| 1. |
- Elmståhl, Sölve, et al.
(författare)
-
How should a group living unit for demented elderly be designed to decrease psychiatric symptoms?
- 1997
-
Ingår i: Alzheimer Disease and Associated Disorders. - : Ovid Technologies (Wolters Kluwer Health). - 0893-0341. ; 11:1, s. 47-52
-
Tidskriftsartikel (refereegranskat)abstract
- The main objectives were to study relationships between the design of group living (GL) units and psychiatric symptoms in demented patients before, 6 months after, and 1 year after admission to GL units. The study population comprised 105 demented elderly (83 ± 6 years), 37% with dementia of Alzheimer's type and 58% with vascular dementia. The patients were relocated by the municipal care planning team after clinical examination. An observational scale (the Organic Brain Syndrome scale) was used to assess confusional symptoms and disorientation. The physical environment was assessed by an architect using the Therapeutic Environment Screening Scale, which evaluates general design, space, lighting, noise, communication area, floor plan, and related factors. Less than 15% of the patients had no signs of dyspraxia, hallucinosis, dysphasia, or depression at admission, whereas 66% or more reported lack of vitality, aggressiveness, or restlessness. Fourteen out of 18 units had a corridor-like design (group A), one unit an L-shaped design (group B), and the others a square or H-shaped design (group C). Patients living in the B unit had less disorientation than the others at the 6-month follow-up. After 1 year, the patients in the A units had more dyspraxia, lack of vitality, and disorientation of identity. The communication areas in the units were negatively associated with 'disorientation for recent memory' and 'lack of vitality,' adjusted for type of dementia (r = -0.13 to -0.16). The size of the activity area, indoor public rooms in square meters, was not correlated to confusional reactions and disorientation. In conclusion, a GL unit design that facilitates perception without reducing the communication area is to be preferred.
|
|
| 2. |
- Elmståhl, Sölve, et al.
(författare)
-
Bias in diet assessment methods - Consequences of collinearity and measurement errors on power and observed relative risks
- 1997
-
Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 26:5, s. 1071-1079
-
Tidskriftsartikel (refereegranskat)abstract
- Background. If several risk factors for disease are considered in a regression model and these factors are affected by measurement errors, the observed relative risk will be attenuated. In nutritional epidemiology, several nutrient variables show strong correlation, described as collinearity. The observed relative risk will then depend not only on the validity of the chosen diet assessment method but also on collinearity between variables in the model. Methods. The validity of different diet assessment methods are compared. The correlation coefficients between common nutrients and foods are given using data from the Malmo Food Study. Intake of nutrients and foods were assessed with a modified diet history method, combining a 2-week food record for beverages and lunch/dinner meals and a food frequency questionnaire for other foods. The study population comprised 165 men and women aged 50-65 years. A multivariate logistic regression model is used to illustrate the effect of collinearity on observed relative risk (RRo). Results. A moderate to high correlation between risk factors will substantially influence RRo even when using diet assessment methods with high validity. Methods with low validity might even give inverse RRo. Conclusion. It is stressed that caution must be exercised and only a selected number of variables should be included in the model, especially when they are highly intercorrelated, since RRo might be severely biased.
|
|
| 3. |
- Elmståhl, Sölve, et al.
(författare)
-
Malnutrition in geriatric patients : A neglected problem?
- 1997
-
Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 26:5, s. 851-855
-
Tidskriftsartikel (refereegranskat)abstract
- The nutrient intake in geriatric long-stay patients and the mortality risk associated with low energy intake were studied in 61 patients, 43 women and 18 men, with a mean age of 87 years, at a geriatric long-stay care hospital during a 6-month follow-up. Dietary intake was assessed with a 9-day dietary record. Energy expenditure was calculated assuming a physical activity level of 1.33 × basal metabolic rate (BMR), predicted from equations given by FAO/WHO. Mean energy intakes were 1557 kcal in men and 1280 kcal in women; 84% of the patients had an intake below estimated energy expenditure and 30% were below estimated BMR. Only 5% received dietary supplement. Eleven out of the 61 patients died during the follow-up and the deceased had lower energy intake than the others (1185 kcal vs 1401 kcal, P<0.05). An energy intake below median (1378 kcal) was associated with an age adjusted increased 6-month mortality risk, odds ratio 12.5. A high proportion of geriatric long-stay patients report dietary intake far below present recommendations and are thereby at risk for having/developing malnutrition. Improved surveillance of geriatric long-stay patients' dietary habits seems justified.
|
|
| 4. |
- Elmståhl, Sölve, et al.
