| 1. |
- Jönsson, Linus, et al.
(författare)
-
Second International Pharmacoeconomic Conference on Alzheimer's Disease
- 2000
-
Ingår i: Alzheimer disease and associated disorders. - : Ovid Technologies (Wolters Kluwer Health). - 1546-4156 .- 0893-0341. ; 14:3, s. 137-140
-
Tidskriftsartikel (refereegranskat)abstract
- The Second International Pharmacoeconomic Conference on Alzheimer's Disease was held in Stockholm, Sweden, on April 4, 2000. The presentations focused on the role of cognition in pharmacoeconomic evaluations, the costs and consequences of behavioral disturbances, quality of life, disease progression models, and methods for valuing informal care. The results from individual studies will be published separately. Cognition has been used as the sole measure of disease severity in economic evaluations in dementia. However, behavioral disturbances are an important determinant of both cost and quality of life and should also be considered when appraising the effect of treatment. Quality-of-life assessment constitutes a single measure of the total impact of the disease, as well as a way of quantifying the benefits of treatment with antidementia drugs so that they can be compared with interventions in other disease areas. Measuring the quality of life of patients with dementia is associated with methodologic difficulties related to the difficulties for some patients in completing usual assessment processes. Disease progression models may be helpful in extrapolating the results from clinical trials to longer time periods and more representative populations. Modeling is an unavoidable part of the economic evaluation of antidementia drugs, and efforts should be made to increase transparency and comparability among models. Informal care constitutes a large percentage of the total care for patients with dementia, and the valuation of these services has a large impact on the results of pharmacoeconomic evaluations. Difficulties lie in quantifying the time spent on caring for the elderly and in attaching the correct price to each unit of time. The contingent valuation method is an alternative way of valuing informal care that so far has not been used in the field of dementia.
|
|
| 2. |
|
|
| 3. |
- Agüero-Torres, Hedda, et al.
(författare)
-
Disability in activities of daily living among the elderly
- 2001
-
Ingår i: Current Opinion in Psychiatry. - 0951-7367 .- 1473-6578. ; 14:4, s. 355-359
-
Tidskriftsartikel (refereegranskat)abstract
- The rise in number and proportion of older people, and the functional disability that is associated with increasing age, generate concern regarding the societal consequences of a large number of disabled elderly persons. Therefore, measuring disability in terms of activities of daily living has become routine in surveys of older people in most studies on ageing. Despite methodological obstacles, research into functional ability in the elderly has progressed during the past few decades. A high prevalence of functional disability in the elderly is consistently reported, although considerable variation has been found among studies. In contrast to functionally independent elderly, disabled elderly have been found to make increased use of home help services, and have higher institutionalization rates and premature mortality. Factors that are consistently reported as being associated with increased functional disability are older age, female sex, lower educational level, lack of exercise, chronic disease and impaired cognition. Among the chronic diseases, dementia is a progressive and disabling condition that accounts for a large proportion of the disability in elderly populations. A combination of various strategies must be employed in the approach to reduction of disability in the elderly population. More research is needed to gain a better understanding of risk and protective factors, so that we will be able to detect persons at early stages of disability, and to plan for services or rehabilitation for severely disabled persons.
|
|
| 4. |
- Agüero-Torres, Hedda, et al.
(författare)
-
Institutionalization in the elderly : The role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study
- 2001
-
Ingår i: Journal of Clinical Epidemiology. - : Elsevier. - 0895-4356 .- 1878-5921. ; 54:8, s. 795-801
-
Tidskriftsartikel (refereegranskat)abstract
- A population-based study of 1810 persons, aged 75+, was investigated to evaluate the role of dementia and other chronic diseases as determinants of institutionalization in the elderly. The study population was examined at baseline and after a 3-year interval. After adjustment for sociodemographic characteristics, functional dependence, dementia, cerebrovascular disease and hip fracture were associated with living in an institution at baseline. Additionally, functional dependence, hip fracture and dementia were also associated with moving to an institution during the 3-year follow-up. In a similar analysis, including only nondemented subjects, the Mini-Mental State Examination emerged as one of the strongest determinants. The population attributable risk percentage of institutionalization during the 3-year follow-up due to dementia was 61%. This study confirms that dementia and cognitive impairment are the main contributors to institutionalization in the elderly, independently of their sociodemographic status, social network, or functional status.
|
|
| 5. |
- Fagerberg, Ingegerd, et al.
