The association between physical frailty and cognitive performance in older adults aged 60-96 years. Data from the "Good Aging in Skåne" (GÅS) Swedish population study.

Background: The association between physical frailty and performance in different cognitive domains in the absence of cognitive disorders is poorly understood. Hence, we aimed to explore the associations between frailty levels based on the Fried Physical Frailty Phenotype and performance of different cognitive domains. We also aimed to examine the associations between cognitive function and each criterion in the Fried Frailty Scale using the same cognitive domains in a non-dementia population aged 60-96 years. Methods: This cross-sectional study included 4,329 participants aged 60-93 years, drawn from the "Good Aging in Skåne" population study. Frailty indices included handgrip strength, physical endurance, body mass index (BMI), physical activity, and walking speed. Cognitive function was assessed across eight domains: episodic memory, processing speed, semantic memory, verbal fluency, working memory, attention, executive function, and visual perception. We constructed adjusted multiple linear regression models for each cognitive domain, with the frailty levels as the independent variable. Likewise, we constructed linear regression models with each cognitive domain as the dependent variable and frailty criteria as independent variables. Results: Physical frailty was associated with poor performance in episodic memory, processing speed, semantic memory, verbal fluency, working memory, attention, and executive functions (p < 0.001 for all associations). Weaker hand grip strength was independently associated with poorer performance in all cognitive domains (p < 0.001-0.015). Conclusions: Higher levels of frailty were associated with poorer performance in all cognitive domains except visual perception. Describing frailty by considering cognitive functioning may provide a better understanding of frailty.

Mortality risk relationship using standard categorized BMI or knee-height based BMI - does the overweight/lower mortality paradox hold true?

BACKGROUND: The body mass index (BMI) is prone to misclassification of obesity due to age-related height loss and resulting measurement errors. Knee-height based BMI (KH-BMI) has not been previously studied in relation to mortality risk in older adults. AIM: To evaluate the age- and sex-specific mortality risk relationship using classic BMI and knee height predicted BMI (KH-BMI) overweight and obesity in a 15-year follow-up study including older Swedish adults aged 60-93 years. METHODS: A 15-year follow-up study among 2,786 individuals aged ≥ 60 years. Height, weight and KH were measured. KH-predicted height was estimated using formulated gender-specific equations. Classic BMI and KH-BMI (kg/m2) were calculated. Mortality data was obtained from the Swedish death registry. Questionnaires were used to collect data on obesity-related lifestyle factors and comorbidities. RESULTS: Cox regression revealed that using the classic BMI, when comparing with the normal/underweight reference group, there was a mortality risk among overweight men (HR = 0.67, 0.52-0.87), overweight women (HR = 0.79, 0.65-0.97), and obese men (HR = 0.60, 0.41-0.89) aged ≥ 80 years old. Using the KH-BMI, only overweight men and overweight women aged ≥ 80 years had a lower mortality risk, men (HR = 0.71, 0.55-0.92); women (HR = 0.77, 0.62-0.95) after adjusting for obesity-related lifestyle factors and comorbidities. DISCUSSION: There is evidence that obesity is overestimated by the BMI, in comparison with the KH-BMI classification. In terms of mortality risk and after adjusting for height, there remains a paradoxical protective association between overweight and mortality. CONCLUSION: Regardless of classic BMI or KH-BMI estimation, overweight men and women aged ≥ 80 years had a lower mortality risk compared to normal/underweight men and women ≥ 80 years.

The Association between Untreated and Treated Hearing Loss and Cognitive Performance in Men and Women Aged 60-96 Years: Data from the Swedish "Good Aging in Skåne" Population Study.