(författare)
-
A 3-year follow-up of stroke patients : Relationships between activities of daily living and personality characteristics
- 1996
-
Ingår i: Archives of Gerontology and Geriatrics. - : Elsevier BV. - 0167-4943. ; 22:3, s. 233-244
-
Tidskriftsartikel (refereegranskat)abstract
- The importance of some personality characteristics for improvement of activities of daily life (ADL) was studied in sixty-six stroke patients, initially admitted to geriatric rehabilitation (n = 37) or the department of medicine (n = 29), 3 years after stroke. Outcome measurements were activities of daily life and motor and mental functions assessed using the Activity Index (AI) by Hamrin and Wohlin. Neuroticism and extroversion were measured with the Eysenck Personality Inventory Scale. Preferred coping strategies were assessed from interviews on how the patients handle difficult events. Major improvements of ADL and motor functions were seen the first year after stroke. There was no major differences between patients admitted, either to geriatric rehabilitation or traditional medical wards regarding the outcome measurements except for better eating ability in the former group 3 years later. Subjects living alone showed deteriorated ADL functions after 3 years. Extrovert personality and active coping strategy predicted improved ADL functions. Multiple regression analyses with AI as the dependent variable proved active coping to predict functional outcome. In conclusion; increased knowledge about personality characteristics can improve possibilities for a more individual rehabilitation program.
|
|
| 5. |
- Elmståhl, Sölve, et al.
(författare)
-
Behavioral disturbances and pharmacological treatment of patients with dementia in family caregiving : A 2-year follow-up
- 1998
-
Ingår i: International Psychogeriatrics. - 1041-6102. ; 10:3, s. 239-252
-
Tidskriftsartikel (refereegranskat)abstract
- Behavioral disturbances are common in dementia. Polypharmacy due to progression of disease and fluctuation of symptoms among patients might increase risk of overtreatment and/or undertreatment. Drug prescription habits were studied in relationship to symptoms of dementia after relocation of patients to group-living care units (GC). Seventy-six demented patients (mean age 81 years) were assessed before, 12 months after, and 24 months after relocation to GC. Vascular dementia was found in 47%, Alzheimer's dementia in 46%, and other dementias in 7%. Medications, regular or as required, were recorded from medication lists. Repeated observations of symptoms like depressive mood and lack of vitality were made with validated scales. Eighty percent of the patients were prescribed drugs; 40% were given neuroleptics and 9% were given antidepressants. During the 2-year follow-up, polypharmacy increased; patients with five drugs or more increased from 15% to 35%; usage of neuroleptics or sedatives, as required, increased from 8% to 25%, p < .01. Depressive mood was noted in 86% after 2 years and 74% showed aggressiveness and anxiety, but only 12% of the patients with depressive symptoms were on antidepressants. Analgesics were prescribed to 26% of patients. In conclusion, a high proportion of patients with dementia had depressive mood and undertreatment of depressive disorder might be suspected. Polypharmacy increased during the 2-year follow-up; this finding calls for careful monitoring of adverse drug reactions, because of the deteriorating cognitive function of these patients.
|
|
| 6. |
- Elmståhl, Sölve, et al.