(författare)
-
Influencing aspects in nursing education on Swedish nursing students' choice of first work area as graduated nurses
- 2000
-
Ingår i: Journal of Nursing Education. - : SLACK, Inc.. - 0148-4834 .- 1938-2421 .- 0022-3158. ; 39:5, s. 211-218
-
Tidskriftsartikel (refereegranskat)abstract
- It is difficult to recruit RNs to positions in various areas of elder care. The aim of this study is to understand the meaning of Swedish nursing students' reasoning during education about where in the health care system they would like to work as RNs after graduation. The students were interviewed using the same guide at the end of each of their three academic years. In the second and the third year the students kept diaries about their clinical education. A phenomenological-hermeneutic method of analysis was used, and eight themes appeared vital for the students' choice of work area after graduation. The deeper interpretations of the results imply that the students received contradictory messages during the education in elder care. Students found that nurses working in this field were often isolated with no apparent support system, which in turn reinforced their own ambivalence and reluctance towards future work in elder care.
|
|
| 6. |
- Fratiglioni, Laura, et al.
(författare)
-
Åldrandets epidemiologi med fokus på fysisk och mental funktionsförmåga
- 2001
-
Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 98:6, s. 552-558
-
Tidskriftsartikel (refereegranskat)abstract
- In the past decades, the »graying« of the population has emerged as a world-wide phenomenon, leading to an increased interest in research on aging. Many population-based studies have been initiated in several countries, such as the Kungsholmen Project in Stockholm, Sweden. These studies have shown that older adults can be recruited to participate in intensive physiological and clinical evaluations, and that longitudinal surveys are well accepted by the elderly. Comorbidity and physical and mental functioning have emerged as important variables for describing health status and identifying risk factors. Dementia arose as one of the most common diseases in the very old, as dementia prevalence nearly doubles every fifth year. Some risk factors for Alzheimer’s disease have been identified and interesting working hypotheses have been suggested. The natural history of the dementias have been sufficiently outlined for allocating medical and social resources, and for counseling patients and relatives.
|
|
| 7. |
- Giron, Maria Stella T, et al.
(författare)
-
Psychotropic drug use in elderly people with and without dementia
- 2001
-
Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 16:9, s. 900-906
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo determine the prevalence of psychotropic drug use in very old persons with and without dementia in two time periods, and describe the patterns of psychotropic drug use between institutions and non-institutions.MethodsDescriptive analysis on a sample of subjects aged 81+ from a population-based study in Stockholm, Sweden. Psychotropic drug use data were collected from the 1987-1989 and 1994-1996 periods of the study. The diagnosis of dementia was based on the DSM III-R.ResultsAbout 41% of the subjects used at least one psychotropic drug in both periods. Women and subjects in institutions more commonly used psychotropic drugs. The most commonly reported were, in rank order, hypnotics-sedatives, anxiolytics, antipsychotics and antidepressants. Hypnotics-sedatives and anxiolytics were the most commonly used in both institutions and non-institutions. More persons with dementia used psychotropic drugs in both periods. The use of newer drugs, for example, SSRI, was evident. Multivariate analyses showed increased risk for psychotropic drug use among subjects in institutions.ConclusionsThis study confirms the high rate of psychotropic drug use in the very old, particularly in persons with dementia. Psychotropic drug use was high among subjects living in institutions.
|
|
| 8. |
- Giron, Maria Stella T, et al.
