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  • 1.
    Akner, Gunnar
    Örebro University Hospital.
    Bräcklighet och multisjuklighet: nödvändigt att flytta fokus från handläggning av isolerade sjukdomar till multipla hälsoproblem inom en individualiserad, integrerad och målstyrd process över tid2012In: Svensk Geriatrik, ISSN 2001-2047, Vol. 1, no 1, p. 7-12Article in journal (Other academic)
  • 2.
    Akner, Gunnar
    Örebro University.
    Frailty and multimorbidity in elderly people: a shift in management approach2013In: Clinical Geriatrics, ISSN 1095-1598, Vol. 21, no 9Article in journal (Refereed)
    Abstract [en]

    Frailty and multimorbidity may be regarded as a homeostatic failure of a complex system, and these conditions are commonly encountered in elderly people. The concept of “frailty” has been used to describe an individual’s biological age, and the concept of “multimorbidity” is reserved for the simultaneous presence of two or more chronic health problems in one person. As frailty and multimorbidity are being better understood, optimal management of frail, multimorbid elderly patients is being re-evaluated. In this article, the author provides an overview of frailty, chronic disease, and multimorbidity, and describes how their optimal management can serve as a foundation for developing more expedient, organized, and goal-oriented care of elderly people with complex health problems. The author also describes important challenges for future research and development regarding the management of complex health issues in elderly people; these include transitioning from single disease management to multiple disease management, and expanding the conventional organ-based work-up and treatment plan with repeated evaluations of different systems and functional domains using the comprehensive geriatric assessment method. As noted, one particular challenge that must be addressed is the development of medical records that can serve as a much-needed “geroscope,” enabling an overview of the patient’s health situation, disease management, and follow-up care.

  • 3.
    Akner, Gunnar
    Örebro University.
    International Perspectives in Geriatric Care: Geriatric Care in Sweden2014In: Current Diagnosis & Treatment: Geriatrics / [ed] Brie A. Williams, Anna Chang, Cyrus Ahalt, Helen Chen, Rebecca Conant, C. Seth Landefeld, Christine Richie, Michi Yukawa, McGraw-Hill, 2014, p. 539-542Chapter in book (Refereed)
  • 4.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Karolinska Institutet.
    Kvarboendeprincipen2016In: Svensk Geriatrik, ISSN 2001-2047, no 2, p. 6-6Article in journal (Other academic)
  • 5.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Multidomän-analys av multisjuka äldre personer måste baseras på sedvanlig klinisk analys och får inte ersättas av skattningsskalor.2017In: Svensk Geriatrik, ISSN 2001-2047, no 2, p. 6-Article in journal (Other academic)
  • 6.
    Akner, Gunnar
    Örebro University.
    Multimorbidity in elderly: analysis, management and proposal of a geriatric care center2011 (ed. 1)Book (Other (popular science, discussion, etc.))
  • 7.
    Akner, Gunnar
    Örebro University ; Örebro University Hospital.
    Multisjuklighet hos äldre personer2012In: Äldres hälsa: ett sjukgymnastiskt perspektiv / [ed] Elisabeth Rydwik, Lund: Studentlitteratur AB, 2012, 1, p. 367-382Chapter in book (Other academic)
  • 8.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nationella kvalitetsregister – möjligheter och risker.2017In: Svensk Geriatrik, ISSN 2001-2047, no 1, p. 6-6Article in journal (Other academic)
  • 9.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nutrition hos ”sköra”, äldre personer2017In: Svensk Geriatrik, ISSN 2001-2047, no 3, p. 30-35Article in journal (Other academic)
  • 10.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nödvändigt att förbättra förbättringsarbetet kring läkemedel: Back to basics2017In: Svensk Geriatrik, ISSN 2001-2047, no 3, p. 6-6Article in journal (Other academic)
  • 11.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Rapport från framtidens geriatrik och äldrevård2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 43-44, p. 1850-1852Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    I denna rapport från framtiden kan vi visa redan nu, hur man i framtiden – utan nämnvärda svårigheter – lyckades utforma ett integrerat, koordinerat och mänskligt vårdsystem, baserat på kunskapsområdet geriatrik och anpassat för äldre personer med multipla, ofta komplexa, hälsoproblem. Det är påtagligt hur smidigt reformeringen kunde ske när man utgick från de enskilda äldre personerna i stället för från organisation, ekonomi och styrning.

  • 12.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Skattning av risk för undernäringstillstånd.2017In: Svensk Geriatrik, ISSN 2001-2047, no 2, article id 22-23Article in journal (Other academic)
  • 13.
    Akner, Gunnar
    Örebro University.
    Undernutritionstillstånd vid KOL2014In: KOL: Kroniskt obstruktiv lungsjukdom / [ed] Kjell Larsson, Stockholm: Studentlitteratur AB, 2014, 3, p. 497-508Chapter in book (Other academic)
  • 14.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Karolinska Institutet.
    Vad tycker äldre personer om "lämpligt boende" för äldre personer?2016In: Svensk Geriatrik, ISSN 2001-2047, no 1, p. 6-6Article in journal (Other academic)
  • 15.
    Akner, Gunnar
    Örebro University.
    Vilka evidens finns för dagens styrning av äldrevården?2014In: Sjukhusläkaren, ISSN 1651-2715, no 4, p. 34-34Article in journal (Other academic)
  • 16.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Vision för framtidens geriatrik2016In: Svensk Geriatrik, ISSN 2001-2047, no 4, article id 9-13Article in journal (Other academic)
  • 17.
    Akner, Gunnar
    Örebro University.
    Äldrevården måste bli mer proaktiv och personinriktad2014In: Sjukhusläkaren, ISSN 1651-2715, no 6, p. 17-17Article in journal (Other (popular science, discussion, etc.))
  • 18.
    Akner, Gunnar
    et al.
    Örebro University ; Karolinska Institutet.
    Boström, Anne-Marie
    Karolinska Institutet.
    Krachler, Benno
    Kalix sjukhus.
    Orrevall, Ylva
    Karolinska University Hospital.
    Rundgren, Åke
    University of Gothenburg.
    Sahlin, Nils-Eric
    Lund University.
    Kosttillägg för undernärda äldre: en systematisk litteraturöversikt2014Report (Other academic)
  • 19.
    Akner, Gunnar
    et al.
    Örebro University Hospital.
    Engelheart, Stina
    Örebro Municipality.
    Inventering av Backagården i Örebro kommun hösten 2010: mat - måltider - hälsotillstånd2011Report (Other academic)
  • 20.
    Akner, Gunnar
    et al.
    Örebro University.
    Gustafson, Yngve
    Umeå University.
    Geriatriken behöver skifta fokus: från sjukdom till person2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 31-32, article id CYICArticle in journal (Other (popular science, discussion, etc.))
  • 21.
    Akner, Gunnar
    et al.
    Örebro University.
    Gustafson, Yngve
    Umeå University.
    Personalized Geriatric Medicine2014In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 5, no 3, p. 145-146Article in journal (Refereed)
  • 22.
    Akner, Gunnar
    et al.
    Örebro University.
    Rothenberg, Elisabet
    Kristianstad University.
    Multisjuka och bräckliga äldre2015In: Mat och hälsa: En klinisk handbok / [ed] Tommy Cederholm, Elisabet Rothenberg, Stockholm: Studentlitteratur AB, 2015, 1, p. 105-108Chapter in book (Other academic)
  • 23.
    Akner, Gunnar
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Rundgren, Åke
    Göteborg Universitet, Göteborg.
    Gustafson, Yngve
    Umeå universitet, Umeå.
    Inrätta ett geriatriskt centrum som utvecklar vården2012In: Dagens medicin, ISSN 1104-7488, no 8, p. 18-19Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Ett geriatriskt centrum skulle fungera som en utvecklingsmotor för att sprida kunskaper och erfarenheter till hela vård-/omsorgssystemet, skriver tre debattörer

