Subjective health and illness, coping and life satisfaction in an 80-year-old Swedish population-implications for mortality.

BACKGROUND: Multimorbidity and illness will become more common due to increased life expectancy. PURPOSE: This study describes various combinations of diseases and symptoms and explores implications for mortality in a sample of 80-year-olds followed up to 95 years of age. Furthermore, reported subjective health, coping, and life satisfaction is explored. METHOD: 212 persons, born in 1908, were classified into four groups based on their number of diseases and reported symptoms according to a health examination at the age of 80. These groups were compared regarding standardized measurements of subjective health, depression, coping, life satisfaction, and mortality. RESULTS: The mortality risks, the hazard ratios, were of the same magnitude, 1.8-2.2, whether the persons experienced several symptoms, had several diseases, or a combination of several symptoms and several diseases when compared to the healthy group of respondents. CONCLUSION: The experience of subjective signs of illness carries the same mortality risks as diseases.

Monochromatic phototherapy: effective treatment for grade II chronic pressure ulcers in elderly patients.

BACKGROUND AND AIMS: Monochromatic pulsating light may have effects on wound healing. In an earlier study of grade II ulcers, there was a tendency toward better healing in the phototherapy group (p=0.06). The present study on patients with grade II ulcers was performed to verify these findings. Data from this study were pooled with data from the earlier study. METHODS: Ninety-four patients were offered participation in the new study and 76 patients were evaluated. They were pooled with 87 patients from the earlier study, bringing the total to 163. All patients were treated with monochromatic pulsating light or placebo over the ulcerated area, according to a specified program up to 12 weeks. RESULTS: The mean normalized reduction in pressure ulcer size at week 12 was 0.79 for the phototherapy group and 0.50 for the placebo group (95% confidence interval 0.01-0.53; p=0.039). No serious side-effects were noted. CONCLUSIONS: Monochromatic pulsating light accelerates healing in grade II pressure ulcers in elderly patients.

Incidence and risk factors for depression and anxiety disorders: results from a 34-year longitudinal Swedish cohort study.

This study is based on a total cohort (N = 192) of people born in 1902 and 1903 and living in southern Sweden. Subjects were assessed at baseline when 67 years of age and on eight further occasions over 34 years or until death. The participation rate in the nine examinations ranged from 78-100%. Interviews, psychological tests, and medical examinations were used as well as information on medical diagnoses from primary health care records and hospital records. The cumulative probability for the development of clinical depression during the follow-up was 8% and for anxiety 6%. The incidence rate for depression and for anxiety was highest during the period 67-81 years. Persons with poor financial status were more likely to be diagnosed with depression but no significant risk factor for anxiety was found. Only 14% developed depression and anxiety during the follow-up period, females more often than men. The strongest risk factors for the development of depression were perceived economic problems.

ADL dependence and perceived health among elderly deaf sign-language users: a comparison with a matched group of elderly hearing people.

The main purpose of the study was to investigate dependence in ADL and perceived health among elderly deaf sign-language users and to compare these findings with data from a matched hearing elderly population sample. Data on the deaf population were collected through assessments and structured interviews in sign language. Data on the hearing population were retrieved from the Swedish National Study and Ageing and Care (SNAC), while only a few variables from the questionnaire were used in the present study. Each deaf individual was matched by three hearing persons. Matching was performed according to gender, age, and living situation. The main finding is that elderly deaf sign-language users are more dependent in ADL but simultaneously report better health than their hearing counterparts. The differences in ADL dependence can be explained by factors linked to the communication problems experienced by deaf sign-language users, but also by cultural factors. The better health reported by the deaf sample may be attributed to adaptive mechanisms that deaf sign-language users have been claimed to develop. This research provides new information on a vulnerable group of elderly people, i.e. deaf sign-language users, that has previously been given little scientific attention.

Sense of coherence is a sensitive measure for changes in subjects with Parkinson's disease during 1 year.

To investigate subjective and objective changes in function in subjects with Parkinson's disease (PD) home visits with interviews were performed with a 1-year interval. Depressive symptoms were rated with the Geriatric Depression Scale, subjective health with the generic SF-36 scale and the disease-specific PDQ-8 scale; objective changes were assessed according to the Hoehn and Yahr scale; insomnia was rated with an eight-item questionnaire and the sense of coherence (SOC) was determined with the short version of that scale. A total of 91 subjects (39 women and 52 men with a mean age of 70 years) living at home, most of them moderately to severely disabled, were interviewed. Time since diagnosis was <2 years for 13%, 2-10 years for 55%, and >10 years for 32%. During the studied year the subjects' status declined significantly as shown by changes in both the PDQ-8 and the Hoehn and Yahr scales. The most striking finding was a pronounced decrease in the SOC scale (p < 0.0001). This indicates that the subjects' ability to handle stress-related problems secondary to the progress of disease might have decreased. In order to optimize nursing care for subjects with PD, in addition to medical treatment, an assessment of the SOC could aid nursing staff in evaluating subjects' ability to handle their life situation.

