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Sjölund, Britt-Marie
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Marques, M. J., Woods, B., Hopper, L., Jelley, H., Irving, K., Kerpershoek, L., . . . Gonçalves-Pereira, M. (2019). Relationship quality and sense of coherence in dementia: results of a European cohort study. International Journal of Geriatric Psychiatry, 34(5), 745-755
Open this publication in new window or tab >>Relationship quality and sense of coherence in dementia: results of a European cohort study
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2019 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 34, no 5, p. 745-755Article in journal (Refereed) Published
Abstract [en]

Objective: Quality of life of people with dementia and their family carers is strongly influenced by interpersonal issues and personal resources. In this context, relationship quality (RQ) and sense of coherence (SOC) potentially protect and promote health. We aimed to identify what influences RQ in dyads of people with dementia and their carers and to examine differences in their perspectives.

Methods: Cross-sectional data from the Actifcare cohort study of 451 community-dwelling people with dementia and their primary carers in eight European countries. Comprehensive assessments included the Positive Affect Index (RQ) and the Orientation to Life Questionnaire (SOC).

Results: Regression analyses revealed that RQ as perceived by people with dementia was associated with carer education, stress and spouse caregiving. RQ as perceived by carers was associated with carer stress, depression, being a spouse, social support, reported neuropsychiatric symptoms of dementia and carer SOC. Neuropsychiatric symptoms and carer stress contributed to discrepancies in RQ ratings within the dyad. The only factor associated with both individual RQ ratings and with discrepancies was carer stress (negative feelings sub-score). No significant differences in the overall perception of RQ were evident between spouses and adult children carers, but RQ determinants differed between the two.

Conclusions: In this European sample, carer SOC was associated with carer-reported RQ. RQ determinants differed according to the perspective considered (person with dementia or carer) and carer subgroup. A deeper understanding of RQ and its determinants will help to tailor interventions that address these distinct perspectives and potentially improve dementia outcomes.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Alzheimer's disease, dementia, dyadic perspective, family care, relationship quality, sense of coherence
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:hig:diva-29376 (URN)10.1002/gps.5082 (DOI)000465019800013 ()30729572 (PubMedID)2-s2.0-85062789270 (Scopus ID)
Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-08-15Bibliographically approved
Bieber, A., Stephan, A., Verbeek, H., Verhey, F., Kerpershoek, L., Wolfs, C., . . . Meyer, G. (2018). Access to community care for people with dementia and their informal carers: Case vignettes for a European comparison ofstructures and common pathways to formalcare [Zugang zu professioneller Unterstützung für Menschen mit Demenz und ihre Angehörigen: Fallvignetten für den europäischen Vergleich von Strukturen und Zugangswegen zu professioneller Pflege]. Zeitschrift für Gerontologie und Geriatrie (Print), 51(5), 530-536
Open this publication in new window or tab >>Access to community care for people with dementia and their informal carers: Case vignettes for a European comparison ofstructures and common pathways to formalcare [Zugang zu professioneller Unterstützung für Menschen mit Demenz und ihre Angehörigen: Fallvignetten für den europäischen Vergleich von Strukturen und Zugangswegen zu professioneller Pflege]
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2018 (English)In: Zeitschrift für Gerontologie und Geriatrie (Print), ISSN 0948-6704, E-ISSN 1435-1269, Vol. 51, no 5, p. 530-536Article in journal (Refereed) Published
Abstract [en]

Background

People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time.

Objectives

Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project.

Materials and methods

The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario.

Results

A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system.

Conclusion

Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.

Keywords
Dementia, Health services accessibility, Care, Comparative study, Europe
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hig:diva-24651 (URN)10.1007/s00391-017-1266-7 (DOI)000437252800007 ()28616816 (PubMedID)2-s2.0-85020741314 (Scopus ID)
Available from: 2017-07-03 Created: 2017-07-03 Last updated: 2018-08-15Bibliographically approved
Stephan, A., Bieber, A., Hopper, L., Joyce, R., Irving, K., Zanetti, O., . . . Meyer, G. (2018). Barriers and facilitators to the access to and use of formal dementia care: findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries. BMC Geriatrics, 18(1), Article ID 131.
Open this publication in new window or tab >>Barriers and facilitators to the access to and use of formal dementia care: findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries
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2018 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, no 1, article id 131Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals.

