Social and emotional loneliness among non-demented and demented elderly people.

There is a lack of studies about loneliness and cognitive functioning among elderly people and, above all, among those with cognitive impairment. The aim of this study is to investigate loneliness, both social and emotional, in non-demented and demented elderly people. The study is based on 589 persons, who answered the question about social loneliness (often being lonely) in the Kungsholmen longitudinal project. All subjects were examined extensively to reach a diagnosis and to determine the dementia level. Data were collected through structured interviews on subjective social loneliness as well as emotional loneliness (feelings of loneliness, from often to never) and background variables (age, sex, housing and housing conditions). Non-demented elderly subjects reported themselves to be lonely significantly less often compared to demented subjects, but there were no differences in the emotional experience of loneliness. Social loneliness was more common in the different levels of dementia and increased with reduced cognitive functioning, while emotional loneliness decreased. Living together with someone and living in one's own apartment showed a positive influence on feelings of loneliness.

Quality of life among the elderly. State of mood and loneliness in two selected groups.

Cognitively impaired and intact elderly subjects from a longitudinal project were interviewed in a follow-up study about their present state of mood and how often they experienced loneliness. In all, 315 subjects were involved in the study. The dropout rate was high, about 50%, due to death and to the fact that some elderly persons--especially those with slightly impaired cognitive function--declined to participate. The present state of mood was measured by the Geriatric Depression Scale and loneliness was assessed by the question, 'Do you experience loneliness often, sometimes, seldom or never?' Most subjects (4 out of 5), above all those who were cognitively intact, reported basic satisfaction with their lives. The greatest difference in response between the two cognitive groups was found in the question about having an empty life. Loneliness and sad mood prevailed especially among subjects with cognitive difficulties. In summary, experiencing loneliness had a negative influence on the state of mood in both cognitive groups, particularly among persons with cognitive impairment.

Copying and handwriting ability in the screening of cognitive dysfunction in old age.

Geometric copying and handwriting tests are often assessed in the screening of cognitive deficiency in the elderly. The aim of the study was to show the regression of geometrical copying and handwriting with increasing cognitive impairment in old age. The study is population-based and includes 668 subjects aged 75 years and older, living in an inner-city area of Stockholm. The subjects were asked to copy a cube, two pentagons, a rhombus, two intersecting rectangles, and a circle. They were also asked to write a complete sentence spontaneously, a sentence from dictation and their name. Geometric copying and handwriting skills decreased in direct proportion to decreased cognitive functioning. The skills most sensitive to small changes in cognition were copying the cube and the pentagons. Other skills were less sensitive to small changes: writing a complete sentence, copying a rhombus, two rectangles and writing one's name. However, copying and handwriting appear to complement each other. Copying of the rectangles and rhombus is more useful than the other figures because these two can be discriminated throughout different stages of dementia. Sentence writing from dictation and signature can be used to evaluate severely impaired subjects because these skills seem to be retained longer than the spontaneous sentence writing.

Human-figure drawing (HFD) in the screening of cognitive impairment in old age.

OBJECTIVE: The aim of the study is to test the hypothesis that freehand human-figure drawing (HFD), can be used as a complementary screening instrument to differentiate between demented elderly people and healthy elderly controls in population based studies. METHOD: HFD was examined in 668 elderly ( > or = 75 years of age) participants from an epidemiological study in Stockholm, who were asked to draw a human figure. The drawings were analysed on the content of body details and structural characteristics. RESULT: The results show quite clearly that the body details and the height decrease with decreasing cognitive function, whereas the centredness (the distance in cm from the centre of the figure to the centre of the paper) increases with decreasing cognitive functioning. Demented people place their figures in the upper left corner of the sheet, compared with the mostly well centred figures of non-demented people. Age, on the other hand, has an influence on the HFD as after 90 years of age most of the variables show regressive changes. CONCLUSION: The HFD can help to differentiate between demented and non-demented subjects as well as between dementia of different severity. The HFD does not help us, however, to discriminate between Alzheimer's disease and vascular dementia. Age has an influence on the HFD in the sense that after 90 years most of the variables regress to a smaller or more primitive form.