  • 24.
    Akner, Gunnar
    et al.
    Örebro University.
    Stina, Engelheart
    Örebro Municipality ; Örebro University.
    Vanligt att kommunalt bistånd till äldre rör nutrition2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 45, article id CHUEArticle in journal (Other academic)
    Abstract [sv]

    För ungefär hälften av de personer över 65 år som hade kommunalt bistånd för vård och omsorginsatser var biståndsbesluten relaterade till mat, måltider eller nutrition. Det visar en punktprevalensstudie i Örebro kommun.

  • 25.
    Anderson, Jenny
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    "JAG ÄR INTE MOGEN FÖR DET ÄNNU": En kvalitativ intervjustudie om äldres tankar kring att vara äldre och att flytta till äldreboende.2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING

     

    Sveriges befolkning blir allt äldre och antalet personer över 80 år ökar. Många vill bo kvar hemma men äldre med stora hjälpbehov flyttar till äldreboende. Syftet med studien var att belysa äldres uppfattningar om att vara äldre och deras syn på äldreboende. Vidare hur de ser på att själva bo på ett äldreboende och deras syn på att diskutera en framtida flytt till äldreboende med anhöriga eller vårdpersonal. Studien genomfördes med en kvalitativ ansats och intervjuer gjordes. Analysen av intervjumaterialet skedde med en kvalitativ manifest innehållsanalys. Resultatet visade att de äldre inte såg sig själva som äldre trots de förändringar åldrandet medfört. De äldre hade både en positiv och negativ syn på äldreboende som de grundade på erfarenheter från två äldreboenden. De ville bo kvar hemma och en flytt till äldreboende var ännu ingen aktuell fråga. Men en anledning till att i framtiden flytta till äldreboende skulle vara att inte längre kunna sköta sin hygien. De flesta informanterna hade inte diskuterat en framtida flytt till äldreboende med någon, men upplevde ändå att deras anhöriga kände till deras vilja. Flera såg det som positivt att bli kontaktade av vården och få information om äldreboende och hemtjänst. Resultatet antyder att det kan vara av vikt att veta hur äldre ser på äldreboende och hur de vill ha det den dagen deras hjälpbehov ökar.

     

     

     

  • 26.
    Brålander, Zara
    et al.
    University of Kalmar, School of Human Sciences.
    Svensson, Åsa
    University of Kalmar, School of Human Sciences.
    Faktorer som främjar respektive hindrar en god interaktion mellan vårdpersonal och personer med demens.: En systematisk litteraturstudie.2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning

     

    Bakgrund: Demenssjukdomar är vanligt förekommande hos äldre, vid 90 års ålder är cirka 50 procent drabbade av demenssjukdomar. Demenssjukdomar leder till beteende- och kommunikations svårigheter, vilket kan försvåra omvårdnadsarbetet och interaktionen mellan vårdpersonal och personer med demens. Syfte: Belysa faktorer som främjar respektive hindrar en god interaktion mellan vårdpersonal och personer med demens. Metod: En systematisk litteraturstudie baserad på tio vetenskapliga artiklar. Resultat: Omvårdnaden av personer med demens påverkas av interaktionen mellan dem och vårdpersonalen. Interaktionen i sin tur påverkas av olika främjande respektive hindrande faktorer. En central faktor var kommunikationens betydelse hos både vårdpersonal och personer med demens. Det framkom att både vårdpersonal och personer med demens kan påverka interaktionen, men det är vårdpersonalen som har det största ansvaret. Slutsats: Med en ökad kunskap om hur främjande respektive hindrande faktorer hos vårdpersonal och hos personer med demens påverkar interaktionen ökar möjligheten att tillgodose patienternas behov och samtidigt få dem att känna sig unika och värdefulla.

  • 27.
    Darreh-Shori, Taher
    et al.
    Karolinska Institutet.
    Vijayaraghavan, Swetha
    Karolinska Institutet.
    Aeinehband, Shahin
    Karolinska University Hospital Solna.
    Piehl, Fredrik
    Karolinska University Hospital Solna.
    Lindblom, Rickard P. F.
    Karolinska University Hospital Solna.
    Nilsson, Bo
    Uppsala University.
    Nilsson Ekdahl, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Uppsala University.
    Långström, Bengt
    Uppsala University;Imperial College, UK;Odense University Hospital, University of Southern Denmark, Denmark.
    Almkvist, Ove
    Karolinska Institutet;Stockholm University.
    Nordberg, Agneta
    Karolinska Institutet;Karolinska University Hospital Huddinge.
    Functional variability in butyrylcholinesterase activity regulates intrathecal cytokine and astroglial biomarker profiles in patients with Alzheimer's disease2013In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 34, no 11, p. 2465-2481Article in journal (Refereed)
    Abstract [en]