METHOD: Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports.

RESULTS: Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives.

CONCLUSION: Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Dementia, Focus groups, Formal care, Informal carer, Person with dementia, Utilisation
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-26942 (URN)10.1186/s12877-018-0816-1 (DOI)000434336700001 ()29866102 (PubMedID)2-s2.0-85047981002 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2018-06-12 Created: 2018-06-12 Last updated: 2019-08-12Bibliographically approved
Tuvesson, H., Hellström, A., Sjöberg, L., Sjölund, B.-M., Nordell, E. & Fagerström, C. (2018). Life weariness and suicidal thoughts in late life: a national study in Sweden. Aging & Mental Health, 22(10), 1365-137
Open this publication in new window or tab >>Life weariness and suicidal thoughts in late life: a national study in Sweden
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2018 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, no 10, p. 1365-137Article in journal (Refereed) Published
Abstract [en]

Objectives: This study aimed at investigating the point prevalence of life weariness and suicidal thoughts and their relationship with socio-demographic characteristics in a population of older adults in Sweden. Method: Data from 7913 individuals aged 60 years and older were drawn from the Swedish National Study on Aging and Care, a collaborative study in Sweden. Life weariness and suicidal thoughts were measured by one item derived from the Montgomery–Åsberg Depression Rating Scale. A multinomial regression model was used to investigate the relationships of socio-demographic characteristics with life weariness and suicidal thoughts. Results: Living in urban and semi-urban areas, being of advanced age, being divorced and having lower educational levels were related to life weariness. Living in a residential care facility, being widowed or unmarried, being born in a non-Nordic European country and experiencing financial difficulties were related to both life weariness and suicidal thoughts. Sex was found to be unrelated to either life weariness or suicidal thoughts. Conclusion: This study found that several socio-demographic variables were associated with life weariness and suicidal thoughts among older adults. Specific attention to older individuals with these characteristics may be warranted as they might be more vulnerable to life weariness and suicidal thoughts.

Keywords
life weariness, National study, older adults, socio-demographics, suicidal thoughts
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-24867 (URN)10.1080/13607863.2017.1348484 (DOI)000455491500017 ()28685600 (PubMedID)2-s2.0-85021985390 (Scopus ID)
Available from: 2017-08-17 Created: 2017-08-17 Last updated: 2019-03-01Bibliographically approved
Sjölund, B.-M., Mamhidir, A.-G. & Engström, M. (2017). Pain prevalence among residents living in nursing homes and factors associated with quality of life and well-being.
Open this publication in new window or tab >>Pain prevalence among residents living in nursing homes and factors associated with quality of life and well-being
2017 (English)In: Article in journal (Other academic) Submitted
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-25928 (URN)
Projects
Smärta hos äldre med eller utan kognitiv nedsättning - en interventionsstudie där äldres och vårdares perspektiv efterfrågas
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-03-13Bibliographically approved
Broda, A., Bieber, A., Meyer, G., Hopper, L., Joyce, R., Irving, K., . . . Stephan, A. (2017). Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries. BMC Health Services Research, 17(1), Article ID 518.
Open this publication in new window or tab >>Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries
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2017 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 518Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers.

METHODS: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries.

RESULTS: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness.

CONCLUSIONS: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

Keywords
Access to formal dementia care, Dementia, Expert interviews
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-24878 (URN)10.1186/s12913-017-2456-0 (DOI)000407074700002 ()28774307 (PubMedID)2-s2.0-85026838647 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2017-08-18 Created: 2017-08-18 Last updated: 2018-03-13Bibliographically approved
Mamhidir, A.-G., Sjölund, B.-M., Fläckman, B., Wimo, A., Sköldunger, A. & Engström, M. (2017). Systematic pain assessment in nursing homes: a cluster-randomized trial using mixed-methods approach. BMC Geriatrics, 17, Article ID 61.
Open this publication in new window or tab >>Systematic pain assessment in nursing homes: a cluster-randomized trial using mixed-methods approach
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2017 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 61Article in journal (Refereed) Published
Abstract [en]

Background

Chronic pain affects nursing home residents’ daily life. Pain assessment is central to adequate pain management. The overall aim was to investigate effects of a pain management intervention on nursing homes residents and to describe staffs’ experiences of the intervention.

