| 1. |
- Berner, Jessica, et al.
(författare)
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Factors influencing Internet usage in older adults (65 years and above) living in rural and urban Sweden
- 2015
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Ingår i: Health Informatics Journal. - : Sage Publications. - 1460-4582 .- 1741-2811. ; 21:3, s. 237-249
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Tidskriftsartikel (refereegranskat)abstract
- Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.
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| 2. |
- Palmqvist, Sebastian, et al.
(författare)
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Detailed comparison of amyloid PET and CSF biomarkers for identifying early Alzheimer disease
- 2015
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Ingår i: Neurology. - : Lippincott Williams & Wilkins. - 1526-632X .- 0028-3878. ; 85:14, s. 1240-1249
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To compare the diagnostic accuracy of CSF biomarkers and amyloid PET for diagnosing early-stage Alzheimer disease (AD).Methods:From the prospective, longitudinal BioFINDER study, we included 122 healthy elderly and 34 patients with mild cognitive impairment who developed AD dementia within 3 years (MCI-AD). -Amyloid (A) deposition in 9 brain regions was examined with [F-18]-flutemetamol PET. CSF was analyzed with INNOTEST and EUROIMMUN ELISAs. The results were replicated in 146 controls and 64 patients with MCI-AD from the Alzheimer's Disease Neuroimaging Initiative study.Results:The best CSF measures for identifying MCI-AD were A42/total tau (t-tau) and A42/hyperphosphorylated tau (p-tau) (area under the curve [AUC] 0.93-0.94). The best PET measures performed similarly (AUC 0.92-0.93; anterior cingulate, posterior cingulate/precuneus, and global neocortical uptake). CSF A42/t-tau and A42/p-tau performed better than CSF A42 and A42/40 (AUC difference 0.03-0.12, p < 0.05). Using nonoptimized cutoffs, CSF A42/t-tau had the highest accuracy of all CSF/PET biomarkers (sensitivity 97%, specificity 83%). The combination of CSF and PET was not better than using either biomarker separately.Conclusions:Amyloid PET and CSF biomarkers can identify early AD with high accuracy. There were no differences between the best CSF and PET measures and no improvement when combining them. Regional PET measures were not better than assessing the global A deposition. The results were replicated in an independent cohort using another CSF assay and PET tracer. The choice between CSF and amyloid PET biomarkers for identifying early AD can be based on availability, costs, and doctor/patient preferences since both have equally high diagnostic accuracy.Classification of evidence:This study provides Class III evidence that amyloid PET and CSF biomarkers identify early-stage AD equally accurately.
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| 3. |
- Hammar, Tora, 1984-, et al.
(författare)
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Potential drug-related problems detected by electronic expert support system : physicians’ views on clinical relevance
- 2015
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Ingår i: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 37:5, s. 941-948
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Tidskriftsartikel (refereegranskat)abstract
- Background Drug-related problems cause suffering for patients and substantial costs. Multi-dose drug dispensing is a service in which patients receive their medication packed in bags with one unit for each dose occasion. The electronic expert support system (EES) is a clinical decision support system that provides alerts if potential drug-related problems are detected among a patients’ current prescriptions, including drug–drug interactions, therapy duplications, high doses, drug-disease interactions, drug gender warnings, and inappropriate drugs and doses for geriatric or pediatric patients. Objective The aim of the study was to explore physicians’ views on the clinical relevance of alerts provided by EES. Furthermore we investigated if physicians performed any changes in drug treatment following the alerts and if there were any differences in perceived relevance and performed changes between different types of alerts and drugs. Setting Two geriatric clinics and three primary care units in Sweden. Method Prescribed medications for patients (n = 254) with multi-dose drug dispensing were analyzed for potential drug-related problems using EES. For each alert, a physician assessed clinical relevance and indicated any intended action. A total of 15 physicians took part in the study. Changes in drug treatment following the alerts were later measured. The relationship between variables was analyzed using Chi square test. Main outcome measure Physicians’ perceived clinical relevance of each alert, and changes in drug treatment following the alerts. ResultsPhysicians perceived 68 % (502/740) of EES alerts as clinically relevant and 11 % of all alerts were followed by a change in drug treatment. Clinical relevance and likelihood to make changes in drug treatment was related to the alert category and substances involved in the alert. Conclusion In most patients with multi-dose drug dispensing, EES detected potential drug-related problems, with the majority of the alerts regarded as clinically relevant and some followed by measurable changes in drug treatment.