The short human figure drawing scale for evaluation of suspect cognitive dysfunction in old age.

Human figure drawings have been widely used to assess cognitive development in children. In the present study, free-hand human figure drawings were examined for 62 demented patients, and 60 normal elderly subjects. The drawings were scored for 53 body details using a method derived from work with children. A short scale of 15 details was developed by selecting body details with high item-total correlations which are simple to score even for untrained staff. This short scale had excellent interscorer and test-retest reliability and excellent concurrent validity as well. It correlated highly with the Mini-Mental State Examination, a commonly used screening test for dementia. The short scale discriminated demented and non-demented subjects and different levels of dementia severity as graded by the Clinical Dementia Rating Scale. However, no differences were observed between Alzheimer patients and patients with vascular dementia concerning presence of details in human figure drawings.

Loneliness and living conditions of the oldest old.

This paper describes 211 of the oldest old, 90 years or older, in a broad perspective based upon well-being, living conditions and the living situation during a period of two and a half years. The subjects were interviewed, and at the first contact four out of five old persons were living in their own homes, 66% regarded themselves as healthy and three out of five depended on help for primary ADL. Approximately one of two experienced loneliness, the same proportion in each age group 90, 91 etc. Slight relations were found between experienced loneliness and age and subjective health. Slight relations were also found between subjective health and cognitive impairments. During the follow-up period 43% of the old people had died, and all were being cared for in institutions in their final stage of life.

Visual impairment related to cognition and loneliness in old age.

Reported problems in visual acuity were examined as determinants of loneliness experienced by community dwelling people with either impaired or unimpaired cognition. The Mini-Mental State Examination (MMSE) was used as a screening instrument to form a cognitively-impaired (MMSE 20-23/30) and a cognitively-intact group (MMSE 28-30/30). A total of 147 subjects took part in the study and were examined by an optometrist. Subjects with intact cognition tended to report visual problems more often than subjects with cognitive deficits. One out of two subjects had slight visual impairment, in both cognitive groups. After acuity had been optimally corrected, six to seven out of ten subjects' visual acuity did improve. In a multiple regression analysis, higher MMSE score and visual improvement were significantly related to lower levels of self-reported loneliness among the elderly with their cognition intact, but not among the subjects with impaired cognition.

ADL capacity and loneliness among elderly persons with cognitive impairment.

Advancing age brings a natural weakening of functions, making the individual rely more on support from the community and next-of-kin. The purpose of this study was to investigate, in relation to subjective loneliness, the ADL dependence of elderly persons with and without impaired cognitive capacity. 264 persons were interviewed. The Mini-Mental State Examination was used as a screening instrument for obtaining a cognitively-impaired and a normal group of elderly. Persons with impaired cognitive capacity who experienced loneliness had the greatest ADL dependence.

Predicting dementia from the Mini-Mental State Examination in an elderly population: the role of education.

Our study aimed to assess whether education affects the positive predictive value of the MMSE when it is used as a screening test for dementia. The MMSE has been consistently found to correlate with education and, at the same time, education is regarded by some researchers as being of potential etiological significance for dementia. In the present study, results on the MMSE from a community-based study in Sweden were compared with two standards: the clinical diagnosis of dementia and the Katz index of daily living activities. For both these comparisons, education did not substantially change the predictive ability of the MMSE. Our data, when compared with previous studies, show that the influence of education on the predictive ability of the MMSE varies in different populations. We conclude that differential MMSE cut-off points for different educational levels or adjustment techniques for education are not universally applicable.

Loneliness among elderly people living in stockholm: a population study.