Background/Objectives: Recent decades have witnessed a sharp increase in research investigating the association between hearing loss and cognitive impairment. Few previous studies have stratified for sex when investigating this issue, where results were inconsistent and require further clarification. Thus, the objective was to investigate the association between self-reported hearing loss and levels of cognitive impairment, stratified for sex. Methods: In this cross-sectional study, data were collected from 2001 to 2016. The study sample consisted of 5075 individuals, 2325 (45.8%) men, mean age 68.3 years, and 2750 (54.2%) women, mean age 70.0 years. Multiple variate ordinal regression models were constructed and adjusted for age, marital status, education, physical activity, depressive mood, hypertension, stroke, diabetes, and use of sedatives to investigate associations between groups of self-reported untreated and treated hearing loss and those reporting no hearing loss in relation to levels of cognitive impairment assessed by the Mini-Mental State Examination scale. Results: In men, treated hearing loss was associated with levels of cognitive impairment, odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.14-2.36. In women, both untreated hearing loss, (OR = 1.45, CI 1.07-1.98) and treated hearing loss (OR= 1.46, CI 1.06-2.04) were associated with levels of cognitive impairment. Conclusions: Hearing loss was found to be associated with cognitive impairment despite hearing aid use as well as awareness amongst physicians. The introduction of screening programs for hearing loss in older adults could be a crucial step for earlier identification of individuals at higher risk of developing cognitive impairment and dementia.

The association between loneliness, social isolation, and sleep disturbances in older adults: A follow-up study from the Swedish good aging in Skåne project.

Objectives: The aim of this follow-up study was to investigate whether loneliness and social isolation in a sample of older adults, mean age of 67.4 years at baseline examination, were associated with sleep disturbances at re-examination at a mean age of 76.4 years. Methods: The study sample consisted of 2897 participants. Data on loneliness, social isolation, and sleep disturbances were collected through questionnaires and medical examinations. Logistic regression models were constructed to identify associations between levels of loneliness and social isolation at baseline and sleep disturbances at follow-up. Sociodemographic and health-related confounding factors were controlled for in the models. Results: Sleep disturbances were reported by 25.6% (95% CI: 24.0%-27.2%) at baseline and 23.7% (95% CI: 22.1%-25.3%) at re-examination. Odds ratios for sleep disturbances at re-examination in relation to not being lonely or socially isolated were as follows: single occasions of loneliness (OR: 1.37, 95% CI: 1.05-1.78), recurring periods/constant loneliness (OR: 1.92, 95% CI: 1.01-1.99), less severe social isolation (OR: 1.18, 95% CI: 0.78-1.79), and severe social isolation (OR: 1.88, 95% CI: 1.01-3.49). Discussion: Sleep disturbances are common among older adults and are associated with loneliness and social isolation. Healthcare professionals should be aware of the potential effects of loneliness and social isolation when investigating sleep disturbances in older adults.

Loneliness, social isolation, and health complaints among older people: A population-based study from the "Good Aging in Skåne (GÅS)" project.

Purpose: To explore associations between perceived loneliness, social isolation, and health complaints among older people. Methods: 5804 participants from the Swedish population study "Good Aging in Skåne" were included. Structured interviews and questionnaires were used to assess perceived loneliness, social isolation, 30 somatic and mental-health related symptoms, socio-demographics, lifestyle, and health. The mentioned symptoms were divided into seven symptom domains: depressive, tension, gastrointestinal- and urinary, musculoskeletal, metabolic, cardiopulmonary, and head-related symptoms. Multiple linear regression was performed to assess associations between reported symptoms and degree of perceived loneliness and social isolation. Multiple logistic regression models were constructed to investigate associations between the prevalence of symptoms in the symptom domains and perceived loneliness and social isolation. Results: 60% of the participants reported feeling lonely at least occasionally. Social isolation was noted by 6%. Higher levels of perceived loneliness were associated to an increased number of reported symptoms. Lonely participants had a higher prevalence of symptoms in all investigated symptom domains, ranging from 67% (gastrointestinal-urinary) to 96% (depressive) for the group experiencing constant loneliness. Conclusions: Perceived loneliness is a common condition among older people in modern day Sweden and potentially harmful for their subjective well-being and health.

Non-monotone cellular automata: Order prevails over chaos.

We consider a model for the propagation of electrical impulses or activity in a neuronal network. The vertices of a square lattice represent neurons, and the edges of the lattice represent the synaptic connections. Each vertex v is assigned a type: inhibitory or excitatory. The dynamics of propagation of the initial activity captures features of the "integrate-and-fire" model. We study the spread of activation in a large network and describe possible spatio-temporal limiting patterns depending on the initial activation. The rich palette of the limits with qualitatively different properties, including expanding patterns, fixed patterns, and patterns moving across the network, allows us to argue that this is a versatile model for the study of associative memory.

