb constitute a vulnerable population with increased risk of morbidity, polypharmacy, and mortality as well as impaired oral health. The aim of this cross-sectional study was to investigate whether any relationship existed between oral health issues in older orthopaedic patients and mortality. Material and Methods : The study population consisted of older orthopedic patients emergently admitted to a hospital in southern Sweden due to mainly fractures of the hip. Their oral health at admission was assessed by trained nurses using the revised oral assessment guide (ROAG), as well as examined by dental hygienists. Medical and demographic data were collected from medical records and mortality from the national population registry. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Data were analysed using foremost dichotomized data derived from mean values and then processed using multiple logistic regression adjusted for identified probable confounders. Results : Of the 187 study patients (≥65 years) with a mean age of 81 (SD 7.9) years, 71% were women, mean CCI score was 6.7 and 90-days mortality 12.3%. Oral health issues (ROAG >8, 73%) consisted mainly of problems with teeth/dentures (41%), tongue (36%), lips (35%), and saliva (28%). In patients with any oral health impairment (ROAG >8) the 90-days mortality was significantly increased (p=0.040), using logistic regression analysis adjusted for age, gender, comorbidity, and use of ≥5 drugs. In patients with a ROAG score ≥10 (≥mean) the association remained at 90-days (p=0.029) and 180-days (p=0.013). Decayed teeth were present in 24% and was significantly associated with ROAG >8 (p=0.020). Conclusion : The main finding of this study was a possible relationship between oral health impairment at admission and early mortality in orthogeriatric hospitalised patients. The opportunity to identify their oral health problems can help improving further care planning and care.
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16.
  • Ekstrom, Wilhelmina, et al. (författare)
  • Sex effects on short-term complications after hip fracture: a prospective cohort study
  • 2015
  • Ingår i: Clinical Interventions in Aging. - 1178-1998 .- 1176-9092. ; 10, s. 1259-1266
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To evaluate potential sex differences and other factors associated with complications within 4 months after a hip fracture. Methods: A total of 1,915 patients. 65 years (480 men) with hip fracture were consecutively included in a prospective multicenter cohort study. A review of medical records and patient interviews according to a study protocol based on the Standardized Audit of Hip Fractures in Europe (SAHFE, RIKSHOFT) was performed. Sex differences in comorbidity according to the American Society of Anesthesiologists score and complications 4 months after a hip fracture were registered. Multivariate logistic regression analysis was performed to identify factors related to complications. Results: Male sex was associated with worse general health according to the American Society of Anesthesiologists classification (P=0.005) and with more comorbidities (P<0.001). Male sex emerged as a risk factor for developing pneumonia (P<0.001), and additionally, 18% of the men suffered from cardiac complications compared with 13% of the females (P=0.018). Female sex was predisposed for urinary tract infections, 30% vs 23% in males (P=0.001). Mortality was higher in the male vs female group, both within 30 days (15% vs 10%, P=0.001) and at 4 months (24% vs 14%, P=0.001). Conditions associated with pneumonia were male sex, pulmonary disease, and cognitive impairment. Cardiac complications were associated with delayed surgery and cardiovascular and pulmonary disease. Conclusion: Before surgery, men with hip fracture already have a poorer health status and higher comorbidity rate than women, thus resulting in a twofold increased risk of pneumonia. Cognitive dysfunction and pulmonary disease contributed to pneumonia in men. Delayed surgery seems to increase the risk for cardiac complications. It is important to consider the sex perspective early on together with cardiopulmonary comorbidity and cognitive dysfunction to be able to counteract serious complications that may lead to death.
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17.
  • Elmståhl, Sölve, et al. (författare)
  • The Life Satisfaction Index-A (LSI-A) : Normative Data for a General Swedish Population Aged 60 to 93 Years
  • 2020
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 15, s. 2031-2039
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose of Study: To gain Swedish norm value for the Life Satisfaction Index-A (LSI-A) in a population 60-93+ years old stratified for sex and age and to relate these norm values with respect to number of chronic diseases and functional impairment. Materials and Methods: The study population included a random sample of 2656 men (45.7%) and 3159 (54.3%) women from the longitudinal national studies' "Good Aging in Skane" (GAS) and SNAC-B, both part of the Swedish National Study on Aging and Care (SNAC). Data on Neugartens Life Satisfaction Index-A (LSI-A), medical history, activities of daily life (ADL) and socio-demographics were collected through structured interviews and questionnaires. Results: Men scored significantly higher than women; 28.5, sd=6.9, and 27.3, sd=6.6, respectively, out of maximum 40 points. For both genders the scores decreased with age, mean score 6.0 points, lower for men and 7.1 points lower for women between 60 and 93+ years. The highest score was noted for healthy individuals where both men and women scored 29.5 points, sd=6.2. Increased number of chronic diseases and dependency in ADLs were associated with lower LS. Conclusion: Nom values here presented may facilitate assessments and evaluation of life satisfaction in the general elder population and as reference values to clinical trials. Female sex, rising age, morbidity and impaired functional ability were all associated with impaired LS.
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18.
  • Falk Erhag, Hanna, et al. (författare)
  • The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings : A Systematic Review of the Literature
  • 2023
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 18, s. 249-261
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill.Purpose: To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients > 65 years in acute clinical settings.Design: Systematic review with narrative synthesis.Methods: Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020.Results: Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review.Conclusion: A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients’ quality of life is warranted.
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19.