(författare)
-
Caregiver's burden of patients 3 years after stroke assessed by a novel caregiver burden scale
- 1996
-
Ingår i: Archives of Physical Medicine and Rehabilitation. - 0003-9993 .- 1532-821X. ; 77:2, s. 177-182
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess burden of caregivers to stroke patients three year after a primary stroke and to test validity and reliability of a novel caregiver burden scale (CB scale). Design: A longitudinal community-based 3- year follow-up study of 35 consecutive primary stroke patients initially admitted to an Acute Medical Unit (mean age 82yr). The validity of the CB scale was studied in 150 patients (mean age 77yr):83 demented outpatients assessed for need of group living and 67 outpatients with stroke from a general geriatric day-care unit. Reliability was studied in another 23 outpatients (mean age 72yr) with stroke from the same unit. Methods: A 22- item CB scale for different types of caregiver burden and scales for neuroticism and extroversion (Eysenck Personality Inventory) and quality of life (11-item scale). Activities of daily life were assessed by a 6-item scale, initially and 3 years later. Outcome Measure: Reliability and validity of the CB scale. Improvements of activities of daily life of stroke patients. Results: Factor analyses of the CB scale gave five indices-general strain, isolation, disappointment, emotional involvement, and environment-having good kappa values, .89 to 1.00 and Cronbach's alpha, .70 to .87, except for environment. A higher burden was related to a closer relationship but not to the living situation. The highest caregiver burden was found among patients showing the greatest improvements of ADL, when divided into tertiles. The patient's degree of extroversion and quality of life were negatively correlated to caregiver burden, -.46 (p < .05) and .59 (p < .01). Conclusions: The CB scale proved to be a valid and reliable instrument to assess caregiver burden. To improve the caregiver situation, individual patient personality characteristics, like extroversion, feeling of quality of life, and progression of the disease, must be considered.
|
|
| 7. |
- Elmståhl, Sölve, et al.
(författare)
-
Family caregiving in dementia : Prediction of caregiver burden 12 months after relocation to group-living care
- 1998
-
Ingår i: International Psychogeriatrics. - 1041-6102. ; 10:2, s. 127-146
-
Tidskriftsartikel (refereegranskat)abstract
- The strain of caregiving associated with the care of demented persons living at home often continues after relocation, and group-living-care units (GL), designed for a small number of subjects, have been developed. The aim was to prospectively describe caregiver burden in relationship to symptoms of patients with dementia after relocation to GL. Sixty-four caregivers and 64 demented patients were assessed before, 6 months after, and 12 months after relocation. Thirty-six caregivers were children, 7 were spouses, and 21 were others. Validated scales were used for caregiver burden and dementia symptoms. Total burden of caregivers decreased after 12 months, but the degree of isolation was unchanged and feeling of disappointment increased significantly. The burden was not related to changes of activities of daily life or disorientation. Patients' lack of vitality at relocation independently predicted caregiver's burden 1 year later. Hallucinations and changes of symptoms during the first year were associated with less caregiver burden, probably due to greater detachment of the relationship. The caregiver burden remains 1 year after relocation and any support to the caregiver should consider patients' symptoms, especially lack of vitality.
|
|
| 8. |
- Elmståhl, Sölve, et al.
(författare)
-
Postural hypotension and EEG variables predict cognitive decline : Results from a 5-Year follow-up of healthy elderly women
- 1997
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 8:3, s. 180-187
-
Tidskriftsartikel (refereegranskat)abstract
- Quantified electroencephalographic activity (EEG) has been used to study normal ageing and dementia. Few studies have described longitudinal changes in the very old. A cognitive decline has been described in subjects with white-matter lesions and hypertension but the association with hypotension is unclear. Our aim was to study the predictive value of quantified EEG for the development of cognitive decline and associations with postural hypotension. Participants: Thirty-three healthy women aged 75–95 years, with no signs of cerebrovascular disease, dementia or acute illness at baseline examination took part in a longitudinal 5-year follow-up study. The women were recruited from a random selection using the Municipal Registry. Quantified EEG was assessed twice and recorded on a Siemens-Elema connected to a Biological Banker. The medical and neuropsychological examination was conducted twice. Dementia was classified according to DSM criteria. The assessment included Mini-Mental Scale Examination (MMSE), spatial and vocabulary tests. Blood pressure was measured in supine position and an orthostatic test was performed with continuous ECG recording. Seven women (cases) developed cognitive decline at the 5-year follow-up, defined as newly developed MMSE < 27 and dementia symptoms. Low beta activity at baseline predicted development of cognitive decline. The women who remained healthy at follow-up showed an increase of alpha and theta activity. The cases had a higher orthostatic blood pressure fall during tilting at baseline (16 mm Hg) than the controls (1 mm Hg, p < 0.01). The orthostatic reaction was correlated with increased levels of theta and alpha activity at follow-up (r = −0.47 to −0.52; p < 0.01). Low beta activity predicts for cognitive decline in the elderly and an orthostatic blood pressure reaction is a risk factor for cognitive decline.
