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Being old in our society: health, functional status, and effects of research
Karolinska Institutet.ORCID iD: 0000-0001-5800-6454
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis concerns health and functional status in old age, as well as older adults' attitudes towards research participation. Five studies were performed using data from the Kungsholmen Project, a population-based study on ageing and dementia ongoing in Stockholm since 1987.

Occurrence of dementia. Both prevalence and incidence of dementia were investigated. In the 75-79 age group the incidence rates for dementia were 19.6 for women and 12.4 for men per 1,000 person-years, whereas the corresponding figures were 86.7 and 15.0 among 90+ year old subjects. A prevalence study with an enlarged sample of nonagenarians showed that the probability of having dementia after the age of 75 increased by 10% each year and 90% every 5 years. AD contributed to 76. 5% and VaD to 17.9% of the prevalent cases.

Health and functional status. Higher morbidity prevalence in women than in men was detected only after the age of 85. 90+ year old women compared to men had an OR=2.2 (95% CI 1.1-4-3) for disability after adjustment for age, education, and number of diseases. Functionally independent men in the youngest age group had a higher risk of death than women (OR=0.4; 95% CI 0.3-0.7), whereas no gender difference was found among disabled subjects. Incidence of long term disability in women was higher than in men only in the 90+ years old subjects, although the difference was not statistically significant after adjustment.

Effects of research. In a postal questionnaire, 79% of the subjects reported advantages in research participation. Older elderly with impaired cognitive functioning and lower education showed the least positive attitude. The first contact and the cognitive testing were judged as the most stressful situations. Community-based longitudinal surveys also appear to have a social function, thus stressing ethical issues regarding the termination of contact when studies are completed.

Conclusions. The dementia incidence increases with age, even in the most advanced ages. This increase is especially evident among women, leading to an increased risk of dementia in the male gender. A large proportion of nonagenarians were functionally independent (73%) despite their advanced age, and 19% had no diseases at all. The gender distribution of morbidity, mortality and disability was modified by age. 90+ year old women were more disabled than men, partially due to the excess of dementia and other chronic diseases. We hypothesise that more women may be at higher risk of developing severe disability than men in the advanced ages due to a longer survival of women with slight disability in earlier ages.

Finally, this thesis provides empirical data concerning the impact of longitudinal research on participants that may help researchers in lowering the refusal rate in epidemiological studies, and might assist ethics committees in making their judgements.

Place, publisher, year, edition, pages
Stockholm: Norstedts Förlag, 2000. , 51 p.
Keyword [en]
ageing, attitude, dementia, functional status, morbidity, participation, population survey, nonagenarians
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:rkh:diva-561ISBN: 91-628-4189-0 (print)OAI: oai:DiVA.org:rkh-561DiVA: diva2:608805
Public defence
2000-05-25, Finskt Äldrecentrum, Sabbatsbergsområdet, Olivecronas väg 14, 00:00
Available from: 2014-09-17 Created: 2013-03-01 Last updated: 2016-04-19Bibliographically approved
List of papers
1. Very Old Women at Highest Risk of Dementia and Alzheimer's Disease: Incidence Data from the Kungsholmen Project, Stockholm
Open this publication in new window or tab >>Very Old Women at Highest Risk of Dementia and Alzheimer's Disease: Incidence Data from the Kungsholmen Project, Stockholm
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1997 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 48, no 1, 132-138 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To determine the incidence of different types of dementia in the very old, and to explore the relation with age and gender. Design: A dementia-free cohort was followed for an average of three years in Stockholm, Sweden. At the end of the follow-up, the subjects were interviewed by nurses, clinically examined by physicians, and cognitively assessed by psychologists. Deceased cohort members were studied using death certificates, hospital clinical records, and discharge diagnoses. Dementia diagnoses were made according to the DSM-III-R criteria independently by two physicians. Participants: The cohort consisted of 1,473 subjects (75+ years old), of which 987 were clinically examined at follow-up, 314 died before the examination, and 172 refused to participate. Results: During the follow-up, 148 subjects developed dementia. In the age-group 75 to 79, the incidence rates for dementia were 19.6 for women and 12.4 for men per 1,000 person-years, whereas for 90+ year-old subjects the corresponding figures were 86.7 and 15.0 per 1,000 person-years. A similar pattern of distribution by age and gender was seen for Alzheimer's disease. In each age stratum, the incidence rates of dementia and Alzheimer's disease were higher for women than for men. The age-adjusted odds ratio for women was 1.9 for dementia and 3.1 for Alzheimer's disease. Conclusions: (1) The incidence of dementia increases with age, even in the oldest age groups; (2) women have a higher risk of developing dementia than men, especially at very old ages; (3) this pattern is mainly due to the age and gender distribution of Alzheimer's disease, rather than vascular dementia.