  • Flodin, Lena, et al. (författare)
  • Additive effects of nutritional supplementation, together with bisphosphonates, on bone mineral density after hip fracture : a 12-month randomized controlled study
  • 2014
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 9, s. 1043-1050
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: After a hip fracture, a catabolic state develops, with increased bone loss during the first year. The aim of this study was to evaluate the effects of postoperative treatment with calcium, vitamin D, and bisphosphonates (alone or together) with nutritional supplementation on total hip and total body bone mineral density (BMD). Methods: Seventy-nine patients (56 women), with a mean age of 79 years (range, 61-96 years) and with a recent hip fracture, who were ambulatory before fracture and without severe cognitive impairment, were included. Patients were randomized to treatment with bisphosphonates (risedronate 35 mg weekly) for 12 months (B; n=28), treatment with bisphosphonates along with nutritional supplementation (40 g protein, 600 kcal daily) for the first 6 months (BN; n=26), or to controls (C; n=25). All participants received calcium (1,000 mg) and vitamin D3 (800 IU) daily. Total hip and total body BMD were assessed with dual-energy X-ray absorptiometry at baseline, 6, and 12 months. Marker of bone resorption C-terminal telopeptide of collagen I and 25-hydroxy vitamin D were analyzed in serum. Results: Analysis of complete cases (70/79 at 6 months and 67/79 at 12 months) showed an increase in total hip BMD of 0.7% in the BN group, whereas the B and C groups lost 1.1% and 2.4% of BMD, respectively, between baseline and 6 months (P=0.071, between groups). There was no change in total body BMD between baseline and 12 months in the BN group, whereas the B group and C group both lost BMD, with C losing more than B (P=0.009). Intention-to-treat analysis was in concordance with the complete cases analyses. Conclusion: Protein-and energy-rich supplementation in addition to calcium, vitamin D, and bisphosphonate therapy had additive effects on total body BMD and total hip BMD among elderly hip fracture patients.
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20.
  • Fristedt, Sofi, et al. (författare)
  • Mobile geriatric teams – A cost-effective way of improving patient safety and reducing traditional healthcare utilization among the frail elderly? A randomized controlled trial
  • 2019
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 14, s. 1911-1924
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Demographic changes combined with costly technological progress put a financial strain on the healthcare sector in the industrialized world. Hence, there is a constant need to develop new cost-effective treatment procedures in order to optimize the use of available resources. As a response, the concept of a Mobile Geriatric Team (MGT) has emerged not only nationally but also internationally during the last decade; however, scientific evaluation of this initiative has been very scarce. Thus, the objective of this study was to perform a mixed methods analysis, including a prospective, controlled and randomized quantitative evaluation, in combination with an interview-based qualitative assessment, to measure the effectiveness and user satisfaction of MGT. Materials and methods: Community-dwelling, frail elderly people were randomized to an intervention group (n=31, mean age 84) and a control group (n=31, mean age 86). A twoyear retrospective quantitative data collection and a prospective one-year follow-up on healthcare utilization were combined with qualitative interviews. Non-parametric statistics and difference-in-difference (DiD) analyses were applied to the quantitative data. Qualitative data were analyzed using content analysis. Results: No significant group differences in healthcare utilization were found before inclusion. Post intervention, primary care contact (includingMGTs) increased for theMGT group. Inpatient care decreased dramatically for both groups. Hence, the increase in primary care contact forMGT patients was not accompanied by a reduction in inpatient care compared to the control group. Utilization of non-primary care was lower (p< 0.01) post-intervention in both groups. Conclusion: There appears to be a “natural” variation in healthcare needs over time among frail elderly people. Hence, it is vital to perform open, controlled clinical studies in tandem with the implementation of new caregiving strategies. The MGT initiative was clearly appreciated but did not fully achieve the desired reduction in healthcare utilization in this study.
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21.
  • Gunnarsson, Anna-Karin, et al. (författare)
  • Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip-fracture patients receiving urine catheter : a double-blind randomised trial
  • 2017
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 12, s. 137-143
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundUrinary tract infection (UTI) is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries (lat. Vaccinium macrocarpon Ait.)  are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters.AimTo investigate whether cranberry capsules given pre- and postoperatively are useful in preventing hospital-acquired UTIs in female patients with hip fracture and urinary catheter.DesignRandomised, placebo-controlled double-blind trial.MethodFemale patients, age 60 years and older, with hip fracture were recruited (n=227). The patients were randomised to receive cranberry (n=113) or placebo (n=114) capsules daily, from admission to the ward, until five days postoperatively. Urine cultures were obtained at admission and at five and 14 days postoperatively. In addition, EQ-5D assessments were performed and patients were screened for UTI symptoms.ResultThere was no difference between the groups in the proportion of patients with postoperative positive urine cultures. When excluding patients with positive cultures at admission, patients with antibiotic treatment during follow-up, and patients that did not adhere to the protocol, there was a trend towards a protective effect of cranberry treatment against hospital-acquired UTIs ; e.g. 36% (n=33) in the control group vs. 22%  (n=41) in cranberry group (p=0.17) at 5 days postoperatively.ConclusionCranberry concentrate does not seem to have an effect in preventing UTI in female patients with hip fracture and indwelling urinary catheter. 
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22.
  • Gustafsson, Susanne, et al. (författare)
  • Minor positive effects of health-promoting senior meetings for older community-dwelling persons on loneliness, social network, and social support
  • 2017
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 12, s. 1867-1877
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to evaluate the 1-year effect of the health-promoting intervention “senior meetings” for older community-dwelling persons regarding loneliness, social network, and social support. Methods: Secondary analysis of data was carried out from two randomized controlled studies: Elderly Persons in the Risk Zone and Promoting Aging Migrants’ Capabilities. Data from 416 participants who attended the senior meetings and the control group at baseline and the 1-year follow-up in the respective studies were included. Data were aggregated and analyzed with chi-square test and odds ratio (OR) to determine the intervention effect. Results: The senior meetings had a positive effect on social support regarding someone to turn to when in need of advice and backing (OR 1.72, p=0.01). No positive intervention effect could be identified for loneliness, social network, or other aspects of social support. Conclusion: Health-promoting senior meetings for older community-dwelling persons have a minor positive effect on social support. The senior meetings might benefit from a revision to reinforce content focused on loneliness, social network, and social support. However, the modest effect could also depend on the lack of accessible social resources to meet participants’ identified needs, a possible hindrance for a person’s capability. This makes it necessary to conduct further research to evaluate the effect of the senior meetings and other health-promoting initiatives on social aspects of older community-dwelling people’s lives, since these aspects are of high importance for life satisfaction and well-being in old age.
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23.