Being an older family caregiver does not impact healthcare and mortality: Data from the study 'Good Aging in Skåne'.

BACKGROUND: Will being a caregiver further impact the health of a group already at risk of adverse health due to old age? This study aimed to answer the questions whether short- and long-term healthcare consumption and mortality differ between informal caregivers and non-caregivers and between high-burden and low-burden informal caregivers. METHOD: The study population consisted of 423 caregivers and 3444 controls from the Swedish national general population study 'Good Aging in Skåne'. Caregivers were divided into those reporting high and low caregiver burden and information on caregiver status was collected from questionnaires. Data for mortality and healthcare consumption (inpatient and outpatient visits) were obtained from The National Board of Health and Welfare. Mortality was tested with Cox regression models and healthcare consumption with logistic regression models, adjusted for sociodemographic covariates, Activities of daily living (ADL) and number of chronic diseases. RESULTS: Caregivers were younger than non-caregivers, had higher educational background, more independent in ADL and more often men. Of 423 caregivers, 73 (17.3%) reported experiencing high caregiver burden. High-burden caregivers were older, more dependent in personal ADL and gave more hours of care than those reporting low burden. In adjusted regression models, we found no differences in either consumption of healthcare nor mortality between caregivers and non-caregivers and high-burden v. low-burden caregivers looking at short-term (1 and 3 years) and long-term (10 and 15 years) follow-up periods. CONCLUSIONS: Our findings suggest that the characteristic of being a family caregiver does not have an impact on mortality or physical health measured as inpatient admissions or instances of primary care.

Physical Performance in Older Cohorts: A Comparison of 81-Year-Old Swedish Men and Women Born Twelve Years Apart-Results from the Swedish Study "Good Aging in Skåne".

MATERIALS AND METHODS: Birth cohorts of both sexes drawn from the Swedish study "Good Aging in Skåne" for the years 1920-22 and 1932-34 were compared. Walking, the step test, the chair stand test, and the handgrip strength test were used as proxies for the physical performance. The results were adjusted for lifestyle habits and common chronic geriatric diseases. RESULTS: Both men and women in the later-born cohort walked more quickly and completed the chair stand test faster, and women were also quicker in the step test. No significant differences were found in the grip test, in either the male or female cohorts. Discussion. Normative reference values for physical tests of subjects of different ages can be misleading unless cohort effects are considered. Furthermore, age-related trajectories can also be misinterpreted if cohort effects are neglected which, in the longer perspective, could affect health care planning. CONCLUSION: Birth cohort effects should be considered when comparing walking speed, number of steps, chair stands, and the step test, in men and women of older age.

The Life Satisfaction Index-A (LSI-A): Normative Data for a General Swedish Population Aged 60 to 93 Years.

PURPOSE OF STUDY: To gain Swedish norm value for the Life Satisfaction Index-A (LSI-A) in a population 60-93+ years old stratified for sex and age and to relate these norm values with respect to number of chronic diseases and functional impairment. MATERIALS AND METHODS: The study population included a random sample of 2656 men (45.7%) and 3159 (54.3%) women from the longitudinal national studies' "Good Aging in Skåne" (GÅS) and SNAC-B, both part of the Swedish National Study on Aging and Care (SNAC). Data on Neugartens Life Satisfaction Index-A (LSI-A), medical history, activities of daily life (ADL) and socio-demographics were collected through structured interviews and questionnaires. RESULTS: Men scored significantly higher than women; 28.5, sd=6.9, and 27.3, sd=6.6, respectively, out of maximum 40 points. For both genders the scores decreased with age, mean score 6.0 points, lower for men and 7.1 points lower for women between 60 and 93+ years. The highest score was noted for healthy individuals where both men and women scored 29.5 points, sd=6.2. Increased number of chronic diseases and dependency in ADLs were associated with lower LS. CONCLUSION: Norm values here presented may facilitate assessments and evaluation of life satisfaction in the general elder population and as reference values to clinical trials. Female sex, rising age, morbidity and impaired functional ability were all associated with impaired LS.