Methods

A cluster-randomized trial and a mixed-methods approach. Randomized nursing home assignment to intervention or comparison group. The intervention group after theoretical and practical training sessions, performed systematic pain assessments using predominately observational scales with external and internal facilitators supporting the implementation. No measures were taken in the comparison group; pain management continued as before, but after the study corresponding training was provided. Resident data were collected baseline and at two follow-ups using validated scales and record reviews. Nurse group interviews were carried out twice. Primary outcome measures were wellbeing and proxy-measured pain. Secondary outcome measures were ADL-dependency and pain documentation.

Results

Using both non-parametric statistics on residential level and generalized estimating equation (GEE) models to take clustering effects into account, the results revealed non-significant interaction effects for the primary outcome measures, while for ADL-dependency using Katz-ADL there was a significant interaction effect. Comparison group (n = 66 residents) Katz-ADL values showed increased dependency over time, while the intervention group demonstrated no significant change over time (n = 98). In the intervention group, 13/44 residents showed decreased pain scores over the period, 14/44 had no pain score changes ≥ 30% in either direction measured with Doloplus-2. Furthermore, 17/44 residents showed increased pain scores ≥ 30% over time, indicating pain/risk for pain; 8 identified at the first assessment and 9 were new, i.e. developed pain over time. No significant changes in the use of drugs was found in any of the groups. Nursing pain related documentation was sparse. In general, nurses from the outset were positive regarding pain assessments. Persisting positive attitudes seemed strengthened by continued assessment experiences and perceptions of improved pain management.

Conclusion

The implementation of a systematic work approach to pain issues in nursing homes indicates that an increased awareness, collaboration across and shared understanding among the team members of the pain assessment results can improve pain management and lead to decreased physical deterioration or the maintenance of physical and functional abilities among NH residents. However, pain (proxy-measured) and wellbeing level did not reveal any interaction effects between the groups over time.

Trial registration

The study was registered in ISRCTN71142240 in September 2012, retrospectively registered.

Keywords
pain assessment, pain intervention, nursing homes, cluster-randomized trial, mixed-methods
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-23724 (URN)10.1186/s12877-017-0454-z (DOI)000397457500001 ()28241785 (PubMedID)2-s2.0-85021856753 (Scopus ID)
Projects
Smärta hos äldre med eller utan kognitiv nedsättning
Funder
The Dementia Association - The National Association for the Rights of the Demented
Note

Funding agencies:

University of Gavle, Sweden  

Swedish Alzheimer's Foundation  

Available from: 2017-03-07 Created: 2017-03-07 Last updated: 2018-03-13Bibliographically approved
Wimo, A., Sjölund, B.-M., Sköldunger, A., Qui, C., Klarin, I., Nordberg, G. & von Strauss, E. (2016). Cohort Effects in the Prevalence and Survival of People with Dementia in a Rural Area in Northern Sweden. Journal of Alzheimer's Disease, 50(2), 387-396
Open this publication in new window or tab >>Cohort Effects in the Prevalence and Survival of People with Dementia in a Rural Area in Northern Sweden
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2016 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 50, no 2, p. 387-396Article in journal (Refereed) Published
Abstract [en]

Background: Recent studies suggest that trends in cardiovascular risk may result in a decrease in age-specific prevalence of dementia. Studies in rural areas are rare.

Objectives: To study cohort effects in dementia prevalence and survival of people with dementia in a Swedish rural area.

Methods: Participants were from the 1995-1998 Nordanstig Project (NP) (n = 303) and the 2001-2003 Swedish National study on Aging and Care in Nordanstig (SNAC-N) (n = 384). Overall 6-year dementia prevalence and mortality in NP and SNAC-N were compared for people 78 years and older. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for dementia occurrence using the NP study population as the reference group. Cox regression models were used to analyze time to death.

Results: The crude prevalence of dementia was 21.8% in NP and 17.4% in SNAC-N. When the NP cohort was used as the reference group, the age- and gender-adjusted OR of dementia was 0.71 (95% CI 0.48-1.04) in SNAC-N; the OR was 0.47 (0.24-0.90) for men and 0.88 (0.54-1.44) for women. In the extended model, the OR of dementia was significantly lower in SNAC-N than in the NP cohort as a whole (0.63; 0.39-0.99) and in men (0.34; 0.15-0.79), but not in women (0.81; 0.46-1.44). The Cox regression models indicated that the hazard ratio of dying was lower in the SNAC-N than NP population.