  • Han, Xiaolei, et al. (författare)
  • Association of Cardiovascular Health Metrics with Dementia in Rural Chinese Older Adults : A Population-Based Study
  • 2022
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 17, s. 947-956
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: We explore the associations of individual and composite cardiovascular health metrics with all-cause dementia, Alzheimer’s disease, and vascular dementia among rural-dwelling older adults and the potential age variations in their associations.Patients and Methods: This community-based cross-sectional study included 4980 older adults (age ≥ 65 years; 57.23% women) from the baseline examination of MIND-China. In March–September 2018, data were collected via face-to-face interviews, clinical examinations, and laboratory test. We defined six cardiovascular health metrics according to the modified American Heart Association’s recommendations. We diagnosed dementia and its subtypes following the international criteria. Data were analyzed using logistic regression models.Results: Of all the participants, 250 were diagnosed with dementia, including 165 with Alzheimer’s disease and 75 with vascular dementia. Ideal composite global cardiovascular health metrics (vs poor composite metrics) were associated with a multi-adjusted odds ratio (95% confidence interval) of 0.62 (0.42– 0.93) for dementia, 0.88 (0.52– 1.48) for Alzheimer’s disease, and 0.31 (0.16– 0.60) for vascular dementia. Moreover, ideal biological cardiovascular health metrics were associated with multi-adjusted odds ratio of 0.52 (0.28– 0.95) for dementia and 0.21 (0.06– 0.77) for vascular dementia in young–old adults (65– 74 years), whereas ideal behavioral cardiovascular health metrics were associated with multi-adjusted odds ratio of 0.48 (0.26– 0.89) for dementia and 0.16 (0.06– 0.43) for vascular dementia in old–old adults (≥ 75 years).Conclusion: Our results suggest that ideal cardiovascular health metrics are cross-sectionally associated with a low likelihood of dementia and vascular dementia among rural-dwelling older Chinese adults. The associations vary with age, components of cardiovascular health metrics, and dementia subtypes.
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24.
  • Illario, Maddalena, et al. (författare)
  • Interactions Between EIP on AHA Reference Sites and Action Groups to Foster Digital Innovation of Health and Care in European Regions
  • 2022
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 17, s. 343-358
  • Forskningsöversikt (refereegranskat)abstract
    • The article describes some of the achievements of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), after eight years in operation. These results were achieved thanks to the collaborative work of the action groups (AGs) and reference sites (RSs). RS regional ecosystems include key organisations committed to investing in innovation to foster active and healthy ageing. The AGs are groups of professionals committed to sharing their knowledge and skills in active and healthy ageing. This article reports on the approach used by the EIP on AHA to bring together experts and regions in identifying and addressing these challenges. Synergies between AGs offered substantial support to RSs, allowing regional health and care priorities and challenges to be identified and pursued through AG commitments. Building upon the experiences of the EIP on AHA, the Reference Sites Collaborative Network has set up a number of thematic action groups that bring together multidisciplinary experts from across Europe to address the main health and social care challenges at regional, national and European level.
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25.
  • Karlsson, Åsa, et al. (författare)
  • Geriatric Interdisciplinary Home Rehabilitation After Hip Fracture in People with Dementia-A Subgroup Analysis of a Randomized Controlled Trial
  • 2020
  • Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1176-9092 .- 1178-1998. ; 15, s. 1575-1586
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To investigate if the effects of geriatric interdisciplinary home rehabilitation after hip fracture were different among people with dementia compared to those without dementia and to describe the overall outcome after hip fracture in people with dementia. Patients and Methods: A post hoc subgroup analysis of a randomized controlled trial was conducted including 205 people with hip fracture, aged >70, living in ordinary housing or residential care facilities. Early discharge followed by individually designed interdisciplinary home rehabilitation for a maximum of 10 weeks was compared to in-hospital geriatric care according to a multifactorial rehabilitation program. Outcomes were hospital length of stay (LOS), readmissions, falls, mortality, performance in activities of daily living (ADL), and walking ability. Results: Interdisciplinary home rehabilitation vs in-hospital care had comparable effects on falls and mortality between discharge and 12 months and on ADL and walking ability at 3 and 12 months regardless of whether the participants had dementia or not (P 0.05 for all). Among participants with dementia, postoperative LOS was a median of 18 days (interquartile range [IQR] 14-30) in the home rehabilitation group vs 23 days (IQR 15-30) in the control group (P=0.254) with comparable numbers of readmissions after discharge. Dementia was associated with increased risk of falling (odds ratio [OR] 3.86; 95% confidence interval [CI]: 2.05-7.27; P<0.001) and increased mortality (OR 4.20; 95% CI 1.79-9.92, P=0.001) between discharge and 12 months and with greater dependence in ADL and walking at 3 and 12 months compared to participants without dementia (P<0.001 for all). Conclusion: The effects of geriatric interdisciplinary home rehabilitation vs in-hospital geriatric care did not differ in participants with and without dementia. However, the statistical power of this subgroup analysis was likely insufficient to detect differences between the groups. Dementia was associated with a substantial negative impact on the outcomes following the hip fracture. Our findings support offering interdisciplinary home rehabilitation after hip fracture to people with dementia.
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26.
  • Libungan, Berglind, et al. (författare)
  • Elderly patients with myocardial infarction selected for conservative or invasive treatment strategy.
  • 2015
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 10, s. 321-327
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: There are limited data on patients aged >75 years with myocardial infarction (MI), especially those who are treated conservatively.HYPOTHESIS: There are important differences in the clinical characteristics and outcome between elderly MI patients selected for invasive or conservative treatment strategy.METHODS: A total of 1,413 elderly patients (>75 years old) admitted to Sahlgrenska University Hospital, Gothenburg, Sweden with a final diagnosis of acute MI in 2001 or 2007, were divided into two groups, those who underwent a conservative treatment strategy (conservative group [CG], n=1,169) and those who underwent coronary angiography and were revascularized if indicated (invasive group [IG], n=244).RESULTS: Other than higher age in the CG, there were no significant differences in traditional risk factors such as hypertension, diabetes, and smoking in the two groups. A higher proportion of patients in the CG had a history of heart failure and cerebrovascular disease. The hazard ratio (with 95% confidence interval), adjusted for potential confounders, for 5 year mortality in the IG in relation to the CG was 0.49 (0.39, 0.62), P<0.0001. Overall, in the elderly with MI, the proportion who underwent an invasive treatment strategy doubled from 12% in 2001 to 24% in 2007, despite a slightly higher mean age.CONCLUSION: Elderly patients with MI in the CG (no coronary angiography), were generally older and a higher proportion had chronic diseases such as congestive heart failure and cerebrovascular disease than those in the IG. Our data suggest that the invasive treatment strategy is associated with better outcome. However, randomized trials will be needed to determine whether revascularization procedures are beneficial in elderly patients with MI, in terms of less symptoms, better outcome, and improved quality of life.