    Butyrylcholinesterase (BuChE) activity is associated with activated astrocytes in Alzheimer's disease brain. The BuChE-K variant exhibits 30%-60% reduced acetylcholine (ACh) hydrolyzing capacity. Considering the increasing evidence of an immune-regulatory role of ACh, we investigated if genetic heterogeneity in BuChE affects cerebrospinal fluid (CSF) biomarkers of inflammation and cholinoceptive glial function. Alzheimer's disease patients (n = 179) were BCHE-K-genotyped. Proteomic and enzymatic analyses were performed on CSF and/or plasma. BuChE genotype was linked with differential CSF levels of glial fibrillary acidic protein, S100B, interleukin-1 beta, and tumor necrosis factor (TNF)-alpha. BCHE-K noncarriers displayed 100%-150% higher glial fibrillary acidic protein and 64%-110% higher S100B than BCHE-K carriers, who, in contrast, had 40%-80% higher interleukin-1b and 21%-27% higher TNF-alpha compared with noncarriers. A high level of CSF BuChE enzymatic phenotype also significantly correlated with higher CSF levels of astroglial markers and several factors of the innate complement system, but lower levels of proinflammatory cytokines. These individuals also displayed beneficial paraclinical and clinical findings, such as high cerebral glucose utilization, low beta-amyloid load, and less severe progression of clinical symptoms. In vitro analysis on human astrocytes confirmed the involvement of a regulated BuChE status in the astroglial responses to TNF-alpha and ACh. Histochemical analysis in a rat model of nerve injury-induced neuroinflammation, showed focal assembly of astroglial cells in proximity of BuChE-immunolabeled sites. In conclusion, these results suggest that BuChE enzymatic activity plays an important role in regulating intrinsic inflammation and activity of cholinoceptive glial cells and that this might be of clinical relevance. The dissociation between astroglial markers and inflammatory cytokines indicates that a proper activation and maintenance of astroglial function is a beneficial response, rather than a disease-driving mechanism. Further studies are needed to explore the therapeutic potential of manipulating BuChE activity or astroglial functional status. (C) 2013 Elsevier Inc. All rights reserved.

  • 28.
    Djukanovic, Ingrid
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sorjonen, Kimmo
    Karolinska Institutet.
    Peterson, Ulla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Association between depressive symptoms and age, sex, loneliness and treatment among older people in Sweden2015In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 19, no 6, p. 560-568Article in journal (Refereed)
    Abstract [en]

    Objectives: The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65–80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication.

    Method: A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65–80 years (n = 6659). Chi square tests and logistic regression analyses were conducted.

    Results: The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75–80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits.

    Conclusion: Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.

  • 29.
    Engelheart, Stina
    et al.
    Örebro Municipality.
    Akner, Gunnar
    Örebro University.
    Äldre personers biståndsbeslut för vård och omsorg i Örebro kommun med fokus på mat, måltider och nutrition: Slutrapport februari 20132013Report (Other academic)
    Abstract [sv]

    Enligt vår kännedom är detta den första kartläggningen av omfattningen av en kommuns vård och omsorg om äldre personer (≥ 65 år) ur ett individperspektiv samt av hur stor del av biståndsbesluten som avser mat-, måltids- och nutritionsrelaterade frågor.

    Kommunens terminologi och klassifikation av biståndsbeslut är utformad från ett utförarperspektiv uppdelad av två lagstiftningar, SoL och HSL. Det krävdes ett omfattande manuellt arbete för att strukturera kommunens registrering av besluten så att materialet kunde beskrivas ur de enskilda äldre personernas perspektiv.

    Medelåldern för personer i särskilt boende var 85 år (spridning 65-105 år), där 69 % var kvinnor. Hos personer med vård och omsorg i hemmet var medelåldern 83 år (spridning 65-110 år), och 70 % var kvinnor.

    Knappt 20 % av personer ≥ 65 år i kommunen hade biståndsbeslut för vård och omsorg med i genomsnitt 3,5 (spridning 1-15) av totalt 19 olika specificerade insatser per person. Ungefär hälften av biståndstagarna hade insatser som var/kunde vara relaterade till mat, måltider och nutrition. Antalet biståndsinsatser hade inget samband med ålder.

    Den omfattande andelen kommunala biståndsbeslut som avser nutritionsrelaterade förhållanden måste leda till att dessa frågor inkluderas i den regelbundet upprepade hälsoanalysen av biståndstagarna samt till förbättrad utbildning i nutrition för vårdoch omsorgspersonal.

  • 30. Engelheart, Stina
    et al.
    Grell, Ulf
    SPF Örebro.
    Edlund, Roland
    SPF Örebro.
    Akner, Gunnar
    Örebro University.
    Matlådor till pensionärer i Örebro län: pilotstudie med kartläggning och provsmakning i tolv kommuner2012Report (Other academic)
  • 31.
    Eriksson, Jeanette Källstrand
    et al.
    Halmstad University, Sweden.
    Hildingh, Cathrine
    Halmstad University, Sweden.
    Buer, Nina
    Örebro University, Sweden.
    Thulesius, Hans
    Region Kronoberg, Sweden.
    Seniors' self-preservation by maintaining established self and defying deterioration - A grounded theory.2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, p. 1-9, article id 30265Article in journal (Refereed)
    Abstract [en]

    The purpose of this classic grounded theory study was to understand how seniors who are living independently resolve issues influenced by visual impairment and high fall risk. We interviewed and observed 13 seniors with visual impairment in their homes. We also interviewed six visual instructors with experience from many hundreds of relevant incidents from the same group of seniors. We found that the seniors are resolving their main concern of "remaining themselves as who they used to be" by self-preservation. Within this category, the strategies maintaining the established self and defying deterioration emerged as the most prominent in our data. The theme maintaining the established self is mostly guided by change inertia and includes living the past (retaining past activities, reminiscing, and keeping the home intact) and facading (hiding impairment, leading to avoidance of becoming a burden and to risk juggling). Defying deterioration is a proactive scheme and involves moving (by exercising, adapting activities, using walking aids, driving), adapting (by finding new ways), and networking by sustaining old support networks or finding new networks. Self-preservation is generic human behavior and modifying this theory to other fields may therefore be worthwhile. In addition, health care providers may have use for the theory in fall preventive planning.

  • 32.
    Fager, Emelié
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Estun, Anneli
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Arbete med smärtbedömning i sent palliativt skede: - ett sjuksköterskeperspektiv2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Effective symptom relief and enhanced well-being are indicated as the most important tasks for nurses in the care of patients in late palliative stage. Pain is one of the most common symptoms at the end of life and pain analysis and regular assessment of pain intensity is one of the national quality indicators for good palliative care. Nurses in a geriatric ward care for people with multiple illnesses and high level of caring needs. It is therefore important to investigate how nurses work on pain assessment and pain estimation in late palliative stage in a geriatric ward.