Conclusions: Trends toward a lower prevalence of dementia in high-income countries seem to be evident in this Swedish rural area, at least in men.

Keywords
Dementia, mortality, prevalence, rural population
National Category
Geriatrics
Identifiers
urn:nbn:se:hig:diva-20887 (URN)10.3233/JAD-150708 (DOI)000368929200006 ()26639970 (PubMedID)2-s2.0-84970917672 (Scopus ID)
Projects
Physical functioning in old age: temporal trends and geographical variation in Sweden
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council
Available from: 2016-01-02 Created: 2015-12-16 Last updated: 2018-03-13Bibliographically approved
Sjölund, B.-M., Wimo, A., Engström, M. & von Strauss, E. (2015). Incidence of ADL Disability in Older Persons, Physical Activities as a Protective Factor and the Need for Informal and Formal Care: Results from the SNAC-N Project. PLoS ONE, 10(9), Article ID e0138901.
Open this publication in new window or tab >>Incidence of ADL Disability in Older Persons, Physical Activities as a Protective Factor and the Need for Informal and Formal Care: Results from the SNAC-N Project
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, article id e0138901Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of the study was to examine 1) the incidence of disability in Activities of Daily Living (ADL), in persons 78 years and older 2) explore whether being physical active earlier is a significant predictor of being disability free at follow-up and 3) describe the amount of informal and formal care in relation to ADL-disability.

METHODS: Data were used from a longitudinal community-based study in Nordanstig (SNAC-N), a part of the Swedish National Study on Aging and Care (SNAC). To study objectives 1) and 2) all ADL-independent participants at baseline (N = 307) were included; for objective 3) all participants 78 years and older were included (N = 316). Data were collected at baseline and at 3- and 6-year follow-ups. ADL-disability was defined as a need for assistance in one or more activities. Informal and formal care were measured using the Resource utilization in Dementia (RUD)-instrument.

RESULTS: The incidence rates for men were similar in the age groups 78-81and 84 years and older, 42.3 vs. 42.5/1000 person-years. For women the incidence rate for ADL-disability increased significantly from the age group 78-81 to the age group 84 years and older, 20.8 vs.118.3/1000 person-years. In the age group 78-81 years, being physically active earlier (aOR 6.2) and during the past 12 month (aOR 2.9) were both significant preventive factors for ADL-disability. Both informal and formal care increased with ADL-disability and the amount of informal care was greater than formal care. The incidence rate for ADL-disability increases with age for women and being physically active is a protective factor for ADL-disability.

CONCLUSION: The incidence rate for ADL-disability increases with age for women, and being physical active is a protective factor for ADL-disability.

Keywords
age groups, disabilities, dementia, cognitive impairment, aging, life expecantcy, morbitity, quality of life
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hig:diva-20368 (URN)10.1371/journal.pone.0138901 (DOI)000361800700115 ()26407207 (PubMedID)2-s2.0-84947221981 (Scopus ID)
Projects
Physical functioning in old age: temporal trends and geographical variation in Sweden
Funder
The Karolinska Institutet's Research Foundation
Available from: 2015-10-02 Created: 2015-10-02 Last updated: 2018-03-13Bibliographically approved
Sjölund, B.-M. (2014). Physical functioning in old age: Temporal trends and geographical variation in Sweden. (Doctoral dissertation). Stockholm: Karolinska Institutet
Open this publication in new window or tab >>Physical functioning in old age: Temporal trends and geographical variation in Sweden
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