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27.
  • Lindberg, Terese, et al. (författare)
  • Prevalence of unknown and untreated arrhythmias in an older outpatient population screened by wireless long-term recording ECG
  • 2016
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 11, s. 1083-1090
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: With longer life expectancies, the prevalence of arrhythmias is increasing; thus, there is a need for new methods to screen the older outpatient population. This population-based study describes the prevalence of arrhythmias in 200 outpatients aged ≥66 years. We also investigated the feasibility of wireless long-term recording (LTR) using the ECG-BodyKom®. Methods: Two hundred elderly persons aged 66–93 years were recruited from the Swedish National Study on Aging and Care in 2010–2013, and data were collected via wireless LTR ECG-BodyKom. Results: Screening with the LTR ECG revealed that persistent atrial fibrillation (AF) occurred in 10% of the outpatient population aged ≥66 years. Paroxysmal AF occurred in 5.5% of the population, with no difference between younger (60–80 years) and older (≥80 years) elderly participants. Furthermore, all patients with paroxysmal AF had a CHA2DS2VASc score of ≥2 and were therefore potential candidates for follow-up and medical examination. LTR ECG-BodyKom can be considered a feasible method to screen for arrhythmias in older outpatient populations. This simple method requires little of the user, and there was high satisfaction with the equipment and a good overall experience wearing it. Conclusion: The increasing occurrence of arrhythmias in the older population, as well as the high number of untreated cases of arrhythmias such as persistent AF and paroxysmal AF, poses a challenge for health care. Therefore, it is essential to develop effective strategies for their prevention and treatment.
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28.
  • Manchaiah, Vinaya, et al. (författare)
  • Applications of direct-to-consumer hearing devices for adults with hearing loss: a review
  • 2017
  • Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1176-9092 .- 1178-1998. ; 12, s. 859-871
  • Forskningsöversikt (refereegranskat)abstract
    • Background: This systematic literature review is aimed at investigating applications of direct-to-consumer hearing devices for adults with hearing loss. This review discusses three categories of direct-to-consumer hearing devices: 1) personal sound amplification products (PSAPs), 2) direct-mail hearing aids, and 3) over-the-counter (OTC) hearing aids. Method: A literature review was conducted using EBSCOhost and included the databases CINAHL, MEDLINE, and PsycINFO. After applying prior agreed inclusion and exclusion criteria, 13 reports were included in the review. Results: Included studies fell into three domains: 1) electroacoustic characteristics, 2) consumer surveys, and 3) outcome evaluations. Electroacoustic characteristics of these devices vary significantly with some meeting the stringent acoustic criteria used for hearing aids, while others producing dangerous output levels (ie, over 120-dB sound pressure level). Low-end (or low-cost) devices were typically poor in acoustic quality and did not meet gain levels necessary for most adult and elderly hearing loss patterns (eg, presbycusis), especially in high frequencies. Despite direct-mail hearing aids and PSAPs being associated with lower satisfaction when compared to hearing aids purchased through hearing health care professionals, consumer surveys suggest that 5%-19% of people with hearing loss purchase hearing aids through direct-mail or online. Studies on outcome evaluation suggest positive outcomes of OTC devices in the elderly population. Of note, OTC outcomes appear better when a hearing health care professional supports these users. Conclusion: While some direct-to-consumer hearing devices have the capability to produce adverse effects due to production of dangerously high sound levels and internal noise, the existing literature suggests that there are potential benefits of these devices. Research of direct-to-consumer hearing devices is limited, and current published studies are of weak quality. Much effort is needed to understand the benefits and limitations of such devices on people with hearing loss.
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29.
  • Manchaiah, Vinaya, et al. (författare)
  • Social representation of hearing aids : cross-cultural study in India, Iran, Portugal, and the United Kingdom
  • 2015
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 10, s. 1601-1615
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The current study was aimed at understanding the social representation of hearing aids in India, Iran, Portugal, and the United Kingdom. We also compared these results to explore the cross-cultural differences and similarities among these countries.Methods: The study involved a cross-sectional design, and the data were collected from four different countries using the snowball sampling method. Data were analyzed using a content analysis to identify the most-similar categories of responses reported, a co-occurrences analysis to see which of these categories are reported commonly, and a chi-square analysis to study if there was any association between positive, neutral, and negative connotations among participants in different countries.Results: The current study revealed four different social representations of hearing aids from India, Iran, Portugal, and the United Kingdom, and also a global index.Conclusion: The study results provide very useful insights into how hearing aids are represented in the society. These findings may have important implications for public education and also for manufacturers from the viewpoint of designing and marketing hearing aids in different countries.
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30.
  • Manchaiah, Vinaya, et al. (författare)
  • Social representation of "hearing loss" : cross-cultural exploratory study in India, Iran, Portugal, and the UK
  • 2015
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 10, s. 1857-1872
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Hearing loss is one of the most common chronic conditions in older adults. In audiology literature, several studies have examined the attitudes and behavior of people with hearing loss; however, not much is known about the manner in which society in general views and perceives hearing loss. This exploratory study was aimed at understanding the social representation of hearing loss (among the general public) in the countries of India, Iran, Portugal, and the UK. We also compared these social representations.Materials and methods: The study involved a cross-sectional design, and participants were recruited using the snowball sampling method. A total of 404 people from four countries participated in the study. Data were collected using a free-association task where participants were asked to produce up to five words or phrases that came to mind while thinking about hearing loss. In addition, they were also asked to indicate if each word they presented had positive, neutral, or negative associations in their view. Data were analyzed using various qualitative and quantitative methods.Results: The most frequently occurring categories were: assessment and management; causes of hearing loss; communication difficulties; disability; hearing ability or disability; hearing instruments; negative mental state; the attitudes of others; and sound and acoustics of the environment. Some categories were reported with similar frequency in most countries (eg, causes of hearing loss, communication difficulties, and negative mental state), whereas others differed among countries. Participants in India reported significantly more positive and fewer negative associations when compared to participants from Iran, Portugal, and the UK. However, there was no statistical difference among neutral responses reported among these countries. Also, more differences were noted among these countries than similarities.Conclusion: These findings provide useful insights into the public perception of hearing loss that may prove useful in public education and counseling.