     Aim: The aim of this study is to describe how nurses work with assessing pain in patients in late palliative care. What are the facilitating and aggravating factors affecting this assessment?

     Method: A qualitative design with an inductive approach was chosen where semi-structured interviews were used as a data collection method. Ten nurses working in geriatric wards in central and southern Sweden were interviewed and a qualitative content analysis was used as the analytical method.

     Result: The categories included  "Using the clinical look", "Use of pain estimation tools," "Impact of the workplace culture on pain assessment", "Impact of relatives on pain assessment", "Palliative Register as a pain assessment tool ". All categories highlighted both facilitating and aggravating factors in pain assessment at late palliative stages.

    Conclusion: All nurses in the study described pain assessment in late palliative stage as a difficult area but one which engaged and affected them strongly. The result shows that there are several aggravating factors for pain assessment at this stage. Older patients with comorbidity, cognitive failure and inability to express their pain verbally, are clearly challenges within pain assessment in late palliative care. In the study results, the clinical gaze and the Palliative Register appear as tools that facilitated the nurses' work on pain assessment.

     

     

    Keywords: Pain assessment, Palliative care, Geriatric care, Clinical gaze, Nursing care

  • 33.
    Heikkilä, Kristiina
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Sarvimäki, Anneli
    Ekman, Sirkka-Liisa
    Culturally congruent care for older people: Finnish care in Sweden2007In: Scandinavian Journal of Caring Science, Vol. 21, p. 354-361Article in journal (Refereed)
    Abstract [en]

    An increasing number of older people belong to minority and immigrant groups. This calls for new models on the subject of how to provide culturally adjusted care for these populations. The aim of this study is to describe how culturally congruency is used in care for older Finnish immigrants in order to promote their well-being. The study was conducted with an ethnographic design, based on participant observations and interviews among residents, staff and visitors in the Finnish Home in Sweden. In the core of the cultural congruency is the use of the Finnish language, and the fact that both residents and staff have Finnish backgrounds. In addition to this, Finnish customs and celebrations, popular culture and topics of discussion, are actively used in order to create a common ground for communication and shared understanding of the individual person. Cultural congruency, based on the residents' mother language, shared athnic background with staff, and shared customs creates a common ground for communication and an understanding. This enables caring relationships, which, in turn, increases the residents' well-being.

  • 34.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Trends in Inappropriate Drug Therapy Prescription in the Elderly in Sweden from 2006 to 2013: Assessment Using National Indicators2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 5, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the document "Indicators of appropriate drug therapy in the elderly" as a guideline for improving prescribing for the elderly. Objective The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indicators for drug treatment. Methods Individual-based data on dispensed prescription drugs for the entire Swedish population aged >= 65 years during eight 3-month periods from 2006 to 2013 were accumulated. The data were extracted from the Swedish Prescribed Drug Register. Eight drug-specific quality indicators were monitored. Results For the entire population studied (n = 1,828,283 in 2013), six of the eight indicators showed an improvement according to the guidelines; the remaining two indicators (drugs with anticholinergic effects and excessive polypharmacy) remained relatively unchanged. For the subgroup aged 65-74 years, three indicators showed an improvement, four indicators remained relatively unchanged (e.g. propiomazine, and oxazepam) and one showed an undesirable trend (anticholinergic drugs) according to guidelines. For the older group (aged >= 75 years), all indicators except excessive polypharmacy showed improvement. Conclusion According to the quality indicators used, the extent of inappropriate drug therapy in the elderly decreased from 2006 to 2013 in Sweden. Thus, prescribers appear to be more likely to change their prescribing patterns for the elderly than previously assumed.

  • 35.
    Håkansson, Krister
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska institutet.
    Ngandu, Tiia
    National Institute for Health and Welfare, Finland.
    Kivipelto, Miia
    Karolinska Institutet;University of Eastern Finland, Finland.
    The Patient with Cognitive Impairment2018In: Treatable and Potentially Preventable Dementias / [ed] Hachinsky, Vladimir, New York: Cambridge University Press, 2018, p. 52-80Chapter in book (Refereed)
  • 36.
    Kirsebom, Marie
    et al.
    Uppsala University.
    Hedström, Mariann
    Uppsala University.
    Wadensten, Barbro
    Uppsala University.
    Pöder, Ulrika
    Uppsala University.
    The frequency of and reasons for acute hospital transfers of older nursing home residents2013In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, no 1, p. 115-120Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. Structured reviews of the electronic healthcare records were performed. Included were residents living in a nursing home age 65+, with healthcare records including documented transfers to the ED during a 9-month period in 2010. The transfer rate to the ED was 594 among a total of 431 residents (M = 1.37 each). 63% resulted in hospitalization (M = 7.12 days). Nursing home's transfer rate differed between 0.00 and 1.03 transfers/ bed and was higher for the private for-profit providers than for public/private non-profit providers. One- fourth of the transfers were caused by falls and/or injuries, including fractures. The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored.

     

  • 37.
    Kivipelto, Miia
    et al.
    Karolinska Institutet ; Karolinska University Hospital ; University of Eastern Finland, Finland.
    Håkansson, Krister
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    A Rare Success against Alzheimer's2017In: Scientific American, ISSN 0036-8733, E-ISSN 1946-7087, Vol. 316, no 4, p. 32-37Article in journal (Other academic)
    Abstract [en]
    • Two hundred experimental drugs intended to treat Alzheimer's disease have failed in the past 30 years. Without new therapies, the number of patients worldwide will increase dramatically by 2050.
    • A ray of hope has come recently from a clinical trial that showed that dementia's cognitive impairment might be prevented by paying close attention to various health factors.
    • Participants in the study who followed a regimen of health-related steps registered improvements on cognitive measures such as memory and mental-processing speed.
    • Results of this research suffice for health care professionals to begin making a series of recommendations to patients on diet, exercise and levels of social engagement that may help prevent dementia.
  • 38.
    Lammes, Eva
    et al.
    Karolinska University Hospital.
    Rydwik, Elisabeth
    Karolinska Institutet.
    Akner, Gunnar
    Örebro University Hospital.
    Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly: a randomised controlled pilot study2012In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 16, no 2, p. 162-167Article in journal (Refereed)
    Abstract [en]

    Objectives: To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RmR) and body composition in the frail elderly.

