| 1. |
- Zethelius, Björn, 1962-
(author)
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Proinsulin and Insulin Sensitivity as Predictors of Type 2 Diabetes Mellitus and Coronary Heart Disease : Clinical Epidemiological Studies with up to 27 Years of Follow-Up
- 2002
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Doctoral thesis (other academic/artistic)abstract
- Defects in insulin secretion and insulin action are the major abnormalities in the development of Type 2 diabetes. Hyperinsulinemia is a risk marker for Type 2 diabetes and according to some, but not in all studies also for coronary heart disease (CHD). Conventional insulin assays measure immunoreactive insulin including proinsulin-like molecules. Proinsulin and insulin measured by specific methods, insulin sensitivity measured by the euglycemic insulin clamp and early insulin response after a glucose challenge give more detailed information and may be better estimates of true risk for Type 2 diabetes and CHD. This study examined relationships between proinsulin, insulin, insulin secretion and insulin sensitivity for the development of Type 2 diabetes and CHD. The investigation of the prognostic significance of proinsulin and insulin for the development of Type 2 diabetes and CHD was performed in prospective studies of 50-year and 70-year-old men in a population-based cohort. The results indicated, that increased proinsulin concentrations, was a marker of increased risk for Type 2 diabetes independent of measurements of insulin secretion and insulin sensitivity whereas insulin was not. Proinsulin was shown to be a predictor for CHD mortality and morbidity, respectively, independent of conventional risk factors, whereas insulin was not. Insulin sensitivity measured by the gold standard euglycemic insulin clamp at age 70 was a predictor of CHD morbidity, independently of established risk factors.In summary, these data provide evidence that an increased concentration of proinsulin and not an elevated plasma insulin level per se, that constitutes the association with Type 2 diabetes and CHD and that insulin resistance per se, is associated with CHD risk.
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| 2. |
- Ärnlöv, Johan, 1970-
(author)
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Left Ventricular Function in Elderly Men : Metabolic, Hormonal, Genetic and Prognostic Implications
- 2002
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Doctoral thesis (other academic/artistic)abstract
- Heart failure and left ventricular dysfunction are major causes of morbidity and mortality. In this thesis, metabolic, hormonal, genetic and prognostic aspects of echocardiographically determined left ventricular function were investigated in a fairly large longitudinal population-based study of men. The participants were examined both at age 50 and 70 years and were followed for mortality using the national cause-of-death registry.Several factors associated with the insulin resistance syndrome predicted left ventricular systolic dysfunction independent of myocardial infarction, hypertension, diabetes and the use of cardiovascular medication after twenty years follow-up. Plasma levels of N-terminal atrial natriuretic peptide (N-ANP) were significantly increased in men with left ventricular dysfunction in comparison to healthy men. However, the diagnostic accuracy was poor due to the extensive overlapping between the groups. Relations between a haplotype of the novel hUNC-93B1 gene and the E/A-ratio were found and validated in separate samples of the cohort. Myocardial performance index (a Doppler derived index of combined left ventricular systolic and diastolic function) and left ventricular ejection fraction were found to be predictors for cardiovascular mortality independent of traditional cardiovascular risk factors in a longitudinal analysis with a mean follow-up of seven years.In conclusion, this thesis showed that left ventricular function is influenced by metabolic, hormonal and genetic factors and that echocardiographic measurements of left ventricular function, such as the myocardial performance index, are strong independent risk factors for cardiovascular mortality in elderly men.