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31.
  • Mekonnen, Habtamu Sewunet, et al. (författare)
  • Being an Elderly Person Living in Metropolitan Cities of Northwestern Ethiopia : A Descriptive Phenomenological Study
  • 2023
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 18, s. 205-218
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: As people grow old, they pass through various life courses. Thus, it is important to realize aging in the context of each of these stages, as aging is not only physiological and psychological processes. To understand the lifeworld experiences of the phenomenon "being an elderly person" from the individual perspective was important, in this study, within day-to-day life in Metropolitan cities of northwestern Ethiopia.OBJECTIVE: The aim of this study was to describe the lifeworld of elderly persons living in Bahir Dar and Gondar Cities, Northwest Ethiopia.METHODS: A community based qualitative study conducted from October 29, 2021 to November 6, 2021. A purposive sampling technique and in-depth interviews were used for sampling and data collection, respectively. To explore the life experience /life-world/ of the elderly, a descriptive phenomenological study was conducted among 15 elderly persons. The audio records were transcribed and the field notes incorporated. Transcribed texts were translated into the English language, and a descriptive phenomenological analysis was done.RESULTS: In this study, the essence of the phenomenon, being an elderly person, means, in an ebb and flow motion, balancing a life change characterized by changing perspective, ambiguity to body functions, and preparing for being released. The elderly experienced physical, mental, and psychosocial changes. They had encountered positive and negative situations throughout their life span. They also expressed that their time was over and wished to prepare for God's Kingdom.CONCLUSION: The use of phenomenology for this research provided an opportunity for a deeper understanding of the experiences of elderly persons. With knowledge from this study, nurses and other health professionals can understand and support the elderly from an individual point of view.
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32.
  • Mulasso, Anna, et al. (författare)
  • Associations of frailty and psychosocial factors with autonomy in daily activities : a cross-sectional study in Italian community-dwelling older adults.
  • 2016
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 11, s. 37-45
  • Tidskriftsartikel (refereegranskat)abstract
    • Frailty has been recognized as a risk factor for geriatric adverse events. Little is known of the role of psychosocial factors associated with frailty in explaining negative outcomes of aging. This study was aimed at 1) evaluating the differences in psychosocial factors among robust, prefrail, and frail individuals and 2) investigating whether there was any interaction effect of frailty status with empirically identified clusters of psychosocial factors on autonomy in the activities of daily living (ADLs). Two-hundred and ten older adults (age 73±6 years, 66% women) were involved in this study. Frailty was assessed using an adapted version of the frailty phenotype. The psychosocial factors investigated were depressive symptoms using the 20-item Center for Epidemiologic Studies Depression Scale, social isolation using the Friendship Scale, and loneliness feeling using the eight-item UCLA Loneliness Scale. The autonomy in ADLs was measured with the Groningen Activity Restriction Scale. Thirty-one percent of participants were robust, 55% prefrail, and 14% frail. We performed an analysis of covariance which showed differences between robust, prefrail, and frail individuals for all the psychosocial variables: Center for Epidemiologic Studies Depression Scale, F(2, 205)=18.48, P<0.001; Friendship Scale, F(2, 205)=4.59, P=0.011; UCLA Loneliness Scale, F(2, 205)=5.87, P=0.003, controlling for age and sex. Using the same covariates, the two-way analysis of covariance indicated an interaction effect of frailty with psychosocial factors in determining ADLs, F(4, 199)=3.53, P=0.008. This study demonstrates the close relationship between frailty and psychosocial factors, suggesting the need to take into account simultaneously physical and psychosocial components of human functioning.
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33.
  • Noonan, K., et al. (författare)
  • Sustained inflammation 1.5 years post-stroke is not associated with depression in elderly stroke survivors
  • 2013
  • Ingår i: Clinical Interventions in Aging. - : Informa UK Limited. - 1176-9092 .- 1178-1998. ; 8, s. 69-74
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Depression is common in elderly stroke survivors and has been associated with systemic Methods: The Barthel Index was used to measure the level of impairment in activities of daily living at 3 Results: Mean C-reactive protein and white cell count levels in stroke patients were significantly Conclusion: We found evidence for a sustained peripheral inflammatory response at 18 months post-
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34.
  • Olsson, Lovisa A., 1950-, et al. (författare)
  • Subjective well-being in Swedish active seniors and its relationship with physical activity and commonly available biomarkers
  • 2014
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press. - 1176-9092 .- 1178-1998. ; 9, s. 233-239
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Physical activity is claimed to be related to well-being and to a lower risk of cardiovascular disease. Therefore, the possible associations of well-being with physical activity and biomarkers of somatic health were studied in a sample of Swedish active seniors to determine the strength of these associations.Methods: Three hundred and eighty-nine community-dwelling senior citizens (127 men and 262 women) of mean age 74 +/- 5 years were recruited for this cross-sectional population study. Serum samples were analyzed for lipoproteins and markers of inflammation. The Psychological General Well-Being (PGWB) index was used to measure subjective well-being. Physical activity was assessed by the International Physical Activity Questionnaire modified for the elderly.Results: More than 50% of men and women rated their physical activity as high; in the women, there was a significant difference between the age groups (younger and older than the median age [median =74.1 years], respectively). The mean PGWB index indicates a high degree of subjective well-being in this group of Swedish seniors. Of the PGWB subdimensions, general health had the strongest positive relationship with physical activity (r(2)=5.4%). for the subdimensions of depressed mood, positive well-being, vitality, and PGWB index, physical activity had an r(2)<= 4%, while the contributions of sex, age, and biomarkers were minor.Conclusion: We have estimated the contribution of physical activity to the variance of subjective well-being in active seniors. Physical activity appears to play a greater role as a determinant of subjective well-being than do biomarkers of somatic health, especially in females, but most of the variance remained unaccounted for by the studied variables.
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35.