High Burden among Older Family Caregivers is Associated with High Prevalence of Symptoms: Data from the Swedish Study "Good Aging in Skåne (GÅS)".

BACKGROUND/AIM: Certain groups of informal caregivers have been shown to have worse health compared to noncaregivers. The aim of this cross-sectional study was to explore the health and gender aspects of caregiving in an older Swedish population. METHODS: Our study included 5457 participants from the longitudinal, general population study "Good Aging in Skåne." A total of 33 self-reported symptoms were obtained from questionnaires and were then divided into seven domains: depressive, musculoskeletal, gastrourinary, symptoms related to head, cardiopulmonary, symptoms related to tension, and metabolic symptoms. Multivariate logistic regression analysis was performed to assess the risk of developing symptoms in each of the seven domains, regarding caregiving burden and caregiving in relation to gender. RESULTS: We found that caregivers, compared to noncaregivers, had a higher prevalence for depressive and tension-related symptoms. High-burden caregivers exhibited significantly more individual symptoms and a higher prevalence of symptoms in the depressive, tension, and gastrourinary domains of symptoms compared to both low-burden caregivers and noncaregivers. More than 79% of high-burden caregivers reported general fatigue, and over half of the high-burden caregivers experience depressive mood. Female caregivers showed a significantly higher risk of reporting depressive symptoms (OR = 1.54, 95% CI 1.19-1.98) and tension-related symptoms compared to male caregivers. CONCLUSION: Depressive and tension-related symptoms were more common in caregivers, especially in high-burden caregivers. High-burden caregivers might be at a risk of adverse mental health, and this highlights the need to offer proper support to these groups.

Pain and alcohol: a comparison of two cohorts of 60 year old women and men: findings from the Good Aging in Skåne study.

Background and aims Pain, use of painkillers and alcohol are highly prevalent in the general population. Aims of the study were to describe differences in pain, alcohol consumption and use of painkillers among two 60 year old birth cohorts stratified by gender. Methods Participants were recruited from the Skåne centre of The Swedish National study on Aging and Care, a multicentre, prospective, longitudinal study. The sample comprised 60 year old men and women born between 1941 and 1943 and recruited to the study between 2001 and 2004 (n=663) and 60 year old men and women born in the period 1952-1954 and recruited to the study between 2013 and 2015 (n=924). Specially trained research staff conducted the interviews. For descriptive statistics the variables were presented in total numbers, percentages, mean and standard deviation, and 1st and 3rd quartile are also shown. The sample was divided into four groups: men and women born in the period 1941-1943, men and women born in the period 1952-1954, respectively. Results No difference in alcohol intake was detected between the two birth cohorts. All participants, regardless of pain or not, reported alcohol use below the specified risk level for both sexes. Teetotallers were more common in the 1952-1954 male cohort, 128 (29%), p<0.029. Two hundred and eighty one Men born between 1952 and 1954 reported pain (59.0%), compared to 173 men born between 1941 and 1943 (51.6%), p<0.034. There was no difference between the male cohorts in use of painkillers, p<0.062. No difference was found between the two female cohorts in terms of pain, p<0.144. One hundred and ten women in the 1941-43 cohort used painkillers (53.1%) compared to 119 women born between 1952 and 1954 (40.1%), p<0.004. When comparing men and women with pain born between 1941 and 1942, men with moderate pain use more alcohol, 157 g/month (q1 10, q3 365) than women, 44 g/month (q1 0, q3 134), p<0.001. Men with severe pain also use more alcohol, 96 g/month (q1 17, q3 324) than women, 27 g/month (q1 0, q1 118), p<0.030, and when those with pain were merged into a group, men use more alcohol, 175 g/month (q1 31, q3 356), than women, 68 g/month (q1 1, q3 207), p<0.001. This also applies to the later cohort; men, 132 g/month (q1 22, q3 270), compared to women, 76 g/month (q1 8, q3 182), p<0.001. When merging all pain into one group women use more painkillers both in the 1941-43 cohort, men (39.9%) compared to women (53.1%), p<0.010 and in the 1952-54 cohort, men (18.5%) compared to women (26.6%), p<0.003. Use of analgesics and alcohol is common but the highest percentage is among women born between 1941 and 1943, 45 (48.9%). Conclusions Pain and alcohol use are common among 60 year old women and men. A gender difference is that women use more painkillers. In the 1941-43 cohort almost every second woman with moderate pain who took painkillers also consumed alcohol. Implications It is time to alert prescribers that a large section of the population uses alcohol combined with painkillers. More research is needed to better understand the long-term perspective on health when using both painkillers and alcohol.