Place, publisher, year, edition, pages
American Academy of Neurology, 1997
Keyword
Alzheimer's disease, dementia, old women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-619 (URN)10.1212/WNL.48.1.132 (DOI)9008508 (PubMedID)
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2016-04-19Bibliographically approved
2. Aging and the occurrence of dementia: Findings From a Population-Based Cohort With a Large Sample of Nonagenarians
Open this publication in new window or tab >>Aging and the occurrence of dementia: Findings From a Population-Based Cohort With a Large Sample of Nonagenarians
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1999 (English)In: Archives of Neurology, ISSN 0003-9942, E-ISSN 1538-3687, Vol. 56, no 5, 587-592 p.Article in journal (Refereed) Published
Abstract [en]

Context In spite of numerous studies on the occurrence of dementia, many questions remain, such as the relation between age, aging, and dementing disorders. This question is relevant both for understanding the pathogenetic mechanism of the dementias and for the public health prospective because of the increasing number of 85-year-old or older persons in our population.

Objective To estimate the occurrence of dementia in the very old, including nonagenarians, in relation to age, gender, and different dementia types.

Design An epidemiological survey where all participants were clinically examined by physicians, assessed by psychologists, and interviewed by nurses. The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for dementia were followed. A category of "questionable dementia" was added when all criteria were not fulfilled. A double diagnostic procedure was used for all subjects.

Setting Community-based population, including all inhabitants of 2 areas in central Stockholm, Sweden (N=1848).

Participants Of the 1848 subjects in the study population, 168 (9.1%) had died and 56 (3%) moved before examination. Of the remaining subjects, 1424 (87.7%) were examined, and the refusal rate was 12.3%.

Main Outcome Measures Age- and gender-specific prevalence figures, and gender- and education-adjusted odds ratios were used.

Results At the end of the diagnostic procedure, 358 clinically definite cases of dementia and 101 questionable cases of dementia were identified. Alzheimer disease (AD) contributed to 76.5%, and vascular dementia (VaD) to 17.9%. The prevalence of dementia increases from 13% in the 77- to 84-year-old subjects to 48% among persons 95 years and older (from 18% to 61% when questionable cases were included). The odds ratio for subjects 90 to 94 years and 95 years and older in comparison with 77- to 84-year-old subjects was 3.7 (95% confidence interval [CI], 2.7-5.1) and 6.5 (95% CI, 3.9-10.8) for dementia, 4.8 (95% CI, 3.3-7.0) and 8.0 (95% CI, 4.6-14.0) for persons with AD, 2.3 (95% CI, 1.3-4.2) and 4.6 (95% CI, 1.9-11.2) for VaD, respectively.

Conclusions Dementia prevalence continues to increase even in the most advanced ages. This increase is especially evident among women and is more clear for AD. We believe that our prevalence data reflect the differential distribution of dementia risk.