(författare)
-
Sleep problems in a very old population : drug use and clinical correlates
- 2002
-
Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - 1079-5006 .- 1758-535X. ; 57:4, s. M236-40
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Complaints of disturbed or dissatisfied sleep are common among older people. This study aimed to evaluate the prevalence of sleep problems in very old persons and its relation to physical and mental health and drug use. Methods. This is a cross-sectional analysis of sleep problems in a population of old persons living in Stockholm, Sweden. There were 641 subjects aged 81+ years; 77.8% were women, 91.4% were noninstitutionalized, and 68.6% lived alone. All persons underwent a comprehensive medical and psychiatric interview and examination. Sleep problems were assessed using the Clinical Psychopathological Rating Scale (CPRS). Covariates included chronic medical conditions, depression, dementia, pain, self-rated health, activities of daily living, use of hypnotics-sedatives, use of other psychotropic drugs, and use of nonpsychotropic drugs. Results. More than one third of subjects were identified with sleep problems. They were more common among women and persons using a higher number of drugs. Poor self-rated health, depression, and pain were related to the presence of sleep problems. Among persons with sleep problems and depression, only 19.2% used antidepressants, and 46.2% used hypnotics-sedatives. Among persons with sleep problems and pain, 63.2% used analgesics, and 47.0% used hypnotics-sedatives. One or more chronic diseases, use of hypnotics-sedatives, use of other psychotropic drugs, and use of nonpsychotropic drugs were also related to sleep problems. After multivariate analysis, factors significantly related to sleep problems were female gender, depression, pain, and hypnotic-sedative use. Conclusions. Sleep problems were common in this very old population. These results suggest the importance of carefully assessing an older person's complaints to accurately diagnose and effectively treat sleep problems.
|
|
| 9. |
- Giron, Maria Stella T, et al.
(författare)
-
The appropriateness of drug use in an older nondemented and demented population
- 2001
-
Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 49:3, s. 277-83
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the extent of inappropriateness of drug use in an older nondemented and demented population. DESIGN: Descriptive analysis based on data from a sample of older subjects age 81 years and older. Data were collected from the second follow-up conducted in 1994–1996. SETTING: A population-based study of the Kungsholmen project in Stockholm, Sweden. PARTICIPANTS: Drug information was obtained from 681 subjects with a mean age of 86.9 years. The subjects were predominantly women (78%). Thirteen percent resided in institutions and 27.6% were diagnosed with dementia. MEASUREMENTS: Dementia diagnosis based on DSM III-R. Criteria for inappropriateness of drug use: use of drugs with potent anticholinergic properties, drug duplication, potential drug-drug and drug-disease interactions, and inappropriate drug dosage. RESULTS: The mean number of drugs used was 4.6: 4.5 drugs for nondemented and 4.8 for demented subjects. Nondemented subjects more commonly used cardiovascular-system drugs and demented subjects used nervous-system drugs. Demented subjects were more commonly exposed to drug duplication and to drugs with potent anticholinergic properties, both involving the use of psychotropic drugs. Nondemented subjects were more commonly exposed to potential drug-disease interactions, mostly with the use of cardiovascular drugs. The most common drug combination leading to a potential interaction was the use of digoxin with furosemide, occurring more frequently among nondemented subjects. The most common drug-disease interaction was the use of beta-blockers and calcium antagonists in subjects with congestive heart failure. The doses of drugs taken by both nondemented and demented subjects were mostly lower than the defined daily dose. CONCLUSION: There was substantial exposure to presumptive inappropriateness of drug use in this very old nondemented and demented population. The exposure of demented subjects to psychotropic drugs and nondemented subjects to cardiovascular drugs reflect the high frequency of prescribing these drugs in this population.
|
|
| 10. |
- Hillerås, Pernilla, et al.
(författare)
-
Factors influencing well-being in the elderly
- 2001
-
Ingår i: Current Opinion in Psychiatry. - 0951-7367 .- 1473-6578. ; 14:4, s. 361-365
-
Tidskriftsartikel (refereegranskat)abstract
- One of the aims of research on well-being is to discover the factors that either increase or decrease well-being, in both young and old people. Many factors have been studied in relation to well-being, but only some have been found to be associated with it. These factors are demographic (age, sex, culture, marital status), social (socioeconomic status, having children, religion, social contacts) or are related to personality, life events, health, and activities. However, some of these factors have a stronger association than others. This article gives a brief review of this research with special focus on the elderly.
|
|