High-resolution dynamic computer simulation of electrophoresis using a multiphysics software platform.

The modeling and simulation software COMSOL Multiphysics® was recently extended with an electrophoretic transport interface. Its performance was investigated by comparison to results obtained using the 1D dynamic electrophoresis simulators GENTRANS and SIMUL5. Simulations of zone electrophoresis, isotachophoresis, isoelectric focusing and of an oscillating electrolyte system were performed. Smooth profiles were essentially identical indicating that the COMSOL electrophoretic transport interface is able to reproduce results of the 1D simulators. Differences in the way the respective numerical schemes handle steep concentration gradients and associated instabilities were observed. The COMSOL electrophoretic transport interface is expected to be useful as a general model for simulations in 1D, 2D or 3D geometries, as well as for simulations combining electrophoresis with other physical phenomena.

The association between medical diagnosis and caregiver burden: a cross-sectional study of recipients of informal support and caregivers from the general population study 'Good Aging in Skåne', Sweden.

BACKGROUND: Different kinds of chronic diseases might imply different dimensions of caregiver burden, not previously described among the caregivers to recipients from the general elder population. AIM: The main objective was to examine differences in burden between the 343 caregivers to persons with different diagnoses. METHODS: A group of elderly recipients of informal care (n = 343) from the general population study 'Good Aging in Skåne' (GÅS) Sweden, were divided into five diagnostic groups: dementia (n = 90), heart and lung diseases (n = 48), stroke (n = 62), fractures (n = 66), depression (n = 40) and the group "other", consisting of different diagnoses (n = 37) according to ICD-10. Differences in burden were analyzed using the Caregiver Burden Scale (CBS), a 22-item scale consisting of five dimensions: general strain, isolation, disappointment, emotional involvement and environmental burden. A total burden index comprises the mean of all the 22 items and a higher score indicates a higher burden. RESULTS: The most common diagnosis associated to caregiving was dementia and fracture and the median hours weekly for informal support with instrumental ADL for the five diagnostic groups ranged from 7 to 45 h for spouses and from 4 to 7 h for parents. The highest proportion of caregivers scoring high total burden was seen among recipients with dementia (50%) and depression (38%); the OR for high total burden for the dementia group was 4.26 (2.29-7.92) and depression group 2.38 (1.08-5.24) adjusted for covariates like age, gender and ADL and these two groups had higher self-perception of burden in all the dimensions, especially the dimension's emotional burden and strain. CONCLUSION: Informal support constitutes a substantial time for instrumental ADL for the diseased elders. Caregivers to persons with dementia and depression experience high burden.

The association between indicators of health and housing in people with Parkinson's disease.

BACKGROUND: There are knowledge gaps about the life situation for people ageing with Parkinson's disease (PD), with virtually no understanding of home and health dynamics. Therefore, the aim of the present study was to explore the association between aspects of health and objective as well as perceived housing in people with PD. METHODS: Participants were recruited from three hospitals in the region of Skåne in southern Sweden. The sample for the present study included 231 (62 % men) participants with PD, with a mean age of 75 (min-max, 45-93) years. The data collection procedure included a self-administered postal survey and a subsequent home visit where structured interviews, observations and clinical assessments were administered. To study the association between aspects of health and housing canonical correlation was applied. Twelve variables (6 in the health and 6 in the housing set) were included. This corresponds to about 20 individuals per variable and is considered sufficient to accurately interpret the largest (i.e., first) canonical correlation. RESULTS: The analysis between the health variables and housing variables set yielded two significant pairs of variates with the canonical correlations 0.68 (p < 0.0001) and 0.33 (p = 0.0112), respectively. For the first pair of variates the canonical R(2) was 0.46. The results showed that external control beliefs and behavioral aspects of meaning of home contributed the most to the housing variate, whereas difficulties/dependence in activities of daily living (ADL) and functional limitations contributed the most to the health variate. Although a significant relationship was found for the second canonical correlation, the shared variance between the two variates was considerably lower; R(2) = 0.11. CONCLUSIONS: This study suggests that people with PD who have more functional limitations, difficulties in ADL and are more dependent perceive their homes as less meaningful from a behavioral perspective. Moreover, they tend to rely on external influences managing their housing situation. With this kind of knowledge at hand, health care and social services professionals are in a better position to observe and efficiently address problems related to health and housing among people with PD.