Place, publisher, year, edition, pages
American Medical Association, 1999
Keyword
aging, dementia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-615 (URN)10.1001/archneur.56.5.587 (DOI)10328254 (PubMedID)
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2016-04-19Bibliographically approved
3. Morbidity and comorbidity in relation to functional status: a community-based study of the oldest old (90+ years)
Open this publication in new window or tab >>Morbidity and comorbidity in relation to functional status: a community-based study of the oldest old (90+ years)
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2000 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 48, no 11, 1462-1469 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To describe health and functional status in the oldest old; to explore the relationships of morbidity and functional status; and to verify whether this relationship was modified by gender. DESIGN AND SETTING: A community-based survey including all inhabitants aged > or = 90 living in central Stockholm, Sweden. All participants were clinically examined by physicians, cognitively assessed by psychologists, and interviewed by nurses. Diagnoses were made according to the International Classification of Diseases-Ninth Revision (ICD-9), the DSM-III-R criteria for dementia, and Katz index of activities of daily living. PARTICIPANTS: Of the 698 subjects in the study population, 99 (14%) had died and 29 (4%) moved before examination. Of the remaining subjects, 502 (88.1%) were examined, and the refusal rate was 11.9%. MEASUREMENTS: Age- and gender-specific prevalence figures, and age-, gender- and education-adjusted odds ratios (OR) were used. RESULTS: Of 502 examined subjects, 19% had no disease and 73% were functionally independent. Dementia was the most prevalent disease among women (42.2%), and cardio- and cerebrovascular diseases were the most frequent among men (42.4%). Women had higher prevalences of dementia (adjusted OR = 2.1, 95% confidence interval (CI) 1.2-3.7) and fractures and musculoskeletal diseases (adjusted OR = 2.8, 95% CI 1.1-7.3), whereas men had a higher prevalence of malignancy (OR = 0.2, 95% CI 0.1-0.7). Women were more disabled than men independent of age, education, and number of diseases (adjusted OR = 2.2, 95% CI 1.1-4.3). CONCLUSIONS: A great proportion of nonagenarians were functionally independent despite their advanced age. Further studies are needed to clarify the excess of disability among very old women.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2000
Keyword
aged, health status
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-614 (URN)11083324 (PubMedID)
Note

Som manuskript i avhandling. As manuscript in dissertation.

Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2016-04-19Bibliographically approved
4. Morbidity, mortality and basic functioning in the elderly: The effect of age on the differential gender distribution
Open this publication in new window or tab >>Morbidity, mortality and basic functioning in the elderly: The effect of age on the differential gender distribution
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-1043 (URN)
Note

Som manuskript i avhandling. As manuscript in dissertation.

Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2016-04-19Bibliographically approved
5. Attitudes and participation of the elderly in population surveys: data from a longitudinal study on aging and dementia in Stockholm
Open this publication in new window or tab >>Attitudes and participation of the elderly in population surveys: data from a longitudinal study on aging and dementia in Stockholm
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1998 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 51, no 3, 181-187 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this article was to assess the attitudes of older adults (age >74 years) toward research participation. A questionnaire was mailed to the study population (n = 1197) which included people who had participated in a longitudinal study once, twice, three times, or more. The participants showed a positive attitude in general as 79% saw an advantage of participation and 72% did not report any negative reaction. Older elderly with impaired cognitive functioning and lower education showed the least positive attitude, reporting the first contact and the cognitive testing as the most stressful situations. The group who had participated more than once was the most positive, but more often refused some parts of the clinical examination. We conclude that: (1) more attention is necessary to the initial contact; (2) reduction of stressful or tiring examinations is recommended; and (3) complete information about the research, including the right to refuse individual parts of the study, must be given. Such procedures will improve both the quality and the ethics of the research.

Place, publisher, year, edition, pages
Elsevier, 1998
Keyword
elderly, participation, attitude, cognitive impairment, population survey, longitudinal study
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-618 (URN)10.1016/S0895-4356(97)00242-4 (DOI)9495683 (PubMedID)
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2016-04-19Bibliographically approved

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