|
|
| 9. |
- Siennicki-Lantz, Arkadiusz, et al.
(författare)
-
Cerebral blood flow in white matter is correlated with systolic blood pressure and EEG in senile dementia of the Alzheimer type
- 1998
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 9:1, s. 29-38
-
Tidskriftsartikel (refereegranskat)abstract
- The presence and functional significance of white matter lesions in the ageing brain and in dementia as well as their relation to blood pressure are often discussed. The aim of this study was to evaluate cerebral blood flow in white matter (WMCBF) and its relation to systemic blood pressure and multichannel EEG. WMCBF was measured in 24 elderly women with senile dementia of Alzheimer's type (SDAT, median age 85.5, range 68-93) and 20 age-matched controls (median age 86.0, range 79-93) using 99mTc-HMPAO single photon emission CT. A significant low WMCBF could be observed in all analysed regions in SDAT subjects compared to controls, with the greatest decline in the posterior region (parietotemporo-occipital area). Correlations between quantified EEG from the posterior regions and WMCBF were seen. Systolic blood pressure was significantly lower in the SDAT group and was positively correlated with WMCBF in the posterior and anterior brain regions. Whether low systemic blood pressure is the result of cerebral dysfunction is unclear.
|
|
| 10. |
- Siennicki-Lantz, Arkadiusz, et al.
(författare)
-
How to interpret differing cerebral blood flow patterns estimated with 99tcm-hmpao and 99tcm-ecd spet in a healthy population
- 1999
-
Ingår i: Nuclear Medicine Communications. - : Ovid Technologies (Wolters Kluwer Health). - 0143-3636. ; 20:3, s. 219-226
-
Tidskriftsartikel (refereegranskat)abstract
- Two radiopharmaceuticals, 99Tcm-hexamethyl propylene amine oxime (99Tcm-HMPAO) and 99Tcm-ethyl cysteinate dimer (99Tcm-ECD), are currently used to determine cerebral blood flow. 99Tcm-ECD is, by virtue of its greater stability, superceding 99Tcm-HMPAO for routine examinations. Since the clinical assessment of 99Tcm-ECD images is usually based on experience with 99Tcm-HMPAO, we used both radiopharmaceuticals to compare regional cerebral blood flow in the same individuals. Eleven healthy subjects aged 67.1 ± 6.3 years (mean ± S.D.) underwent 99Tcm-ECD followed by 99Tcm-HMPAO single photon emission tomography. Cerebral blood flow was quantified in cortical and central regions of interest (basal ganglia, ventricles, white matter) in relation to cerebellar uptake. The intra-subject comparison of cerebral blood flow in the cortical areas revealed higher levels of perfusion in the posterior parietal, parieto-occipital and temporo-occipital areas using 99Tcm-ECD. In contrast to the cortical areas, cerebral blood flow in the central areas was greater using 99Tcm-HMPAO, especially in the centrum semiovale, basal ganglia, frontal white matter and frontal horns. This difference in cerebral blood flow when imaging healthy individuals with 99Tcm-ECD and 99Tcm-HMPAO should be taken into account in clinical practice when changing from one radiopharmaceutical to the other.
|
|
