| 1. |
- Boström, Gustaf, et al.
(författare)
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Antidepressant use and mortality in very old people
- 2016
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Ingår i: International psychogeriatrics. - : Cambridge University Press. - 1041-6102 .- 1741-203X. ; 28:7, s. 1201-1210
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Antidepressant treatment may increase the risk of death. The association between antidepressants and mortality has been evaluated in community-dwelling older people, but not in representative samples of very old people, among whom dementia, multimorbidity, and disability are common.METHODS: Umeå 85+/GERDA study participants (n = 992) aged 85, 90, and ≥95 years were followed for up to five years. Cox proportional hazard regression models were used to analyze mortality risk associated with baseline antidepressant treatment, adjusted for potential confounders.RESULTS: Mean age was 89 years; 27% of participants had dementia, 20% had stroke histories, 29% had heart failure, and 16% used antidepressants. In age- and sex-adjusted analyses, antidepressant use was associated with a 76% increased mortality risk (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.41-2.19). Adding adjustment for Geriatric Depression Scale score, HR was 1.62 (95% CI, 1.29-2.03). The association was not significant when adjusting for additional confounding factors (HR = 1.08; 95% CI, 0.85-1.38). Interaction analyses in the fully adjusted model revealed a significant interaction between sex and antidepressant use (HR: 1.76; 95% CI, 1.05-2.94). Among male and female antidepressant users, the HRs for death were 0.76 (95% CI, 0.47-1.24) and 1.28 (95% CI, 0.97-1.70), respectively.CONCLUSION: Among very old people, baseline antidepressant treatment does not seem to be independently associated with increased mortality risk. However, the risk may be different in men and women. This difference and the potential risk of initial treatment require further investigation in future cohort studies of very old people.
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| 2. |
- Boström, Gustaf, et al.
(författare)
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Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care : a randomized controlled trial
- 2016
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 31:8, s. 868-878
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia.METHODS: Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini-Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45 min every other weekday for 4 months. The 15-item Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7 months.RESULTS: No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7 months. Among participants with GDS scores ≥ 5, reductions in GDS score were observed in the exercise and control groups at 4 months (-1.58, P = 0.001 and -1.54, P = 0.004) and 7 months (-1.25, P = 0.01 and -1.45, P = 0.007). Among participants with MADRS scores ≥ 7, a reduction in MADRS score was observed at 4 months in the control group (-2.80, P = 0.009) and at 7 months in the exercise and control groups (-3.17, P = 0.003 and -3.34, P = 0.002).CONCLUSIONS: A 4-month high-intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non-exercise group activities may reduce high levels of depressive symptoms.
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| 3. |
- Niklasson, Johan, et al.
(författare)
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High morale and survival
- 2016
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Ingår i: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 85, s. 75-75
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Niklasson, Johan, et al.
(författare)
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High morale is associated with increased survival in the very old
- 2015
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Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 44:4, s. 630-636
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: high morale is defined as future-oriented optimism. Previous research suggests that a high morale independently predicts increased survival among old people, though very old people have not been specifically studied.OBJECTIVE: to investigate whether high morale is associated with increased survival among very old people.SUBJECTS: the Umeå 85+/GErontological Regional DAtabase-study (GERDA) recruited participants aged 85 years and older in northern Sweden and western Finland during 2000-02 and 2005-07, of whom 646 were included in this study.METHODS: demographic, functional- and health-related data were collected in this population-based study through structured interviews and assessments carried out during home visits and from reviews of medical records. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale.RESULTS: the 5-year survival rate was 31.9% for participants with low morale, 39.4% for moderate and 55.6% for those with high morale. In an unadjusted Cox model, the relative risk (RR) of mortality was higher among participants with low morale (RR = 1.86, P < 0.001) and moderate morale (RR = 1.59, P < 0.001) compared with participants with high morale. Similar results were found after adjustment for age and gender. In a Cox model adjusted for several demographic, health- and function-related confounders, including age and gender, mortality was higher among participants with low morale (RR = 1.36, P = 0.032) than those with high morale. There was a similar but non-significant pattern towards increased mortality in participants with moderate morale (RR = 1.21, P value = 0.136).CONCLUSION: high morale is independently associated with increased survival among very old people.
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| 5. |
- Niklasson, Johan, et al.
(författare)
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Higher morale is associated with lower risk of depressive disorders five years later among very old people
- 2017
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 69, s. 61-68
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to investigate whether higher morale, i.e. future-oriented optimism, at baseline was associated with lower risk of depressive disorders five years later among very old people.Methods The Umeå85+/GErontological Regional Database, a population-based study with a longitudinal design, recruited participants in Sweden and Finland aged 85, 90 and ≥95 years. The sample in the present study included 647 individuals (89.1±4.4 years (Mean±SD), range 85-103). After five years, 216 were alive and agreed to a follow-up (92.6±3.4 years, range 90-104). The Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale. The depressive disorder diagnosis was determined according to DSM-IV based on medical records and interview data including assessment scales for depressive disorders. A number of sociodemographic, functional and health-related variables were analysed as possible confounders.Results For those with no depressive disorders at baseline, the only baseline variable significantly associated with depressive disorders five years later was the PGCMS score. A logistic regression model showed lower risk of depressive disorders five years later with higher baseline PGCMS scores (odds ratio 0.779 for one point increase in PGCMS, p<0.001). The association remained after adjusting for social isolation (p<0.1 association with depressive disorders five years later).Conclusion Our results indicate that the higher the morale, the lower the risk of depressive disorders five years later among very old people. The PGCMS seems to identify those very old individuals at increased risk of depressive disorders five years later. Preventive measures could befocused on this group.