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| 4. |
- Religa, D., et al.
(författare)
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SveDem, the Swedish Dementia Registry - A tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice
- 2015
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Swedish Dementia Registry (SveDem) was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden. Methods: SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se). The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes. Results: The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden. Conclusion: SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.
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| 5. |
- Sjölund, Britt-Marie, et al.
(författare)
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Incidence of ADL Disability in Older Persons, Physical Activities as a Protective Factor and the Need for Informal and Formal Care : Results from the SNAC-N Project
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the study was to examine 1) the incidence of disability in Activities of Daily Living (ADL), in persons 78 years and older 2) explore whether being physical active earlier is a significant predictor of being disability free at follow-up and 3) describe the amount of informal and formal care in relation to ADL-disability.METHODS: Data were used from a longitudinal community-based study in Nordanstig (SNAC-N), a part of the Swedish National Study on Aging and Care (SNAC). To study objectives 1) and 2) all ADL-independent participants at baseline (N = 307) were included; for objective 3) all participants 78 years and older were included (N = 316). Data were collected at baseline and at 3- and 6-year follow-ups. ADL-disability was defined as a need for assistance in one or more activities. Informal and formal care were measured using the Resource utilization in Dementia (RUD)-instrument.RESULTS: The incidence rates for men were similar in the age groups 78-81and 84 years and older, 42.3 vs. 42.5/1000 person-years. For women the incidence rate for ADL-disability increased significantly from the age group 78-81 to the age group 84 years and older, 20.8 vs.118.3/1000 person-years. In the age group 78-81 years, being physically active earlier (aOR 6.2) and during the past 12 month (aOR 2.9) were both significant preventive factors for ADL-disability. Both informal and formal care increased with ADL-disability and the amount of informal care was greater than formal care. The incidence rate for ADL-disability increases with age for women and being physically active is a protective factor for ADL-disability.CONCLUSION: The incidence rate for ADL-disability increases with age for women, and being physical active is a protective factor for ADL-disability.
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| 6. |
- Johanson, Cecilia N, et al.
(författare)
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Salivary secretion and drug treatment in four 70-year-old Swedish cohorts during a period of 30 years
- 2015
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Ingår i: Gerodontology. - : Wiley. - 0734-0664. ; 32:3, s. 202-210
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim was to examine the association between drug treatment and unstimulated and stimulated whole saliva in four 70-year-old Swedish cohorts, between 1971 and 2001. Background Both diseases and their medication can affect the salivary secretion rate. Materials and methods The study was based on selected samples of four cohorts born in 1901/1902, 1906/1907, 1911/1912 and 1930/1931, respectively, a total of 1072 individuals. The response rate varied between 65% and 85%. Results The mean value for the stimulated salivary secretion rate was higher in men (1.30.8ml/min) than in women (1.0 +/- 0.7ml/min) (p<0.001)). There was a significant association between the salivary secretion rate and the number of drugs among both women (p<0.01) and men (p<0.001). This influence was most pronounced in participants who were treated with cardiovascular drugs, mainly diuretics and non-selective -adrenoceptor blockers, but also with antipsychotics and antidepressants, even when adjusted for cohort, gender, number of teeth and other drugs. There was an increase in treatment with medicines during the three decades. Conclusion In these four groups of 70-year-old participants, high drug consumption was associated with lower salivary flow. Unstimulated secretion was only affected in women and then, when taking four or more drugs. Pronounced hyposalivation was, however, uncommon. Cardiovascular drugs, antidepressants and antipsychotics were associated with low salivary secretion. In this age group, the frequently observed association between polypharmacy and a lower saliva secretion rate represents a risk of impaired dental health.
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| 7. |
- Olsson, Annakarin, 1969-, et al.