    Design: Open, randomised, controlled pilot treatment study.

    Setting: Community-based research centre. Participants: ninety-six community-dwelling frail elderly people aged 75 and older, 40% men.

    Intervention: Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 x 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group. 

    Measurements: The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months’ intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals).

    Results: The training group showed a significantly increased RmR at 3 months. Otherwise, there were no observed differences within or between the four groups.There was no correlation over time between energy intake, RmR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study (‘responders’) had a statistically significantly lower Bmi (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the ‘non-responders.’The ‘non-responders’ showed a small but statistically significant decrease in body fat percentage at F1, and inbody weight, Bmi and FFm at 9 months (F3).

    Conclusion: individual nutrition counselling and physical exercise had no effect on energy intake, RmR or fat free mass in community-dwelling frail elderly people aged 75 and older. interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.

  • 39.
    Petrazzuoli, Ferdinando
    et al.
    SNAMID Natl Soc Med Educ Gen Practice, Italy;Lund University, Sweden.
    Palmqvist, Sebastian
    Lund University, Sweden.
    Thulesius, Hans
    Lund University, Sweden.
    Buono, Nicola
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Pirrotta, Enzo
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Cuffari, Alfredo
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Cambielli, Marco
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    D'Urso, Maurizio
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Farinaro, Carmine
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Chiumeo, Francesco
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Marsala, Valerio
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Wiig, Elisabeth H.
    Boston Univ, USA.
    A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years2014In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 26, no 9, p. 1493-1500Article in journal (Refereed)
    Abstract [en]

    Background: A Quick Test of Cognitive Speed (AQT) is a brief test that can identify cognitive impairment. AQT has been validated in Arabic, English, Greek, Japanese, Norwegian, Spanish, and Swedish. The aim of this study was to develop Italian criterion-referenced norms for AQT. Methods: AQT consists of three test plates where the patient shall rapidly name (1) the color of 40 blue, red, yellow, or black squares (AQT color), (2) the form of 40 black figures (circles, squares, triangles, or rectangles; AQT form), (3) the color and form of 40 figures (consisting of previous colors and forms; AQT color-form). The AQT test was administered to 121 Italian cognitively healthy primary care patients (age range: 45-90 years). Their mean Mini-Mental State Examination (MMSE) score was 28.8 +/- 0.9 points (range 26-30 points). AQT naming times in seconds were used for developing preliminary criterion cut-off times for different age groups. Results: Age was found to have a significant moderate positive correlation with AQT naming times color (r = 0.65, p < 0.001), form (r = 0.53, p < 0.001), color-form (r = 0.63, p < 0.001) and a moderate negative correlation with MMSE score (r = -0.44, p < 0.001) and AQT naming times differed significantly between younger (45-55 years old), older (56-70 years old), and the oldest (71-90 years old) participants. Years of education correlated positively but weakly with MMSE score (r = 0.27, p = 0.003) and negatively but weakly with AQT color (r = -0.16, p = ns), form (r = -0.24, p = 0.007), and color-form (r = -0.19, p = 0.005). We established preliminary cut-off times for the AQT test based on +1 and +2 standard deviations according to the approach in other languages and settings. Conclusions: This is the first Italian normative AQT study. Future studies of AQT - a test useful for dementia screening in primary care - will eventually refine cut-off times for normality balancing sensitivity and specificity in cognitive diagnostics.

  • 40.
    Petrazzuoli, Ferdinando
    et al.
    Lund University, Sweden..
    Vinker, Shlomo
    Tel Aviv Univ, Israel.
    Koskela, Tuomas H.
    Univ Tampere, Finland.
    Frese, Thomas
    Martin Luther Univ Halle Wittenberg, Germany.
    Buono, Nicola
    SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Soler, Jean Karl
    Mediterranean Inst Primary Care, Malta.
    Ahrensberg, Jette
    Univ Aarhus, Res Unit Gen Practice, Denmark.
    Asenova, Radost
    Med Univ Plovdiv, Bulgaria.
    Boreu, Quinti Foguet
    Univ Autonoma Barcelona, Spain.
    Peker, Gulsen Ceyhun
    Ankara Univ, Turkey.
    Collins, Claire
    Irish Coll Gen Practitioners, Ireland.
    Hanzevacki, Miro
    Hlth Care Ctr Zagreb, Croatia.
    Hoffmann, Kathryn
    Med Univ Vienna, Austria.
    Iftode, Claudia
    Timis Soc Family Med, Romania.
    Kurpas, Donata
    Wroclaw Med Univ, Poland.
    Le Reste, Jean Yves
    Univ Bretagne Occidentale, France.
    Lichtwarck, Bjorn
    Innlandet Hosp Trust, Norway.
    Petek, Davorina
    Univ Ljubljana, Slovenia.
    Pinto, Daniel
    NOVA Med Sch, Portugal.
    Schrans, Diego
    Univ Ghent, Belgium.
    Streit, Sven
    Univ Bern, Switzerland.
    Tang, Eugene Yee Hing
    Newcastle Univ, UK.
    Tatsioni, Athina
    Univ Ioannina, Greece.
    Torzsa, Peter
    Semmelweis Univ, Hungary.
    Unalan, Pemra C.
    Marmara Univ, Turkey.
    van Marwijk, Harm
    Univ Manchester, UK.
    Thulesius, Hans
    Lund University, Sweden.
    Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries2017In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 29, no 9, p. 1413-1423Article in journal (Refereed)
    Abstract [en]

    Background: Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. Methods: Key informant survey. Setting: Primary care practices across 25 European countries. Subjects: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Main outcome measures: Two by two contingency tables with odds ratios and 95% confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of trying to establish a diagnosis of dementia on their own. Results: Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95% CI 2.28-5.23). Conclusions: Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe.

  • 41.
    Selan, Suzana
    et al.
    Blekinge Institute of Technology;Lund University.
    Siennicki-Lantz, Arkadiusz
    Malmö University Hospital.
    Berglund, Johan
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Self-awareness of heart failure in the oldest old-an observational study of participants, ≥ 80 years old, with an objectively verified heart failure2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, p. 1-8, article id 23Article in journal (Refereed)
    Abstract [en]

    Background

    One of the primary reasons for hospitalisation among elderly individuals with heart failure (HF) is poor self-care. Self-awareness of having HF may be a key-element in successful self-care. The prevalence of self-awareness of HF, and how it is affected by age-and HF-related factors, remains poorly understood. The aims of the present study were to determine the prevalence of self-awareness of HF in participants, ≥ 80 years of age, and to investigate the association between this self-awareness and age-related and HF-related factors.