  • Segernäs Kvitting, Anna, et al. (författare)
  • Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale
  • 2022
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press Ltd. - 1176-9092 .- 1178-1998. ; 17, s. 359-368
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To evaluate if preoperative assessment with A Quick Test of Cognitive Speed (AQT) could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium. Patients and Methods: Cardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (HADS). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and receiver operator characteristic curves (ROC) with area under the curve (AUC) to determine the accuracy. Results: Postoperative delirium occurred in 47 patients (22%) who had lower MMSE scores (median (range), 27 (19-30) vs 28 (20- 30), p=0.009) and slower AQT (median (range), 76 (48-181) vs 70 (40-182) seconds, p=0.030) than patients without delirium. Predictive power measured as AUC (95% CI) was 0.605 (0.51-0.70) for AQT and 0.623 (0.53-0.72) for MMSE. Logistic regression (OR, 95% CI) showed MMSE 27 points (2.72, 1.27-5.86), AQT 70 sec (2.26, 1.03-4.95), HADS-D >4 points (2.60, 1.21-5.58) and longer cardiopulmonary bypass-time (1.007, 1.002-1.013) to be associated with postoperative delirium. Combining these parameters yielded an AUC of 0.736 (0.65-0.82). Conclusion: The ability of predicting delirium using AQT was similar to MMSE, and only slightly higher by combining AQT and MMSE. Adding HADS-D and cardiopulmonary bypass-time to MMSE and AQT increased the predictive power to a borderline acceptable discriminatory value. Preoperative cognitive tests and screening for depressive symptoms may help identify patients at risk of postoperative delirium. Yet, there is still a need to establish useful preoperative tests.
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36.
  • Ståhl, Anna, et al. (författare)
  • Postoperative Physical Therapy to Prevent Hospital-acquired Pneumonia in Patients Over 80 Years Undergoing Hip Fracture Surgery-A Quasi-experimental Study
  • 2020
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press Ltd.. - 1176-9092 .- 1178-1998. ; 15, s. 1821-1829
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Hip fracture requiring surgical fixation is a common condition with high mortality and morbidity in the geriatric population. The patients are usually frail, and vulnerable to postoperative complications and delayed recovery. Few studies have investigated physical therapy methods to prevent hospital-acquired pneumonia (HAP) after hip fracture surgery.Objective: To explore whether an intensified physical therapy regimen can prevent HAP and reduce hospital length of stay in patients aged 80 and older, following hip fracture surgery.Patients and Methods: The inclusion criterion was patients aged 80 or older who had undergone hip fracture surgery at Örebro University Hospital, Sweden during eight months in 2015-2016 (the "physical therapy group") (n=69). The study has a quasi-experimental design with a historical control group (n=64) who had received routine physical therapy treatment. The physical therapy group received intensified postoperative physical therapy treatment, which included daily supervised early mobilization and coached deep breathing exercises with positive expiratory pressure (PEP). The patients were instructed to take deep breaths, and then exhale through the PEP-valve in three sessions of 10 deep breaths, at least four times daily. Early mobilization to a sitting position and walking was advised as soon as possible after surgery.Results: There was a significantly lower incidence of HAP in the physical therapy group; 2/69 (3%, 95%CI: 1- 10) compared to the historical control group 13/64 (20%, 95%CI: 12-32%) (p=0.002). Patients in the physical therapy group had a significantly shorter length of stay than the control group (10.6 +/- 4 vs 13.4 +/- 9 days, p=0.022).Conclusion: Intensified physical therapy treatment after hip fracture surgery may be of benefit to reduce the incidence of HAP in patients over 80 years; however, the results need to be confirmed in randomized controlled trials.
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37.
  • Thang, Nguyen Dang, et al. (författare)
  • Characteristics of and outcomes for elderly patients with acute myocardial infarction : differences between females and males
  • 2016
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 11, s. 1309-1316
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: This study analyzed age-adjusted sex differences among acute myocardial infarction (AMI) patients aged 75 years and above with regard to 7-year mortality (primary end point) and the frequency of angiograms and admission to the coronary care unit (CCU) as well as 1-year mortality (secondary end points).METHODS: A retrospective cohort study comprised 1,414 AMI patients (748 females and 666 males) aged at least 75 years, who were admitted to Sahlgrenska University Hospital in Gothenburg, Sweden, during two periods (2001/2002 and 2007). All comparisons between female and male patients were age adjusted.RESULTS: Females were older and their previous history included fewer AMIs, coronary artery bypass grafting procedures, and renal diseases, but more frequent incidence of hypertension. On the contrary, males had higher age-adjusted 7-year mortality in relation to females (hazard ratio [HR] 1.16 with corresponding 95% confidence interval [95% CI 1.03, 1.31], P=0.02). Admission to the CCU was more frequent among males than females (odds ratio [OR] 1.38 [95% CI 1.11, 1.72], P=0.004). There was a nonsignificant trend toward more coronary angiographies performed among males (OR 1.34 [95% CI 1.00, 1.79], P=0.05), as well as a nonsignificant trend toward higher 1-year mortality (HR 1.18 [95% CI 0.99, 1.39], P=0.06).CONCLUSION: In an AMI population aged 75 years and above, males had higher age-adjusted 7-year mortality and higher rate of admission to the CCU than females. One-year mortality did not differ significantly between the sexes, nor did the frequency of performed coronary angiograms.
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38.
  • Welford, Paul, et al. (författare)
  • Effects of Yoga and Aerobic Exercise on Verbal Fluency in Physically Inactive Older Adults : Randomized Controlled Trial (FitForAge).
  • 2023
  • Ingår i: Clinical Interventions in Aging. - : Dove Press. - 1176-9092 .- 1178-1998. ; 18, s. 533-545
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To compare the effects on verbal fluency of a supported yoga-based exercise intervention to an aerobic exercise intervention and a wait-list control group.PARTICIPANTS AND METHODS: Eighty-two physically-inactive but otherwise healthy adults (mean age 72.5 years, range 65-85, 77% female) were recruited into a 12-week, three-group, parallel randomized controlled trial. Participants were supported to complete ≥3 Hatha yoga classes per/week or ≥3 structured aerobic exercise sessions/week. A wait-list control group continued usual daily activities only. Verbal fluency, including total-FAS, animals, and verbs, was assessed before and after interventions. Group effects were assessed using analysis of covariance (ANCOVA).RESULTS: Twenty-seven participants were randomized to yoga, 29 to aerobic exercise and 26 to a waitlist. At 12-week follow-up, compared to baseline, there were increases in mean total-FAS in the yoga (+5.0 words, p=0.002) and aerobic exercise groups (+6.6 words, p=0.004). Mean total-FAS in the wait-list control group remained stable (-0.5 words, p=0.838). There were medium-magnitude estimated treatment effects on total-FAS for yoga versus wait-list control and aerobic exercise versus wait-list control: Hedges' g=0.51 (p=0.213) and 0.57 (p=0.098) respectively. In addition, small-to-medium magnitude estimated treatment effects were seen on animals and verbs for yoga versus wait-list control and aerobic exercise versus wait-list control: g=0.28 (p=0.155), 0.19 (p=0.766) and 0.50 (p=0.085), 0.59 (p=0.233) respectively.CONCLUSION: Participation in yoga or aerobic exercise was associated with estimated improvements in verbal fluency compared to a non-active control group. Yoga and aerobic exercise may be promising approaches by which to promote cognitive function among older adults.TRIAL REGISTRATION: DRKS00015093, U1111-1217-4248.