The purpose was to investigate experienced loneliness among the elderly. The material included 1725 people, aged 75 and over. The study describes relationships between loneliness, social network, cognitive function and health. Thirty-five per cent experienced loneliness, and a higher percentage was found among women. A gradual increase in loneliness was found up to the age of 90, after which a levelling was found. Elderly persons living together with a partner experienced less loneliness. There were no significant differences between those with and without children. Ten per cent reported not having any friends and, of these, one out of two experienced loneliness. A high frequency of experienced loneliness was found among elderly people with reduced cognitive function. Subjectively experienced bad health and loneliness were strongly related to each other, i.e. a person who experienced loneliness did usually not feel completely healthy.

Subjective loneliness--a comparison between elderly and relatives.

The survey was aimed at examining the differences between the elderly's subjectively experienced loneliness and relatives' appraisal of the situation. The interviews contained structured questions about relatives' knowledge of the elderly's loneliness and their social contacts with the elderly. In total, 178 relatives took part in the interviews. The Cognitive-impaired group included 66 pairs elderly/relatives, where the elderly persons were cognitively impaired, and the Cognitive-intact group 112 pairs, where the elderly persons had normal cognitive function. There were differences between relatives' appraisal of loneliness and the elderly's own experience. The elderly with cognitive deficits seemed to feel loneliness more often than persons with intact cognitive ability. Relatives tended to overestimate the elderly's loneliness, especially among persons with cognitive difficulties. These elderly more often had short frequent visits, while persons in the Cognitive-intact group had longer, but not so frequent visits.

Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education.

We studied the prevalence of different types of dementia in an elderly population in Stockholm, Sweden, in relation to age, sex, and education. The study confirmed Alzheimer's disease (AD) as the most frequent type of dementia and the positive association of dementias with age, even in the most advanced ages. In contrast to previously reported data, we found the same proportion of AD and vascular dementia in the different age strata, and no sex differences regarding the prevalence of different dementia types. Finally, less educated people had a higher prevalence of all dementias, due essentially to a higher prevalence of alcoholic dementia and unspecified type of dementia. The prevalence of AD was similar across different levels of education.

Continuous cardiac output determination using transtracheal Doppler: initial results in humans.

Transtracheal Doppler, a procedure developed in the authors' laboratory, provides an estimate of cardiac output in endotracheally intubated dogs. The present study reports initial results in humans with a Doppler probe incorporated into an endotracheal tube. The system was first calibrated by empirically determining phi, the angle of the ultrasound beam with respect to the blood velocity vector. For a best least squares fit for phi, aortic diameters can be calibrated over a range of 22-37 mm. The calibration was then tested in a separate group of patients using the same empirically derived angle to calculate cardiac outputs. The transtracheal Doppler cardiac outputs show good correlation with those obtained by thermodilution over a range of cardiac outputs, 2.69-8.62 1/min, R2 = 0.835.

Transtracheal Doppler: a new procedure for continuous cardiac output measurement.

An endotracheal tube with a 5 mm diameter ultrasonic transducer incorporated into its distal end was inserted into the tracheas of six anesthetized dogs. The device provides for ultrasound measurement of aortic diameter and blood velocity in the ascending aorta to obtain cardiac outputs. Because measurements are made proximal to the origins of the aortic arch vessels, total cardiac output is obtained. Procedures for measurement of aortic diameter, aortic blood velocity, and cardiac output are discussed. The resulting data were used to empirically determine the angle of incidence of the ultrasound beam that gave the best least squares fit over a range of thermodilution cardiac outputs. For an angle of incidence of 62.3 degrees, the relationship between cardiac output determined by thermal dilution and by transtracheal Doppler was transtracheal Doppler cardiac output = -.69 + 1.19 thermal dilution cardiac output. R2 = .82. The results from this preliminary assessment of the feasibility of measuring cardiac output in dogs using transtracheal Doppler suggest that additional studies should be pursued. Additional issues that require investigation include confirmation of constancy of human anatomy and demonstration of lack of tracheal trauma from the Doppler equipped endotracheal tube.