Geriatric rehabilitation as an integral part of geriatric medicine in the Nordic countries.

OBJECTIVES: First, to outline the theoretical and practical framework for geriatric rehabilitation in the Nordic countries and second, to survey the scientific medical publications for evidence-based geriatric rehabilitation. METHODS: Brainstorming on geriatric rehabilitation in a working group of Nordic teachers in geriatric medicine. Papers on scientific programmes for geriatric rehabilitation from Internet sources were collected and analyzed. All articles describing randomized studies in geriatric rehabilitation were selected for meta-analyses. The papers were divided into four groups according to diseases, infirmity and resource settings: stroke, hip-fractures, acute admissions and programmes conducted in nursing homes, day hospitals and home services. RESULTS: The literature survey included 30 scientific studies (9496 patients) in randomized trials with valid endpoints. Geriatric rehabilitation programmes for stroke patients in geriatric settings (six papers, 1138 patients) reduced mortality and the need for nursing home placement, but the outcome for ADL function was not significantly changed. Function and length of stay varied between the studies. The outcome of geriatric rehabilitation was even more decisive in the randomized hip-fracture studies (seven articles, 2414 patients): the readmission rate and cost were significantly better. Ten studies were found, comparing the outcome of acute admissions of frail elderly patients (4683) with either geriatric (GEMU, GRU) or general medical wards. The effect of rehabilitation regarding mortality rate at one year, placement in a nursing home, physical function, contentment with services, readmission rate and cost was significant improvement in the geriatric settings. Internal comparisons of geriatric programmes in nursing homes, day hospitals and in-home services (seven studies, 1261 patient) revealed some differences in outcomes regarding function, contentment and costs. CONCLUSION: Specialized geriatric rehabilitation is complicated but effective when properly performed. Interdisciplinary teamwork, targeting of patients, comprehensive assessment and intensive and patient-targeted rehabilitation seem to characterize the most effective programmes. Rehabilitation of frail elderly people poses a major future challenge and has to be developed further for the sake of elderly people's quality of life as well as economic reasons.

Monochromatic phototherapy in elderly patients: a new way of treating chronic pressure ulcers?

BACKGROUND AND AIMS: Monochromatic pulsating light may have effects of importance for wound healing, and promising results were obtained in an open study on the healing of pressure ulcers, which motivated the present study. METHODS: One hundred and sixty-four in- and outpatients with grade II and III ulcers were treated with monochromatic pulsating light or placebo over the ulcerated area, according to a specific therapeutic program. RESULTS: No significant effects were observed in the total material. In a subanalysis of grade II ulcers, there was a tendency toward better healing in the monochromatic light group (p = 0.06). A significantly larger reduction in pressure ulcer size was noted among patients in the treatment group with low body weight (BMI < 20). CONCLUSIONS: Monochromatic pulsating light may have effects on pressure ulcer healing, and a new study focusing only on grade II ulcers is under way.

Aspects of quality of life in persons with pre-lingual deafness using sign language: subjective wellbeing, ill-health symptoms, depression and insomnia.

This study investigated health-related quality of life, expressed as subjective wellbeing and the prevalence of depressive symptoms and insomnia, among elderly pre-lingually deaf persons using sign language. Comparisons were made with elderly hearing people. Forty-five pre-lingually deaf persons, 65 years or older, took part (a response rate of 46%). Subjective wellbeing was assessed with the Gothenburg Quality of Life (GQL) instrument. Depressive symptoms were rated with the 15-item version of the geriatric depression scale (GDS), and insomnia was measured with Livingston's sleep scale. Ratings of subjective wellbeing among elderly pre-lingually deaf people were generally high. One third of the deaf persons demonstrated depressive symptoms and nearly two thirds suffered from insomnia. There was substantial correlation between insomnia, depressive symptoms and lower subjective wellbeing. The results strengthened the assumption that depressive symptoms and sleep disturbance are more frequent among elderly pre-lingually deaf people using sign language than among hearing people. On the other hand, and contrary to our expectations, this did not imply significantly lower perceived subjective wellbeing compared with hearing elderly people. Results must be interpreted with caution due to limitations in the study.

Factors of importance to the caregiver burden experienced by family caregivers of Parkinson's disease patients.