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39.
  • Yin, Qingqing, et al. (författare)
  • Targetting Exosomes as a New Biomarker and Therapeutic Approach for Alzheimer's Disease
  • 2020
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 15, s. 195-205
  • Forskningsöversikt (refereegranskat)abstract
    • Alzheimer's disease (AD) is a neurodegenerative disease that mainly occurs in old age and involves progressive cognitive impairment. AD has become a major global issue for public health, with approximately 24 million people currently affected by the disease. Estimates indicted that this number will quadruple by 2050. Because of the high incidence of AD, there is an urgent need to develop new strategies to diagnose and treat AD. Many recent studies have indicated the multiple, yet somewhat controversial, roles of exosomes in AD. Although the underlying mechanisms by which exosomes play a role in AD are still unknown, current evidence suggests that exosomes can carry and spread toxic amyloid-beta, and hyperphosphorylated tau, between cells, and then induce apoptosis, thus contributing to the loss of neurons. In addition, exosomes appear to possess the ability to reduce brain amyloid-beta, and tau hyperphosphorylation, and transfer neuroprotective substances between neural cells. The accumulating data brings hope that the application of exosomes may be helpful for early diagnostics and the identification of new therapeutic targets for AD. Here, we summarized the various roles of exosomes, and how they might relate to the pathogenesis of AD. We also highlight the potential application of exosomes as a therapeutic option in AD therapy.
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40.
  • Åhlund, Kristina, et al. (författare)
  • Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients
  • 2017
  • Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1176-9092 .- 1178-1998. ; 12, s. 1929-1939
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Frail elderly people often use emergency care. During hospitalization, physical decline is common, implying an increased risk of adverse health outcomes. Comprehensive Geriatric Assessment (CGA) has been shown to be beneficial for these patients in hospital care. However, there is very limited evidence about the effects on physical fitness. The aim was to compare effects on physical fitness in the acute care of frail elderly patients at a CGA unit versus conventional care, 3 months after discharge. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted. Patients aged $ 75 years, assessed as frail and in need of inpatient care, were assigned to a CGA unit or conventional care. Measurements of physical fitness, including handgrip strength (HS), timed up-and-go (TUG), and the 6-minute walk test (6-MWT) were made twice, at the hospital index care period and at the 3-month follow-up. Data were analyzed as the mean change from index to the 3-month follow-up, and dichotomized as decline versus stability/improvement in physical fitness. Results: In all, 408 participants, aged 85.7 +/- 5.4 years, were included. The intervention group improved significantly in all components of physical fitness. The controls improved in TUG and declined in HS and 6-MWT. When the changes were dichotomized the intervention group declined to a lesser extent; HS pamp;lt;0.001, 6-MWT pamp;lt;0.001, TUG pamp;lt;0.003. The regression analysis showed the following odds ratios (ORs) for how these outcomes were influenced by the intervention; HS OR 4.4 (confidence interval [CI] 95% 2.2-9.1), 6-MWT OR 13.9 (CI 95% 4.2-46.2), and TUG OR 2.5 (CI 95% 1.1-5.4). Conclusion: This study indicates that the acute care of frail elderly patients at a CGA unit is superior to conventional care in terms of preserving physical fitness at 3 months follow-up. CGA management may positively influence outcomes of great importance for these patients, such as mobility, strength, and endurance.
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41.
  • Åhlund, Kristina, et al. (författare)
  • Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden
  • 2019
  • Ingår i: Clinical Interventions in Aging. - Auckland, New Zealand : Dove Medical Press Ltd.(Dovepress). - 1178-1998 .- 1176-9092. ; 14, s. 577-586
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Physical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis. Methods: Frail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0-12-month analysis and 2) 0-3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty. Results: This study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson's index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89-5.78, p>0.001) and HRHS 2.39 (95% CI 1.33-4.27, p=0.003). The 0-3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42-10.06, p=0.007) and HRHS 2.21 (95% CI 1.07-4.58, p=0.032). Conclusion: In frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.
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42.
  • Egberg, Louise, et al. (författare)
  • Percutaneous transluminal angioplasty between 1998 and 2002 : outcomes of interventions proximal and distal to the inguinal ligament
  • 2008
  • Ingår i: Open Access Surgery. - Shanghai : Dove Medical Press. - 1178-7082. ; 1, s. 9-19
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to examine patients who have undergone percutaneous transluminal angioplasty (PTA) in order to describe patient characteristics and outcomes of interventions proximal and distal to the inguinal ligament and to assess whether different living situations may be associated with the outcome of PTA-intervention.Design: A retrospective descriptive chart review.Setting: A Swedish University Hospital between January 1998 and December 2002.Participants: All patients who have undergone PTA.Main outcome measure: Medical and nursing records from medical, surgical, orthopedic, and geriatric clinics were reviewed to obtain data. A study-specific protocol was developed.Results: Eighty-seven patients were treated with PTA proximal and 101 distal to the inguinal ligament. No significant differences regarding outcome were found. Fifty-two patients had hematoma/bruise as a complication, which was more common among non-diabetic patients; 46 without diabetes versus 6 diagnosed with diabetes (p = 0.001). When comparing patients living situations and mortality, 76 of the deceased patients had been living alone compared to 38 of the survivors (p = 0.001).Conclusions: The patients were younger in the proximal group, however no differences in outcome were found between patients who had undergone PTA whether proximal or distal to the inguinal ligament. Hematomas/bruises as a complication were more common among nondiabetic patients. Amputation was a strong predictor of death during follow-up.