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| 3. |
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| 4. |
- Lundström, Maria
(author)
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Delirium in old patients with femoral neck fracture : risk factors, outcome, prevention and treatment
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Delirium is probably the most common presenting symptom of disease in old age. Delirium, as defined in DSM-IV, is a neuropsychiatric syndrome characterized by disturbance in attention and consciousness, which develops over a short period of time and where the symptoms tend to fluctuate during the course of the day. The overall aim was to increase knowledge about the risk factors and outcome of delirium in old patients with femoral neck fracture and to develop and evaluate a multi-factorial intervention program for prevention and treatment of delirium in these patients.In a prospective study of 101 consecutive patients with a femoral neck fracture, 29.7% were delirious before surgery and another 18.8% developed delirium postoperatively. Of those who were delirious preoperatively all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and seemed to have more postoperative complications, such as infections. Patients with preoperative delirium had a poorer walking ability on discharge compared to patients with postoperative delirium only.In a five-year prospective follow up study 30 out of 78 (38.5%) non-demented patients with a femoral neck fracture developed dementia. Twenty out of 29 (69%) who were delirious postoperatively developed dementia compared to 10 out of 49 (20%) who were not delirious during hospitalization (p<0.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years compared to 17/49 (34.7%) of those who remained lucid postoperatively (p=0.001).A non-randomized multi-factorial intervention study with the aim of preventing and treating delirium among patients with femoral neck fracture (n=49) showed that the incidence of delirium was significantly lower than reported in previously published studies. The incidence of other postoperative complications was also lower and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge.A similar multi-factorial intervention program evaluated as a randomized controlled trial including 199 femoral neck fracture patients showed that fewer intervention patients than controls suffered postoperative delirium (56/102, 55% vs. 73/97, 75%, p=0.003). For intervention patients the postoperative delirium was also of shorter duration (5.0±7.1 days vs. 10.2±13.3 days, p=0.009). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from significantly fewer in-hospital complications, such as decubital ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0±17.9 days vs. 38.0±40.6 days, p=0.028).In conclusion, pre- and postoperative delirium is common and seems to be associated with various risk factors, which require different strategies for prevention and treatment. Delirium is also associated with the development of dementia and a higher mortality rate. Multifactorial intervention programs can successfully be implemented and result in the reduction of delirium, fewer complications and shorter hospitalization.
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| 5. |
- Wilhelmson, Katarina, 1958
(author)
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Longer life - better life? Studies on mortality, morbidity and quality of life among elderly people
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Background: Life expectancy has been increasing, but whether or not the added years are years with good health and quality of life have been vividly debated. Knowledge of the health conditions among elderly is of increasing importance.Aim:- To analyse differences in mortality and morbidity in three cohorts of 70-year olds with special regard to the impact of social factors. - To compare health information from interviews and medical records. - To investigate what elderly people consider being important for their quality of life. - To determine predictors for suicide among the old elderly (75+).Methods: Paper I and II: Random samples of 70-year old people born in 1901/02 (n=973), 1906/07 (n=1036) and 1911/12 (n=619). They were examined and interviewed regarding social background, social network and health. Death records were obtained up to and including 1998. Paper III-V: 85 elderly suicide cases (65 years of age and above) and 153 randomly selected control persons were interviewed in persons or by proxy, and their medical records were reviewed.Results: The later born cohorts had lower mortality compared to the first-born cohort. Participants not living in an institution, non-smokers and those with one or more diseases were among those who had lower mortality in the later born cohorts. There were fewer 70-year olds not feeling healthy, fewer having many symptoms and there were indications of better physical functioning in the later born cohorts. Medical records gave better information concerning specific diseases, while interview data provided better measures of impairments. Elderly persons consider health, social relations, functional ability and activities to be important to the quality of life. Family discord, severe physical illness, loneliness and depression were risk factors for suicide in the old elderly. Conclusions: Good years seem to have been added - although we live longer with diseases. More good years can be gained with improvements in life style behavior and with continued improvements in health services and medical treatment. It is important to recognize and treat depressions among elderly people, especially in the context of severe illness and impairment.