Home and health among different sub-groups of the ageing population: a comparison of two cohorts living in ordinary housing in Sweden.

BACKGROUND: At present a majority of older people remain in their ordinary homes. Research has generated knowledge about home and health dynamics and increased the awareness of the complexity of housing as related to ageing. As this knowledge is based mainly on research on very old, single-living people in ordinary housing there is a need to study other sub-groups of the ageing population. Thus, the aim of the present descriptive study was to compare a younger old cohort with a very old cohort living in ordinary housing in Sweden in order to shed new light on home and health dynamics in different sub-groups of the ageing population. METHODS: Cross-sectional study of two population-based cohorts: one aged 67-70 years (n = 371) and one aged 79-89 years (n = 397) drawn from existing Swedish databases. Structured interviews and observations were conducted to collect data about socio-demographics, aspects of home, and symptoms. Besides descriptive statistics we computed tests of differences using the Chi-squared test and Mann-Whitney U-test. RESULTS: Accessibility was significantly lower in the very old cohort compared to the younger old cohort even though the former were objectively assessed to have fewer environmental barriers. Those in the very old cohort perceived aspects of their housing situation as worse and were more dependent on external influences managing their housing situation. Although a larger proportion of the very old cohort had more functional limitations 22% were independent in ADL. In the younger old cohort 17% were dependent in ADL. CONCLUSIONS: Keeping in mind that there were cohort differences beyond that of age, despite fewer environmental barriers in their dwellings the very old community-living cohort lived in housing with more accessibility problems compared to those of the younger old cohort, caused by their higher prevalence of functional limitations. Those in the very old cohort perceived themselves in a less favourable situation, but still as satisfied with housing as those in the younger old cohort. This kind of knowledge is indicative for prevention and intervention in health care and social services as well as for housing provision and societal planning. Further studies based on truly comparable cohorts are warranted.

Use, non-use and perceived unmet needs of assistive technology among Swedish people in the third age.

PURPOSE: To describe the most prominent use of or perceived unmet need of assistive technology (AT) and to compare the characteristics of users, non-users and those expressing perceived unmet need with respect to overall health, independence in everyday life, environmental barriers and socio-demographic features. METHOD: The study is based on data collected in the "Home and Health in the Third Age Project". In all, 371 individuals participated and data were collected during home visits in southern Sweden by interviewers trained specifically for this project. The data collection comprised well-proven self-report scales and observational formats on the home environment and health indicators as well as questions about basic demographics and socio-structural data. RESULTS: The proportion of users constituted almost half of the total sample. The most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need concerned AT for communication, in total 8%. Those cohabiting were to a higher extent users of AT for furnishing/adaptation, compared to those who lived alone. A higher perceived unmet need was seen among those who lived alone compared with cohabiting people. CONCLUSIONS: These findings are of importance for future planning and development of policy to improve health services for the new generation of elderly. Implications for Rehabilitation In order to support the ageing process, the need for assistive technology has to be monitored in the third age. Assistive technology for furnishings and adaptation are frequently used by individuals in their third age and are important to support ageing in the home. Not only do health aspects impact the use of assistive technology, but gender, living conditions and social situation also matter - older men especially need to be monitored thoroughly according to their perceived unmet needs as well as do older persons living alone.

Relationships between perceived aspects of home and symptoms in a cohort aged 67-70.