    Methods

    A single-centre observational study was conducted in which non-hospitalised participants (80+) with objectively verified HF were identified (n = 90). The statement of having HF or not having HF was used to divide the participants into two groups for comparisons: aware or unaware of one’s own HF. Logistic regression models were completed to determine the impact of age-and HF-related factors on self-awareness.

    Results

    Twenty-six percent (23/90) were aware of their own HF diagnosis. No significant differences were found between the participants who were aware of their own HF diagnosis and the participants who were not. Neither age-nor HF-related factors had influence on the prevalence of self-awareness.

    Conclusions

    Prevalence of self-awareness of own HF in the oldest old is insufficient, and this self-awareness may be influenced by external factors. One such factor is likely the manner in which the HF diagnosis is relayed to the patient by health care professionals.

  • 42.
    Senra, Hugo
    et al.
    King's College London, UK.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Nunes, Nuno
    University of Porto, Portugal.
    Balaskas, Konstantinos
    Moorfields Eye Hospital, UK;University College London, UK.
    Aslam, Tariq
    University of Manchester, UK;Manchester Royal Eye Hospital, UK.
    Costa, Emilia
    University of Porto, Portugal.
    Psychological and Psychosocial Interventions for Depression and Anxiety in Patients with Age-Related Macular Degeneration: A Systematic Review2019In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 27, no 8, p. 755-773Article, review/survey (Refereed)
    Abstract [en]

    Purpose To review the current literature on psychosocial and psychological interventions to prevent and treat depression and anxiety in patients with age-related macular degeneration (AMD). Methods We conducted a systematic review of literature evaluating psychosocial and psychological interventions for depression and anxiety in AMD patients. Primary searches of PubMed, Cochrane library, EMBASE, Global Health, Web of Science, EBSCO, and Science Direct were conducted to include all papers published until April 21st. 2018. Results Of a total of 398 citations retrieved, we selected 12 eligible studies published between 2002 and 2016. We found 9 randomized controlled trials (RCT), and 3 non-randomised intervention (NRI) studies. RCT studies suggested that interventions using group self-management techniques, and individual behavioural activation plus low vision rehabilitation can be effective to treat and prevent depression in AMD patients, and one study suggested that a stepped-care intervention using cognitive-behavioural techniques can be effective to manage anxiety and depression over time. NRI studies highlighted a positive effect of self-help and emotion-focused interventions to reduce depression. Conclusions Clinical practice with AMD patients can rely on some tailored cognitive-behavioural therapeutic protocols to improve patients’ mental health, but further clinical trials will generate the necessary evidence-based knowledge to improve those therapeutic techniques and offer additional tailored interventions for AMD patients.

  • 43.
    Stina, Engelheart
    et al.
    Örebro University.
    Akner, Gunnar
    Örebro University.
    Dietary intake of energy, nutrients and water in elderly people living at home or in nursing home2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 3, p. 265-272Article in journal (Refereed)
    Abstract [en]

    Objectives: There is a lack of detailed information on dietary intake in elderly people at an individual level, which is crucial for improvement of nutritional support. The aim of this study was to investigate the dietary intake in elderly people in two types of living situations. 

    Design: Observational study, analysing prospective data.

    Setting: The dietary intake was studied in elderly people living at home or in nursing home, in different cities of Sweden.

    Participants: A total of 264 elderly people (mean age 84) participated in the observational study.

    Measurements: Dietary intake was measured using weighed food records and food diaries, comparing females and males. The observed dietary intake was related to Recommended intake and Lower intake level.

    Results: All dietary intake and patient characteristic variables showed large individual differences (ranges). We found no significant differences (p>0.05) between those living at home and nursing home residents regarding the average intake of energy, protein and water when expressed as total intake per kg of body weight. A very low daily intake of energy (<20 kcal/kg body weight/day) was observed in 16% of the participants. For vitamin D and iron, 19% and 15%, respectively, had intakes below the Lower intake level. There was no correlation between intake of energy, protein or water and resident characteristics such as age, autonomy, morbidity, nutritional state or cognition.

    Conclusions: The large individual differences (ranges) in energy, nutrients and water show that the use of mean values when analysing dietary intake data from elderly people is misleading. From a clinical perspective it is more important to consider the individual intake of energy, nutrients and water. Ageism is intrinsic in the realm of ‘averageology’.

  • 44.
    Tusch, Erich S.
    et al.
    Harvard Med Sch, USA.
    Alperin, Brittany R.
    Oregon Hlth & Sci Univ, USA.
    Ryan, Eliza
    Harvard Med Sch, USA.
    Holcomb, Phillip J.
    Tufts Univ, USA.
    Mohammed, Abdul K. H.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    Daffner, Kirk R.
    Harvard Med Sch, USA.
    Changes in Neural Activity Underlying Working Memory after Computerized Cognitive Training in Older Adults2016In: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 8, article id 255Article in journal (Refereed)
    Abstract [en]

    Computerized cognitive training (CCT) may counter the impact of aging on cognition, but both the efficacy and neurocognitive mechanisms underlying CCT remain controversial. In this study, 35 older individuals were randomly assigned to Cogmed adaptive working memory (WM) CCT or an active control CCT, featuring five weeks of five similar to 40 min sessions per week. Before and after the 5-week intervention, event-related potentials were measured while subjects completed a visual n-back task with three levels of demand (0-back, 1-back, 2-back). The anterior P3a served as an index of directing attention and the posterior P3b as an index of categorizationNVM updating. We hypothesized that adaptive CCT would be associated with decreased P3 amplitude at low WM demand and increased P3 amplitude at high WM demand. The adaptive CCT group exhibited a training-related increase in the amplitude of the anterior P3a and posterior P3b in response to target stimuli across n-back tasks, while subjects in the active control CCT group demonstrated a post-training decrease in the anterior P3a. Performance did not differ between groups or sessions. Larger overall P3 amplitudes were strongly associated with better task performance. Increased post-CCT P3 amplitude correlated with improved task performance; this relationship was especially robust at high task load. Our findings suggest that adaptive WM training was associated with increased orienting of attention, as indexed by the P3a, and the enhancement of categorization/WM updating processes, as indexed by the P3b. Increased P3 amplitude was linked to improved performance; however. there was no direct association between adaptive training and improved performance.