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| 6. |
- Bergman, Birgitta, 1941
(author)
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On vision in old age. A longitudinal study of subjects 70 to 97 years old
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Aims. The main purpose of this study was to investigate different aspects of vision and visual function in old people, like change in vision and visual ability, to study the natural course of eye diseases, assess needs of visual intervention, investigate risk factors for ocular disorders late in life, and also to investigate coexistence between visual and hearing impairments. Materials and Methods. Within the framework of the Gerontological and Geriatric Population Studies, the H70 Study , launched 1971 in Göteborg, Sweden, a cohort comprising 958 subjects at the start of the study was eye-examined longitudinally at ages 70, 82, 88, 95, and 97 years. At ages 95 and 97, cross-sectional groups were added to extend the sample. Audiological and laboratory data were analysed in connection with the ophthalmological examinations.Results. At age 70, best-corrected normal vision (VA ³0.8) was found in 86%, at age 82 in 48%, at age 88 in 24%, and at age 95 in 8% of subjects. At age 97, severe visual impairment (VA £0.1) was found in every third subject. The deterioration rate (i.e., logMAR change per year) was faster in the highest age interval. At age 82, the visual ability score correlated with distance VA (r = 0.62). In subjects with no pathological findings, median VA was 0.9 at age 82 and 0.8 at age 88. Geographic atrophy was more common than exudative late ARM. At 97 years 30% had undergone cataract surgery. The benefit of regular eye examinations, improvement of glasses, and early cataract surgery was assessed. At age 70, blood folate levels, and physical activity earlier, correlated positively, and body mass index (BMI) correlated negatively, to VA ³0.8 at ages 82 and 88. Higher BMI at 70 correlated to cataract disease at age 88, and smoking at age 70 correlated to early ARM at age 82. Mild impairments of vision and hearing increased from 2% at age 70 to 22% at age 82.Conclusions. In old age, gradual deterioration of vision is encountered. Regular eye screening, with improvement of glasses, and/or cost-effective cataract surgery, should be performed early to increase the time of improved vision. Lifestyle variables may prospectively correlate to future eye health and vision. Combined visual and hearing impairment can result in pronounced problems in everyday activities.
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| 7. |
- Lundin-Olsson, Lillemor, 1950-
(author)
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Prediction and prevention of falls among elderly people in residential care
- 2000
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Doctoral thesis (other academic/artistic)abstract
- Among elderly people, falls lead to a considerable amount of immobility, morbidity, and mortality. The purpose of this study was to develop and evaluate methods for predicting falls, and to evaluate a fall prevention program among elderly people living in residential care facilities. A fall was defined as any event in which the resident unintentionally came to rest on the floor or the ground regardless of whether or not an injury was sustained.In developing the prediction methods, it was hypothesised that older persons showing difficulties in performing a familiar second task while walking were more likely to fall within six months. For residents who stopped walking when talking, the relative risk of falling was 3.5 (95% CL2.0-6.2) compared to those who continued walking. For residents with a time difference (diffTUG) of at least 4.5 seconds between two performances of the Timed Up&Go test, with and without carrying a glass, the hazard ratio for falls was 4.7 (95% Cl: 1.5-14.2) compared to those with a shorter diffTUG.A screening tool, the Mobility Interaction Fall (MIF) chart, was developed and evaluated, then validated in a new sample. This tool included a mobility rating, ‘Stops walking when talking’, ‘diffTUG’, a test of vision, and a concentration rating. In the first sample, the hazard ratio was 12.1 (95% 0:4.6-31.8) for residents classified as ‘high-risk’ compared to ‘low-risk’. The positive predictive value was 78%, and the negative predictive value, the sensitivity, and the specificity were above 80% for falling in six months. In the second sample the prediction accuracy of the MIF chart was lower (hazard ratio 1.7, 95% Cl: 1.1-2.5) and a 6-month fall history or a global rating of fall risk by staff were at least equally valuable. A combination of any two of the methods - the MIF chart, staff judgement, fall history - was more accurate at identifying high risk residents than any method alone. Half of the residents classified by two methods as ‘high risk’ sustained a fall within 6 months.In a randomised study a prevention program directed to residents, staff, and environment resulted in a significant reduction in the number of residents falling (44% vs. 56%; odds ratio 0.62, 95% CF0.41-0.92), the incidence of falls (incidence rate ratio IRR 0.80, 95% CF0.69-0.94) and of femoral fractures (IRR 0.25, 95% 0:0.08-0.82) in the intervention compared to the control group.In conclusion, a combination of any two of the staff judgement, fall history or MIF chart has the potential to identify a large proportion of residents at particular high fall risk. A multidisciplinary and multifactorial fall prevention program directed to residents, staff, and the environment can reduce the numbnumber of residents falling, of falls and of femoral fractures.