(författare)
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Effects of tracking technology on daily life of persons with dementia : three experimental single-case studies
- 2015
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Ingår i: American Journal of Alzheimer’s Disease and Other Dementia. - : SAGE Publications. - 1533-3175 .- 1938-2731. ; 30:1, s. 29-40
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the effects of using tracking technology on independent outdoor activities and psychological well-being in 3 persons with dementia (PwDs) and their spouses.Methods: Three experimental single-case studies with an A1B1A2B2 design. The intervention entailed access to a passive positioning alarm and technical support. Continual daily measures of independent outdoor activities among PwDs' and spouses' worries about these activities were made during all phases.Results: Access to a tracking technology consistently increased the independent outdoor activities of 2 PwDs. One of the spouses consistently reported decreased worry during B phases, another's worry decreased only in B2, and the third showed little variability in worrying across all phases.Conclusion: Tracking technology may support PwDs to engage in independent outdoor activities and decrease spouses' worries; however, randomized controlled group studies are needed to investigate whether these results can be replicated on a group level.
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| 8. |
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| 9. |
- Dahl Aslan, Anna K., et al.
(författare)
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Cognitive consequences of overweight and obesity in the ninth decade of life?
- 2015
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Ingår i: Age and Ageing. - : Oxford University Press. - 0002-0729 .- 1468-2834. ; 44:1, s. 59-65
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/OBJECTIVES: the association between late-life obesity and late-life cognitive abilities is poorly understood. We studied the association between body mass index (BMI) and cognitive change in longitudinal population-based study spanning over the ninth decade of life.SUBJECTS/METHODS: in total, 475 participants free of dementia at baseline from the Lothian Birth Cohort 1921 (mean age: 79.1 years, SD: 0.6) were included. Height and weight were assessed at baseline. BMI was calculated as kg/m(2). Cognitive abilities were assessed at age ∼11 years and at age ∼79, ∼83, ∼87 and ∼90 years.RESULTS: latent growth models showed that men being overweight and obese had a 0.65 (SD: 0.3) and 1.10 (SD: 0.5) points less steep decline in general cognitive ability (as measured by the Moray House Test) for each year than people of normal weight. These associations were to some extent confounded by childhood intelligence. No other association between BMI and cognition was significant, either for men or women. People who were obese in old age had significantly lower childhood intelligence (m = 43.6, SD: 1.3) than people who were normal in weight (m = 47.0, SD: 0.8) and persons being overweight (m = 47.5, SD: 0.8), F (472, 3) = 3.2, P = 0.043.CONCLUSIONS: the current study shows weak or no evidence for an association between BMI in old age and cognitive function, especially not when childhood intelligence is controlled for. Lower intelligence at the age of 11 years predicted obesity at the age of 79 years.
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| 10. |
- Ekdahl, A. W., et al.
(författare)
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Frailty and comprehensive geriatric assessment organized as CGA-ward or CGA-consult for older adult patients in the acute care setting : a systematic review and meta-analysis
- 2015
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Ingår i: European Geriatric Medicine. - : Elsevier. - 1878-7649 .- 1878-7657. ; 6:6, s. 523-540
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Forskningsöversikt (refereegranskat)abstract
- Background: With worldwide population aging, increasing numbers of people need hospital care. Evidence suggests comprehensive geriatric assessment (CGA) is superior to usual care.Objective: To summarize the evidence for the effects of CGA in frail and moderately frail patients compared with usual care in acute care settings.Data sources: CINAHL, PsycInfo, Cochrane Library, EMBASE, and PubMed were searched in October 2011, January 2013, and February 2015.Study eligibility: Randomized controlled trials.Participants: Older adults aged ≥ 65 years who were admitted to hospital with a complex condition, divided into frail and moderately frail groups.Intervention: CGA.Control: Usual care.Outcomes: Change in housing, personal activities of daily living (PADL), instrumental activities of daily living (IADL), readmission, cognitive function, depression, quality-of-life care-giver burden, and mortality.Study appraisal and synthesis: The grading of recommendations assessment development and evaluation (GRADE) system to assess the quality of evidence and PRISMA-guidelines for meta-analyses and reviews. Continuous data were presented as standardized mean differences and dichotomous data were presented as risk differences.Results: Twenty-nine articles based on 17 unique studies (6005 patients in total). CGA was categorized as CGA-ward or CGA-consult. In the frail group, CGA-ward was superior to usual care for change in housing, PADL, and depression. CGA-consult was superior to usual care for PADL and IADL in the moderately frail group.Conclusion: There was a stronger effect for frail older adults and CGA-ward compared with usual care. This highlights the importance of detecting frailty. However, the degree of evidence was limited.
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