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| 6. |
- Niklasson, Johan, et al.
(författare)
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Psychometric properties and feasibility of the Swedish version of the Philadelphia Geriatric Center Morale Scale
- 2015
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Ingår i: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 24:11, s. 2795-2805
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Morale is related to psychological well-being and quality of life in older people. The Philadelphia Geriatric Center Morale Scale (PGCMS) is widely used to assess morale. The purpose of this study was to evaluate the psychometric properties and feasibility of the Swedish version of the 17-item PGCMS among very old people.METHODS: The Umea 85+/GERDA study included Swedish-speaking people aged 85, 90 and 95 years and older, from Sweden and Finland. Participants were interviewed in their own homes using a predefined set of questions. In the main sample, 493 individuals answered all 17 PGCMS items (aged 89.0 +/- 4.3 years). Another 105 answered between 1 and 16 questions (aged 89.6 +/- 4.4 years). A convenience sample was also collected, and 54 individuals answered all 17 PGCMS items twice (aged 84.7 +/- 6.7 years). The same assessor restated the questions within 1 week.RESULTS: Cronbach's alpha was 0.74 among those who answered all 17 questions in the main sample. Confirmatory factor analysis was used to test the construct validity of the most widely used version of the PGCMS, with 17 items and three factors, and showed a generally good fit. Among those answering between 1 and 17 PGCMS questions, 92.6 % (554/598) answered 16 or 17. The convenience sample was used for intra-rater test-retesting, and the intraclass correlation coefficient (ICC) was 0.89. The least significant change between two assessments, with 95 % confidence interval, was 3.53 PGCMS points.CONCLUSION: The Swedish version of the PGCMS seems to have satisfactory psychometric properties and feasibility among very old people.
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| 7. |
- Nyqvist, Fredrica, et al.
(författare)
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Prevalence of loneliness over ten years among the oldest old
- 2017
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45:4, s. 411-418
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Tidskriftsartikel (refereegranskat)abstract
- Aims: This study examined the prevalence of loneliness among the oldest old within a 10-year period and studied the influence of various sociodemographic, social and health characteristics on loneliness.Methods: The study used population-based data from the Umea85+/GErontological Regional DAtabase-study (GERDA) for the years 2000-2002, 2005-2007 and 2010-2012 including 85-year-old, 90-year-old and 95-year-old participants. A final sample of 304 participants in 2000-2002, 329 participants in 2005-2007 and 401 participants in 2010-2012 was included in the analyses.Results: Although the level of loneliness was already high in 2000-2002 (49.3% reported frequent loneliness), the results showed limited changes in loneliness during the 10-year study period. Loneliness was closely related to living alone, depressive symptoms and living in institutional settings.Conclusions: Although societal changes such as solitary living and growing urbanization suggest a changing trend in loneliness, we found that the prevalence of loneliness was relatively stable in this study. Nevertheless, loneliness is common among the oldest old and a focus on social issues related to living arrangements and on depressive symptoms is important in understanding loneliness.
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| 8. |
- Näsman, Marina, et al.
(författare)
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Five-year change in morale is associated with negative life events in very old age
- 2019
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Ingår i: Aging & Mental Health. - : Routledge. - 1360-7863 .- 1364-6915. ; , s. 84-91
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objectives were to study changes in morale in individuals 85 years and older, and to assess the effect of negative life events on morale over a five-year follow-up period.METHOD: The present study is based on longitudinal data from the Umeå85+/GERDA-study, including individuals 85 years and older at baseline (n = 204). Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). Negative life events were assessed using an index including 13 negative life events occurring during the follow-up period. Linear regression was used for the multivariate analyses.RESULTS: The majority of the sample (69.1%) had no significant changes in morale during the five-year follow-up. However, the accumulation of negative life events was significantly associated with a greater decrease in PGCMS. A higher baseline PGCMS score did not attenuate the adverse effect negative life events had on morale.CONCLUSION: Morale seemed to be mainly stable in a five-year follow-up of very old people. It seems, nonetheless, that individuals are affected by negative life events, regardless of level of morale. Preventing negative life events and supporting individuals who experience multiple negative life events could have important implications for the care of very old people.
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| 9. |
- Wiklund, Robert, et al.
(författare)
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Risk factors for hip fracture in very old people : a population-based study
- 2016
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 27:3, s. 923-931
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson's disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development.INTRODUCTION: The purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people.METHODS: In total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression.RESULTS: Participants had a mean age of 89.3 ± 4.7 years; 65.8 % were women, 36.8 % lived in residential care facilities, 33.6 % had dementia, and 20.4 % had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1 %) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR] = 8.57; 95 % confidence interval [CI], 1.90-38.71), Parkinson's disease (HR = 5.12; 95 % CI, 1.82-14.44), currently smoking (HR = 4.38; 95 % CI 2.06-9.33), delirium in the previous month (HR = 2.01; 95 % CI, 1.15-3.49), underweight (body mass index <22; HR = 1.74, 95 % CI, 1.09-2.77), and age (HR = 1.09; 95 % CI, 1.04-1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR = 0.37; 95 % CI, 0.15-0.91), but only for those with bilateral hip prostheses.CONCLUSIONS: Seven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.
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