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43.
  • Arola, Lea Annikki, 1961, et al. (författare)
  • Distribution and evaluation of sense of coherence among older immigrants before and after a health promotion intervention - results from the RCT study promoting aging migrants' capability
  • 2018
  • Ingår i: Clinical Interventions in Aging. - 1178-1998. ; 13, s. 2317-2328
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The migration process can be a threat to a person's sense of coherence (SOC) and to their ability to experience life as comprehensible, manageable, and meaningful. Seen from a salutogenic perspective, this may have a negative impact on the experience of health. Purpose: We describe the distribution of SOC and its components among older persons with an immigrant background now aging in Sweden. In addition, we evaluated whether a group-based health promotion program with a person-centered approach could support the SOC among older persons in this group. Materials and methods: A randomized controlled trial with postintervention follow-ups at 6 and 12 months was conducted with 131 independently living persons aged >= 70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and one follow-up home visit) and a control group (no intervention but access to ordinary health care services). The outcome measure was the SOC measured by SOC-13. Chi-square and ORs were calculated. Results: There was a significant improvement in total SOC scores for the intervention group at 6-month follow-up. Also, the ORs for the SOC components were higher in the person-centered intervention group. However, we found no significant between-group differences nor did the effect last until the 12-month follow-up. Conclusion: Persons who have lived a long time in a host country after migration seem to have a SOC similar to native-born persons. Interventions with a person-centered approach could support the SOC by capturing individual life situations. Such interventions could support older persons by making everyday life more comprehensible and manageable and helping them to cope with challenges in daily life caused by aging.
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44.
  • Arola, L. A., et al. (författare)
  • Distribution and evaluation of sense of coherence among older immigrants before and after a health promotion intervention – results from the RCT study promoting aging migrants’ capability
  • 2018
  • Ingår i: Clinical Interventions in Aging. - 1176-9092. ; 13, s. 2317-2328
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The migration process can be a threat to a person’s sense of coherence (SOC) and to their ability to experience life as comprehensible, manageable, and meaningful. Seen from a salutogenic perspective, this may have a negative impact on the experience of health. Purpose: We describe the distribution of SOC and its components among older persons with an immigrant background now aging in Sweden. In addition, we evaluated whether a group-based health promotion program with a person-centered approach could support the SOC among older persons in this group. Materials and methods: A randomized controlled trial with postintervention follow-ups at 6 and 12 months was conducted with 131 independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and one follow-up home visit) and a control group (no intervention but access to ordinary health care services). The outcome measure was the SOC measured by SOC-13. Chi-square and ORs were calculated. Results: There was a significant improvement in total SOC scores for the intervention group at 6-month follow-up. Also, the ORs for the SOC components were higher in the person-centered intervention group. However, we found no significant between-group differences nor did the effect last until the 12-month follow-up. Conclusion: Persons who have lived a long time in a host country after migration seem to have a SOC similar to native-born persons. Interventions with a person-centered approach could support the SOC by capturing individual life situations. Such interventions could support older persons by making everyday life more comprehensible and manageable and helping them to cope with challenges in daily life caused by aging.
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45.
  • Baijens, Laura W J, et al. (författare)
  • European society for swallowing disorders - European union geriatric medicine society white paper : Oropharyngeal dysphagia as a geriatric syndrome
  • 2016
  • Ingår i: Clinical Interventions in Aging. - 1176-9092. ; 11, s. 1403-1428
  • Forskningsöversikt (refereegranskat)abstract
    • This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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46.
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47.
  • Barywani, Salim B., 1968, et al. (författare)
  • Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality
  • 2015
  • Ingår i: Clinical Interventions in Aging. - : Informa UK Limited. - 1178-1998. ; 10, s. 1547-1553
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS. Methods and results: We followed 353 consecutive patients aged >= 80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1: 1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P < 0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5). In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan-Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41-54) for PCI-treated patients versus 35 months (95% CI 29-42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction <45%, estimated glomerular filtration rate < 35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins. Conclusion: In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.
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48.
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49.
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50.
  • Bramell-Risberg, Eva, et al. (författare)
  • Separate physical tests of lower extremities and postural control are associated with cognitive impairment. Results from the general population study Good Aging in Skåne (GÅS-SNAC).
  • 2012
  • Ingår i: Clinical Interventions in Aging. - 1178-1998. ; 7, s. 195-205
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To investigate whether separate physical tests of the lower extremities, that assess movement speed and postural control, were associated with cognitive impairment in older community-dwelling subjects. SUBJECTS AND METHODS: In this population-based, cross-sectional, cohort study, the following items were assessed: walking speed, walking 2 × 15 m, Timed Up and Go (TUG) at self-selected and fast speeds, one-leg standing, and performance in step- and five chair-stand tests. The study comprised 2115 subjects, aged 60-93 years, with values adjusted for demographics, health-related factors, and comorbidity. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE), and cognitive impairment was defined by the three-word delayed recall task of the MMSE. Subjects who scored 0/3 on the three-word delayed recall task were defined as cases (n = 328), those who scored 1/3 were defined as intermediates (n = 457), and the others as controls (n = 1330). RESULTS: Physical tests performed rapidly were significantly associated with cognitive impairment; this was the case in increased time of five chair stands (P = 0.009, odds ratio [OR] = 1.03), TUG (P < 0.001, OR = 1.11) and walking 2 × 15 m (P < 0.001, OR = 1.05). Inability to stand on one leg for 10 seconds was associated with increased risk of being a case (P < 0.001, OR = 1.78), compared to those able to stand for 30 seconds or longer. More steps during the step test (P < 0.001, OR = 0.95) and higher fast walking speed (P < 0.001, OR = 0.51) were associated with lower risk of being a case. CONCLUSION: Slower movements and reduced postural control were related to an increased risk of being cognitively impaired. All tests that were performed rapidly were able to separate cases from controls. These findings suggest that physical tests that are related to lower extremity and postural control, emphasizing velocity, might be useful in investigating relationships between physical and cognitive function; furthermore, they can be used to complement cognitive impairment diagnoses.
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