  • 45.
    van De Glind, Esther
    et al.
    Academic Medical Center, The Netherlands.
    Stott, David
    University of Glasgow, UK.
    Hooft, L.
    Academic Medical Center, The Netherlands.
    Akner, Gunnar
    Örebro University.
    De Rooij, S.
    Academic Medical Center, The Netherlands.
    Van Munster, Barbara
    AMC, The Netherlands.
    Evidence-based medicine in geriatrics2012In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 3, no Suppl. 1, p. S14-S15Article in journal (Refereed)
    Abstract [en]

    Session Description/Moderator Details.– Evidence-based medicine in geriatrics Geriatric patients often have multiple chronic conditions, use many medications and may suffer from cognitive and functional impairments. A study about prevalence of morbidities in the elderly showed, that 82% of patients aged 65 and over had at least one chronic condition; 24% had even four or more conditions [1]. Due to deteriorating organ functions they are prone to medication-related side effects [2]. Considering these complex problems, arriving at the best treatment for individual older people is complicated.

  • 46.
    van der Ploeg, Milly A.
    et al.
    Leiden Univ, Netherlands.
    Streit, Sven
    Univ Bern, Switzerland.
    Achterberg, Wilco P.
    Leiden Univ, Netherlands.
    Beers, Erna
    Univ Amsterdam, Netherlands.
    Bohnen, Arthur M.
    Erasmus MC, Netherlands.
    Burman, Robert A.
    Vennesla Primary Hlth Care Ctr, Norway.
    Collins, Claire
    Irish Coll Gen Practitioners, Ireland.
    Franco, Fabio G.
    Hosp Israelita Albert Einstein, Brazil.
    Gerasimovska-Kitanovska, Biljana
    Univ St Cyril & Metodius, Macedonia.
    Gintere, Sandra
    Riga Stradins Univ, Latvia.
    Bravo, Raquel Gomez
    Univ Luxembourg, Luxembourg.
    Hoffmann, Kathryn
    Med Univ Vienna, Austria.
    Iftode, Claudia
    Timis Soc Family Med, Romania.
    Pestic, Sanda Kreitmayer
    Univ Tuzla, Bosnia-Herzegovina.
    Koskela, Tuomas H.
    Univ Tampere, Finland.
    Kurpas, Donata
    Wroclaw Med Univ, Poland.
    Maisonneuve, Hubert
    Univ Geneva, Switzerland.
    Mallen, Christan D.
    Keele Univ, UK.
    Merlo, Christoph
    Inst Primary & Community Care Lucerne IHAM, Switzerland.
    Mueller, Yolanda
    Inst Family Med Lausanne IUMF, Switzerland.
    Muth, Christiane
    Goethe Univ, Germany.
    Petrazzuoli, Ferdinando
    Lund University, Sweden;SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Rodondi, Nicolas
    Univ Bern, Switzerland.
    Rosemann, Thomas
    Univ Zurich, Switzerland.
    Sattler, Martin
    SSLMG, Luxembourg.
    Schermer, Tjard
    Radboud Univ Nijmegen, Netherlands.
    Ster, Marija Petek
    Univ Ljubljana, Slovenia.
    Svadlenkova, Zuzana
    Ordinace Repy Sro, Czech Republic.
    Tatsioni, Athina
    Univ Ioannina, Greece.
    Thulesius, Hans
    Lund University, Sweden;Region Kronoberg, Sweden.
    Tkachenko, Victoria
    Shupyk Natl Med Acad Postgrad Educ, Ukraine.
    Torzsa, Peter
    Semmelweis Univ, Hungary.
    Tsopra, Rosy
    Univ Paris 13, France.
    Tuz, Canan
    Erzincan Univ, Turkey.
    Vaes, Bert
    Univ Leuven KU Leuven, Belgium.
    Viegas, Rita P. A.
    NOVA Med Sch, Portugal.
    Vinker, Shlomo
    Tel Aviv Univ, Israel.
    Wallis, Katharine A.
    Univ Auckland, New Zealand.
    Zeller, Andreas
    Univ Basel, Switzerland.
    Gussekloo, Jacobijn
    Leiden Univ, Netherlands.
    Poortvliet, Rosalinde K. E.
    Leiden Univ, Netherlands.
    Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries2019In: Journal of general internal medicine, ISSN 0884-8734, E-ISSN 1525-1497, Vol. 34, no 9, p. 1751-1757Article in journal (Refereed)
    Abstract [en]

    Background Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners' (GPs) advice to stop statins in oldest-old patients. Objective To investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs' advice to stop statins in oldest-old patients. Design We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment. Main Measures Cases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs' advice to stop. Key Results Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45-47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89-90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6-15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5-1.7) and with frailty (ORadj 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5-56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19-42) to 98% (95% CI 96-99). Conclusions The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs' advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs' advice to stop statins.

  • 47.
    Wanby, Pär
    et al.
    Kalmar County Hospital, Sweden.
    Nobin, R
    Kalmar County Hospital, Sweden.
    Von, S-P
    Kalmar County Hospital, Sweden.
    Brudin, L
    Kalmar County Hospital, Sweden.
    Carlsson, Martin
    Kalmar County Hospital, Sweden.
    Serum levels of the bone turnover markers dickkopf-1, sclerostin, osteoprotegerin, osteopontin, osteocalcin and 25-hydroxyvitamin D in Swedish geriatric patients aged 75 years or older with a fresh hip fracture and in healthy controls.2016In: Journal of Endocrinological Investigation, ISSN 0391-4097, E-ISSN 1720-8386, Vol. 39, no 8, p. 855-863Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Bone turnover markers have a potential clinical use in describing bone remodeling and in predicting fractures.

    AIMS: In an elderly population ≥75 years with a fresh hip fracture, and in healthy controls, investigate bone turnover markers and their relation to each other, to vitamin D status and to bone mineral density (BMD).

    METHODS: In a cross-sectional study serum levels of dickkopf-1 (DKK-1), sclerostin (SOST), osteoprotegerin (OPG), osteopontin (OPN), osteocalcin, 25-hydroxyvitamin D (25(OH)D) were analyzed in 89 Swedish patients with a fresh hip fracture and in 82 healthy volunteers. Serum levels of bone markers were determined by Luminex technique.

