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  • 1.
    Hellström, Amanda
    et al.
    Blekinge Institute of Technology, Sweden ; Lund University, Sweden.
    Hagell, Peter
    Lund University, Sweden.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Sweden.
    Willman, Ania
    Blekinge Institute of Technology, Sweden.
    Measurement properties of the Minimal Insomnia Symptom Scale (MISS) in an elderly population in Sweden2010In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 10, article id 84Article in journal (Refereed)
    Abstract [en]

    Background

    Insomnia is common among elderly people and associated with poor health. The Minimal Insomnia Symptom Scale (MISS) is a three item screening instrument that has been found to be psychometrically sound and capable of identifying insomnia in the general population (20-64 years). However, its measurement properties have not been studied in an elderly population. Our aim was to test the measurement properties of the MISS among people aged 65 + in Sweden, by replicating the original study in an elderly sample.

    Methods

    Data from a cross-sectional survey of 548 elderly individuals were analysed in terms of assumptions of summation of items, floor/ceiling effects, reliability and optimal cut-off score by means of ROC-curve analysis and compared with self-reported insomnia criteria.

    Results

    Corrected item-total correlations ranged between 0.64-0.70, floor/ceiling effects were 6.6/0.6% and reliability was 0.81. ROC analysis identified the optimal cut-off score as ≥7 (sensitivity, 0.93; specificity, 0.84; positive/negative predictive values, 0.256/0.995). Using this cut-off score, the prevalence of insomnia in the study sample was 21.7% and most frequent among women and the oldest old.

    Conclusions

    Data support the measurement properties of the MISS as a possible insomnia screening instrument for elderly persons. This study make evident that the MISS is useful for identifying elderly people with insomnia-like sleep problems. Further studies are needed to assess its usefulness in identifying clinically defined insomnia.

  • 2.
    Hellström, Amanda
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Nilsson, Camilla
    County Council Värmland.
    Nilsson, Annina
    County Council Blekinge.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Leg ulcers in older people: a national study addressing variation in diagnosis, pain and sleep disturbance2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 25Article in journal (Refereed)
    Abstract [en]

    Background: Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis. Methods: The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9 % were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously. Results: We found the prevalence of pain intensity >= 5 on the NRS to be 34.8 % in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p < 0.001) and were found in 34.8 % of the total sample. Although more women than men reported pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venousarterial ulcers increased the risk of sleep disturbances, as did higher pain scores. Conclusions: The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met. National guidelines in managing leg ulcers, which also consider consequences such as sleep disturbances, pain and discomfort, are needed.

  • 3.
    Persson, Helene Avik
    et al.
    Lund University.
    Sandgren, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Furst, Carl-Johan
    Lund University;Region Skåne.
    Ahlström, Gerd
    Lund University.
    Behm, Lina
    Lund University.
    Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team's perspective2018In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, article id 134Article in journal (Refereed)
    Abstract [en]

    Background: Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team's perspective. Methods: The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. Results: The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category "Going into a bubble" illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category "The body begins to shut down" illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. Conclusions: This study conveys new knowledge concerning the multidisciplinary team's collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.

  • 4.
    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.

  • 5.
    Streit, Sven
    et al.
    University of Bern, Switzerland.
    Verschoor, Marjolein
    University of Bern, Switzerland.
    Rodondi, Nicolas
    University of Bern, Switzerland;Bern University Hospital, Switzerland.
    Bonfim, Daiana
    Hospital Israelita Albert Einstein, São Paulo, Brazil.
    Burman, Robert A
    4 Vennesla Primary Health Care Centre, Bergen, Norway.
    Collins, Claire
    Irish College of General Practitioners, Ireland.
    Biljana, Gerasimovska Kitanovska
    University St. Cyril and Metodius, Macedonia.
    Gintere, Sandra
    Riga Stradins University, Latvia.
    Gómez Bravo, Raquel
    University of Luxembourg, Luxembourg.
    Hoffmann, Kathryn
    Medical University of Vienna, Austria.
    Iftode, Claudia
    Sano Med West Private Clinic, Romania.
    Johansen, Kasper L
    Danish College of General Practitioners, Denmark.
    Kerse, Ngaire
    University of Auckland, New Zealand.
    Koskela, Tuomas H
    University of Tampere, Finland.
    Peštić, Sanda Kreitmayer
    University of Tuzla, Bosnia-Herzegovina.
    Kurpas, Donata
    Wroclaw Medical University, Poland.
    Mallen, Christian D
    Keele University, UK.
    Maisoneuve, Hubert
    University of Geneva, Switzerland.
    Merlo, Christoph
    Institute of Primary and Community Care Lucerne (IHAM), Switzerland.
    Mueller, Yolanda
    Institute of Family Medicine Lausanne (IUMF), Switzerland.
    Muth, Christiane
    Goethe-University, Germany.
    Šter, Marija Petek
    University of Ljubljana, Slovenia.
    Petrazzuoli, Ferdinando
    SNAMID, Prata Sannita, Italy;Lund University, Sweden.
    Rosemann, Thomas
    University of Zurich, Switzerland.
    Sattler, Martin
    SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg.
    Švadlenková, Zuzana
    Ordinace Řepy, s.r.o., Prague, Czech Republic.
    Tatsioni, Athina
    University of Ioannina, Greece.
    Thulesius, Hans
    Lund University, Sweden;Region Kronoberg, Sweden.
    Tkachenko, Victoria
    Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Ukraine.
    Torzsa, Peter
    Semmelweis University, Hungary.
    Tsopra, Rosy
    Univ Paris, France.
    Canan, Tuz
    Kemaliye Town Hospital, Turkey;Erzincan University, Turkey.
    Viegas, Rita P A
    NOVA Medical School, Portugal.
    Vinker, Shlomo
    Tel Aviv University, Israel.
    de Waal, Margot W M
    Leiden University Medical Center, Netherlands.
    Zeller, Andreas
    Centre for Primary Health Care, Basel, Switzerland.
    Gussekloo, Jacobijn
    Leiden University Medical Center, Netherlands.
    Poortvliet, Rosalinde K E
    Leiden University Medical Center, Netherlands.
    Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, no 1, p. 1-7, article id 93Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision.

    METHODS: Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP.

    RESULTS: The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs' decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48-0.59; ORs per country 0.11-1.78).

    CONCLUSIONS: Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making.

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