BACKGROUND AND AIMS: Caregivers of Parkinson's disease patients are vulnerable to detrimental factors related to caregiving because of the progressive course of the disease. Studies of caregivers of these patients are scarce. The aim of this study was to examine the caregiver burden in Parkinson's disease by analyzing caregiver and patient-related factors. METHODS: Every 3rd patient with Parkinson's disease registered at the outpatient clinic of the Neurology Department was invited to participate. One year after the first investigation, a follow-up was performed with a study of caregiver burden. A total of 65 caregivers took part. In-home interviews with patients and caregivers were performed. ASSESSMENTS: a) caregiver burden, 22 items, comprising five indices: general strain, isolation, disappointment, emotional involvement, and environment; b) sense of coherence, 13 items, with the components comprehensibility, manageability and meaningfulness; c) depressive symptoms, using the Geriatric Depression Scale, 15 items; d) social contacts, 6 items; e) patient subjective health, assessed with the Parkinson's disease questionnaire, 39 items; and f) patient functional status. RESULTS: Bivariate analyses showed significant correlations between caregiver burden and sense of coherence in caregivers, patient functional status, depressive symptoms in caregiver and patient, patient subjective health and time since diagnosis. Multivariate analysis showed depressive symptoms and sense of coherence in caregiver, and functional status in patient to be the most important variables for caregiver burden. CONCLUSIONS: To ease the caregiver burden, attention should be paid to patient functional status and caregivers depressive symptoms. The sense of coherence in caregivers is probably more difficult to influence.

[Geriatric rehabilitation as an integral part of geriatric medicine in the nordic countries.].

OBJECTIVE: Firstly to outline the theoretical and practical framework for geriatric rehabilitation in Iceland and other Nordic countries and secondly to survey the scientific medical publications for evidence based geriatric rehabilitation. METHODS: Brain storming on geriatric rehabilitation in a working group of Nordic teachers in geriatric medicine. Papers on scientific programs for geriatric rehabilitation from Internet sources were collected and analyzed. All articles describing randomized studies in geriatric rehabilitation were selected for overview. The papers were divided into four groups according to diseases, infirmity and resource settings; 1) stroke, 2) hip-fractures, 3) acute admissions and 4) programs conducted in nursing homes, day hospitals and home services. RESULTS: A spectrum of biological and social events creates the conditions underlying most causes for illness and disability in old people. The process of established geriatric services promotes the efficiency of geriatric rehabilitation. The literature survey included 27 scientific studies (8586 patients) on randomized studies with valid endpoints. Geriatric rehabilitation programs for stroke patients in geriatric settings, six studies (1138 patients), reduced mortality and the need for nursing home placement but the outcome for ADL. Function and length of stay was more variable between the studies. The outcome of geriatric rehabilitation was even more decisive in the randomized hip-fracture studies, six studies (2171 patients). Eight studies were found comparing the outcome between acute admission of frail elderly to either geriatric (GEMU, GRU) or general medical wards. The outcome as regards to mortality rate at one year, placement to a nursing home, physical function, contentment with services, readmission rate and cost was all significantly better in the geriatric settings. Internal comparisons of geriatric programs in nursing homes, day hospitals and in home service, seven studies (1261 patient), revealed some differences in outcomes in function, contentment and costs. CONCLUSIONS: Specialized geriatric rehabilitation is complicated but effective when properly performed. Interdisciplinary teamwork, targeting of patients, comprehensive assessment and intensive and patient-targeted rehabilitation seem to characterize the most effective programs. Rehabilitation of frail elderly people poses a major challenge for the future and has to be developed further for the sake of quality of life of elderly people as well as for economic reasons.

Informal and formal support from a multi-disciplinary perspective: a Swedish follow-up between 80 and 82 years of age.

This longitudinal study used a multi-disciplinary approach and examined the relationship between psychosocial and health characteristics and the pattern of informal and formal support for non-institutionalized very old people. The data were derived from a single cohort of 80-year-old people living in Lund, Sweden who were followed over a 3-year period. In order to account for potential sample bias, an analysis at 80 years measured the differences between the participants who were measured at both test periods, the drop-outs who discontinued from the study prior to 82 years, and the deceased who died prior to 82 years (n = 212). Results revealed that the groups differed significantly according to reported number of children and health measures: the participants were most likely to have children and exhibited the best health. Bivariate analyses examined social, psychological and health variables for survivors (n = 93) at both 80 and 82 years in relationship to independent, informal, and formal support type. Loneliness was significantly and consistently associated with support type at both 80 and 82 years: both frequency and strength of loneliness were most often reported in the formal support group. Depression was significantly related to support type at age 80 only. Looking at change in the psychosocial and health measures and change in support over the 3-year period, no significant relationships were found. Our study concludes that for the very old, in addition to requiring increased support over a 3-year period, loneliness is a significant characteristic that may accompany the receipt of support. Professionals who plan and implement social support programmes for elderly persons should also consider emotional and psychological needs.