ADL disability is an age-related condition that leads to poor quality of life, increased health-related care costs, and increased mortality. The proportion of older adults are increasing worldwide, and it is therefore important both for society and the individual that research provide us with information about the process leading to ADL disability and how to identify persons at risk. The most effective design for following the aging process is found in population-based studies that include all older persons, both those living at home and those in residential care. This thesis uses data from three populationbased studies: the Kungsholmen Project (KP), the Nordanstig Project (NP) and the SNAC-N study. The aims of the thesis was to examine temporal changes in physical functioning in older adults, to identify underlying development of new disability and functional decline, as well as to explore geographical variation in physical functioning between urban and rural elderly habitats. We also wanted to describe the amount of informal and formal care in relation to levels of ADL disability. The ultimate aim was to identify factors suitable for prevention. Study I: We I compared two populations of older adults, 75 years and older (the KP and the NP) from different living areas (urban and rural) and found differences in ADL disability, morbidity and disease patterns. The most common health problem in both areas was cardiovascular diseases (39.9% in the urban area and 45.2% in the rural area). There were great differences, urban vs rural, in the prevalence of stroke (7.4% vs 14.0%), diabetes mellitus (6.3% vs 16.1%), and Parkinson’s disease (1.0% vs 3.7%). Having two or more diseases vs. no disease was more common in the rural area than in the urban area, odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.4-2.4. Living area differences (urban vs rural) were found in population attributable risk (PAR) for disability due to stroke (5.6 vs 32.2), diabetes mellitus (1.2 vs 6.1), fractures (1.4 vs 10.7), and hearing impairment (8.7 vs 22.0). Study II: Data were gathered from a population-based study of adults 60 years and older, the SNAC-Nordanstig (SNAC-N), and the study explored the association between ADL disability, muscle strength, disease severity and mortality. Upper and lower muscle strength decreased with increasing age, with a tendency for lower performance in women than in men. A significant association was found between ADL disability and having reduced lower muscle strength. Having an increased number of diseases increased the risk of being ADL disabled. Diseases with the greatest impact on ADL disability were musculoskeletal diseases, hypertension and dementia. ADL disability and being unable to perform the gait speed test were factors that increased the risk of death. Inability to perform the chair stand test or weaker grip strength increased the risk of death for men. Study III: Data from two populations, 78 years and older, the NP (1995-1998) and the SNAC-N study (2001-2003), were used to study time trends in the prevalence of ADL disability and survival, comparing two cohorts. The prevalence of ADL disability was stable from 1995-1998 to 2001-2002 for men, while women became more disabled in ADL over the time period, (OR 2.36; CI 1.12-4.94). No significant difference was found in survival time between the cohorts in either ADL-disabled or non-disabled persons. There was a tendency for increased survival for non-disabled persons in the SNAC-N study compared with the NP, although it was not significant; this was particularly true for women. In general, women survived longer than men did regardless of whether they were ADL disabled or not. Study IV: The aims were to examine the incidence of ADL disability, to explore whether being physically active earlier in life is a significant predictor of being disability free at follow-up, and to describe the amount of informal and formal care received in relation to ADL disability. Data were gathered from persons 78 years and older in the SNAC-N study. The incidence rates for men were almost the same in the age group 78-81 compared with the age group 84 years and older, 42.3 vs. 42.5/1000 person-years. For women the incidence rate for ADL disability increased significantly from the age group 78-81 to the age group 84 years and older, 20.8 vs. 118.3/1000 person-years. In the age group 78-81 years, being physically active earlier (aOR 6.2) and during the past 12 months before the baseline examination (aOR 2.9) were both significant preventive factors for ADL disability. The amount of both informal and formal care increased with the number of ADL activities the persons were dependent on and the amount of informal care was greater than the amount of formal care. Conclusions: This thesis shows an increase in ADL disability due to increased age, and that women are more ADL disabled than men, but also shows how diseases affect ADL disability. The diseases that negatively affect ADL are often due to unhealthy lifestyle, e.g. physical inactivity, obesity and smoking, etc. The results show the importance of prevention of the factors that cause ADL disability, preferably already in midlife. The amount of both informal and formal care increased significantly with the number of ADL activities the persons required help with. Regarding prevention of becoming ADL disabled, it is of importance to find ways to postpone the onset of ADL disability so that we can live longer without disability.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2014
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hig:diva-18497 (URN)978-91-7549-529-3 (ISBN)
Public defence
2014-05-05, Samuelssonsalen, Tomtebodavägen 6 (Scheelelaboratoriet), Solna, 13:00
Supervisors
Projects
Physical functioning in old age: temporal trends and geographical variation in Sweden
Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2018-03-13Bibliographically approved
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