    RESULTS: S-25-hydroxyvitamin D (S-25(OH)D) was decreased in patients compared to controls (48 ± 21 vs. 76 ± 25 nmol/L, p < 0.001). SOST, but none of the other bone turnover markers correlated with BMD (r = 0.50, p < 0.001). Compared with controls, higher levels of OPG (488 ± 1.4 vs. 191 ± 1.4 ng/L, p < 0.001), OPN (69 ± 1.7 vs. 19 ± 1.4 µg/L, p < 0.001), DKK-1 (273 ± 1.7 vs. 168 ± 1.7 ng/L, p < 0.001), and lower levels of osteocalcin (5.8 ± 3.5 vs. 9.5 ± 3.6 µg/L, p < 0.001), were found in the fracture group. Levels of OPG, DKK-1 and SOST in both groups were positively associated. S-25(OH)D concentration was not found to be strongly associated with any of the bone markers.

    CONCLUSIONS: In contrast to findings in other studies, we found no strong correlation between 25(OH)D and the investigated bone markers. Both in patients with a fresh hip fracture and in healthy elderly, DKK-1, SOST and OPG appear to be associated. This suggests a relevance in these relationships meriting further investigation.

  • 48. Westerholm, Barbro
    et al.
    Akner, Gunnar
    Örebro University.
    Fastbom, Johan
    Karolinska Institutet.
    Det behövs en nollvision också för säker läkemedelsbehandling2006In: Dagens Medicin, ISSN 1104-7488, p. 21-21Article in journal (Other (popular science, discussion, etc.))
  • 49.
    Wimo, Anders
    et al.
    Karolinska Institutet;Uppsala University;County Council of Gävleborg;HC Bergsjö.
    Elmstål, S.
    Lund University.
    Fratiglioni, L.
    Karolinska Institutet;Stockholm Gerontology Research Center.
    Sjölund, B.-M.
    Karolinska Institutet.
    Sköldunger, A.
    Karolinska Institutet.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Berglund, Johan
    Blekinge Institute of Technology.
    Lagergren, M.
    Stockholm Gerontology Research Center.
    Formal and informal care of community-living older people: a population-based study from the Swedish National study on Aging and Care2017In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 21, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Objectives: Study formal and informal care of community-living older people in the Swedish National study of Aging and Care (SNAC).

    Design: Cross-sectional, population based cohort.

    Setting: Three areas in Sweden: Municipality of Nordanstig, Stockholm and Skåne County.

    Participants: 3,338 persons ≥72 years.

    Measurements: Patterns and amounts of informal and formal care by cognition and area of residence.

    Results: 73% received no care; 14% formal care; and 17% informal care (7% received both). In the whole study population, including those who used no care, individuals in small municipalities received 9.6 hours of informal care/month; in mid-size municipalities, 6.6; and in urban areas, 5.6. Users of informal care received 33.1 hours of informal care/month in small municipalities, 54.6 in mid-size municipalities and 36.1 in urban areas. Individuals with cognitive impairment received 14.1 hours of informal care/month, 2.7 times more than people with no/slight impairment. In the whole study population, individuals in small municipalities received an average of 3.2 hours of formal care/month; in mid-size municipalities 1.4; and in urban areas, 2.6. Corresponding figures for formal care users were 29.4 hours in small municipalities, 13.6 in mid-size municipalities and 16.7 in urban areas. Formal care users received 7.1 hours, and informal care users, 5.9 hours for each hour/month received by people in the study population as a whole.

    Conclusions: More informal than formal care was provided. Informal care is more frequent in small municipalities than urban areas and for those with than without cognitive impairment. The relationship between data on the whole population and the data on users or care indicates that population-based data are needed to avoid overestimates of care.

  • 50.
    Winger, Anette
    et al.
    Oslo and Akershus University College of Applied Sciences, Norway.
    Kvarstein, Gunnvald
    UIT The Arctic University of Norway, Norway.
    Wyller, Vegard Bruun
    University of Oslo, Norway;Oslo University Hospital, Norway;Akershus University Hospital, Norway.
    Ekstedt, Mirjam
    KTH Royal Institute of Technology;Oslo University Hospital, Norway.
    Sulheim, Dag
    Oslo University Hospital, Norway;Innlandet Hospital Trust, Norway.
    Fagermoen, Even
    University of Oslo, Norway.
    Smastuen, Milada Cvancarova
    Oslo and Akershus University College of Applied Sciences, Norway.
    Helseth, Solvi
    Oslo and Akershus University College of Applied Sciences, Norway.
    Health related quality of life in adolescents with chronic fatigue syndrome: a cross-sectional study2015In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 13, article id 96Article in journal (Refereed)
    Abstract [en]

    Aim: To study health related quality of life (HRQOL) and depressive symptoms in adolescents with chronic fatigue syndrome (CFS) and to investigate in which domains their HRQOL and depressive symptoms differ from those of healthy adolescents.

    Background and objective: Several symptoms such as disabling fatigue, pain and depressive symptoms affect different life domains of adolescents with CFS. Compared to adolescents with other chronic diseases, young people with CFS are reported to be severely impaired, both physiologically and mentally. Despite this, few have investigated the HRQOL in this group.

    Method: This is a cross-sectional study on HRQOL including 120 adolescents with CFS and 39 healthy controls (HC), between 12 and 18 years. The Pediatric Quality of Life Inventory (TM), 4.0 (PedsQL) was used to assess HRQOL. The Mood and Feelings Questionnaire assessed depressive symptoms. Data were collected between March 2010 and October 2012 as part of the NorCAPITAL project (Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial). Linear and logistic regression models were used in analysis, and all tests were two-sided.

    Results: Adolescents with CFS reported significantly lower overall HRQOL compared to HCs. When controlling for gender differences, CFS patients scored 44 points lower overall HRQOL on a scale from 0-100 compared to HCs. The domains with the largest differences were interference with physical health (B = -59, 95 % CI -54 to -65) and school functioning (B = -52, 95 % CI -45 to -58). Both depressive symptoms and being a patient were independently associated with lower levels of HRQOL

    Conclusion: The difference in HRQOL between CFS patients and healthy adolescents was even larger than we expected. The large sample of adolescents with CFS in our study confirms previous findings from smaller studies, and emphasizes that CFS is a seriously disabling condition that has a strong impact on their HRQOL. Even though depressive symptoms were found in the group of patients, they could not statistically explain the poor HRQOL.

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