The importance of the home environment increases with age. Perceived aspects of home influence life satisfaction, perceived health, independence in daily activities and well-being among very old people. However, research on health and perceived aspects of home among senior citizens in earlier phases of the aging process is lacking. Therefore, the main aim was to explore whether perceived aspects of home are related to number of and specific domains of symptoms in a cohort of people aged 67-70. Interview and observation data on aspects of home and health, collected with 371 individuals living in ordinary housing in urban as well as rural areas in southern Sweden, were used. Descriptive statistics, correlations, multiple linear and logistic regression models were employed. The results showed that the median number of symptoms was 6.0. Reporting fewer reported symptoms was associated with a higher meaning of home (p=0.003) and lower external housing related control beliefs (p=0.001) but not with usability in the home. High external control beliefs were significantly associated with symptoms from head (p=0.014), gastrointestinal (p=0.014) and tension symptoms (p≤0.001). Low meaning of home was significantly associated with heart-lung symptoms (p=0.007), and low usability was associated with depressive symptoms (p=0.003). In conclusion, showing that perceived aspects of home are important for health in terms of physical and mental symptoms, this study contributes to the knowledge on the complex interplay of health and home in the third age.

Coping as a caregiver: a question of strain and its consequences on life satisfaction and health-related quality of life.

A majority of us will at some point in our lives take care of family members, relatives and friends in need of assistance. How will this affect us? Strain related to life satisfaction (LS) and health related quality of life (HRQoL) among caregivers aged 60 years and older has not been previously studied. OBJECTIVES: The main objective was to describe characteristics of non-caregivers (n=2233) and caregivers (n=369). Further objectives were to examine differences in HRQoL and LS between caregivers and non-caregivers, and between caregivers stratified by level of strain. METHODS: We analyzed the differences in socio-demographics, social participation, locus of control and symptoms between groups. HRQoL was assessed by Short Form Health Survey (SF-12/PCS and MCS). LS was measured by the Life Satisfaction Index-A (LSI-A). RESULTS: Caregivers were younger, had more years of formal education, more often cohabiting and relied less on powerful others than non-caregivers. One hundred and thirty-three (36%) caregivers reported high strain. In a three-group comparison including non-caregivers and caregivers stratified for strain, high strain was associated with lower SF12-PCS, SF12-MCS and LSI-A (0.014, <0.001 and <0.001, respectively). CONCLUSION: High strain affects caregivers' HRQoL and LS in a negative way. PRACTICE: It is important for the health care sector to consider the possibility that symptoms in a person acting as a caregiver can be related to high perceived strain. IMPLICATIONS: A general policy program aiming to identify caregivers and their needs for support is much needed.

Both deterioration and improvement in activities of daily living are related to falls: a 6-year follow-up of the general elderly population study Good Aging in Skåne.

OBJECTIVES: To determine the relationship between long-term change in activities of daily living (ADL) and falls in the elderly and to identify characteristics of groups at risk for falls. METHODS: This was a 6-year, prospective cohort study using data from the Good Aging in Skåne study in southern Sweden, involving 1,540 elderly subjects, including the oldest-old (age, 60-93 years). The subjects were recruited from the general population. ADL was measured at a baseline and follow-up assessment, using Sonn and Åsberg's revised scale and the ADL staircase. Falls were recorded in a period of 6 months before the follow-up assessment. The association between falls and change in ADL was calculated using adjusted, multiple logistic regression analysis and presented in odds ratios (ORs). RESULTS: Thirteen percent of the study population reported one or several falls in the measured period. Over the course of 6 years, one in four participants changed their ADL status, and parts of this category had an increased risk for falls compared with those who stayed independent in ADL or who had no change in the ADL staircase. Groups with different characteristics had a prominent risk for falls: those with a reduction of two to eight steps in the ADL staircase (OR, 4.05; 95% confidence interval [CI], 1.62-10.11) and those becoming independent from dependency in instrumental ADL (OR, 4.13; 95% CI, 1.89-9.00). The former group had advanced age with a greater burden of cognitive impairment, gait disability, arrhythmia, and fall risk medications. The latter group had a higher prevalence of ischemic heart disease and low walking speed. CONCLUSION: Both deterioration and improvement in ADL over the course of 6 years increased the risk for falls in a general elderly population. Interventional efforts may require different strategies, as groups with different characteristics were at risk. Those at risk with improved ADL function may have a history of sufficient burden of comorbidity combined with obtained mobility for exposure to a fall event.