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| 8. |
- Dey, Debashish Kumar, 1968
(author)
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Anthropometry in the elderly. Population studies on longitudinal changes, secular trends and risk for morbidity and mortality
- 2001
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Doctoral thesis (other academic/artistic)abstract
- The aims of this thesis were to a) describe longitudinal changes in height and body weight (BW) between the ages 70 and 95y; b) describe secular trends in height and BW of 70-year-olds and their relation to social and lifestyle factors; c) investigate waist circumference (WC) and body mass index (BMI) at age 70 as risk for stroke during a 15-y follow-up; and, d) examine the relationship between 1) BMI at age 70 and 15-y all- cause mortality, 2) the percentage of weight change from age 70 to 75 and subsequent 5- and 10-y mortality. The studies were performed within the framework of the gerontological and geriatric population studies in Göteborg, Sweden-the H70 studies. In the H70 studies, 3,128 70-year-olds (1,426 males and 1,702 females) from four cohorts participated in medical examinations during 1971/72 (Cohort I; 449 men and 524 women), 1976/77 (Cohort II; 474 men and 562 women), 1981/82 (Cohort III; 302 men and 317 women), and 1992 (Cohort V; 201 men and 299 women). Longitudinal changes in anthropometry were studied in Cohort-I where participants and survivors were followed from ages 70 to 95 with 11 examinations in between. Secular trends were studied in participants of all four cohorts (I, II, III and V). Morbidity (stroke) and mortality were studied in participants (2,628) of three cohorts (I, II and III). BW and standing height were measured in the morning and were recorded to the nearest 0.1kg and centimeter with the subjects wearing light clothes. BMI was calculated from weight (kg) divided by height (m) squared. WC was measured horizontally half-way between the lowest floating ribs and iliac crests with subjects in standing position. From ages 70 to 95, height decreased 4 and 5 cm and BW decreased 3 and 5 kg in males and females, respectively. Due to the decrease in both height and BW, BMI was less affected. Individuals of later-born cohorts were found 1 to 2 cm taller and 1.5 to 6.3 kg heavier than earlier-born cohorts. "Year of birth" was a positive predictor for BW (p<0.001) and BMI (p<0.001) in males, and for height (p<0.05) and BW (p<0.01) in females. Physical inactivity was a positive (p<0.01) and "current smoking" a negative (p<0.001) predictor for BMI in both sexes. "More than basic education" was a positive predictor for height (p<0.001) in both sexes and a negative predictor for body weight (p<0.01) and BMI (p<0.001) in females only. During the 15-y follow-up from age 70, the adjusted relative risk (RR) for non-fatal and all strokes in males were 1.69 (95% CI 1.03 - 2.78) and 1.62 (95% CI 1.06 - 2.47), respectively, in the highest WC quartile compared to the lowest quartile. In females, an elevated RR in the highest WC quartile 1.49 (95% CI 1.02 - 2.25) for all strokes disappeared after adjustment for systolic blood pressure. In males, the adjusted RR in the highest BMI quartile for non-fatal stroke and all strokes were 1.72 (95% CI 1.07 - 2.77) and 1.66 (95% CI 1.10 - 2.51), respectively. In females, RR for any stroke across the BMI quartiles was not found to be significantly different. In both sexes, neither WC nor BMI were risks for fatal stroke. The RR for 15-y mortality from age 70 were highest in the lowest BMI quintiles of males 1.20 (95% CI 0.96 - 1.51) and females 1.49 (95% CI 1.14 - 1.96). After exclusion of first five-years death, no excess risk were found in males for following 5- and 10-y mortality across the quintiles. However, a U-shaped relation was observed in females after such exclusions. A weight loss of ³10% between ages 70 and 75 meant a significantly higher risk for subsequent 5- and 10-y mortality in both sexes.The results indicate that height and BW decreases significantly after age 70 and more prominently in females. Trends in increasing height and BW among the new generations of 70-year-olds are partly attributable to variations in social and lifestyle factors. Both high BMI and WC are risks for stroke in elderly males. On the other hand, both low BMI and weight loss are risk for mortality in both sexes. The results might be of importance to the understanding of anthropometry and its relation to morbidity and mortality in the ageing population.
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