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  • 1.
    Aguero-Torres, H
    et al.
    Aging Research Center (ARC).
    Kivipelto, M
    Aging Research Center (ARC).
    von Strauss, Eva
    Aging Research Center (ARC).
    Rethinking the dementia diagnoses in a population-based study: What is Alzheimer's disease and what is vascular dementia? A study from the Kungsholmen Project2006In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 22, no 3, p. 244-249Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the hypothesis that older adults often are affected by more than one disease, making the differential diagnosis between Alzheimer’s disease (AD) and vascular dementia (VaD) difficult. Methods: Incident dementia cases (n = 308) from a population-based longitudinal study of people 75+ years were investigated. The DSM-III-R criteria were used for the clinical diagnosis of dementia. Data on vascular disorders (hypertension, cerebrovascular and ischemic heart diseases, heart failure, atrial fibrillation, diabetes) as well as type of onset/course of dementia were used retrospectively to reclassify dementias. Results: Only 47% of the AD cases were reclassified as pure AD without any vascular disorder. Among subjects with AD and with a vascular component, cerebrovascular disease was the most common (41%). Only 25% of VaD were reclassified as pure VaD. Further, 26% of the pure AD subjects developed a vascular disorder in the following 3 years. Conclusions: Both vascular and degenerative mechanisms may often contribute to the expression of dementia among the elderly. Most of the AD cases have vascular involvements, and pure dementia types in very old subjects constitute only a minority of dementia cases.

  • 2.
    Agüero-Torres, H
    et al.
    Stockholm Gerontology Research Center, Karolinska Institute.
    Fratiglioni, L
    Guo, Z
    Viitanen, M
    von Strauss, Eva
    Winblad, B
    Dementia is the major cause of functional dependence in the elderly: 3-year follow-up data from a population-based study1998In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 88, no 10, p. 1452-1456Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of this investigation was to study the role of dementia and other common age-related diseases as determinants of dependence in activities of daily living (ADL) in the elderly. METHODS: The study population consisted of 1745 persons, aged 75 years and older, living in a district of Stockholm. They were examined at baseline and after a 3-year follow-up interval. Katz's index was used to measure functional status. Functional dependence at baseline, functional decline, and development of functional dependence at follow-up were examined in relation to sociodemographic characteristics and chronic conditions. RESULTS: At baseline, factors associated with functional dependence were age, dementia, cerebrovascular disease, heart disease, and hip fracture. However, only age and dementia were associated with the development of functional dependence and decline after 3 years. In a similar analysis, including only nondemented subjects. Mini-Mental State Examination scores emerged as one of the strongest determinants. The population attributable risk percentage of dementia in the development of functional dependence was 49%. CONCLUSIONS: In a very old population, dementia and cognitive impairment make the strongest contribution to both the development of long-term functional dependence and decline in function.

  • 3.
    Agüero-Torres, Hedda
    et al.
    Stockholm Gerontology Research Center and Division of Geriatric Medicine, NEUROTEC, Karolinska Institutet, Stockholm.
    von Strauss, Eva
    Stockholm Gerontology Research Center and Division of Geriatric Medicine, NEUROTEC, Karolinska Institutet, Stockholm.
    Viitanen, Matti
    Stockholm Gerontology Research Center and Division of Geriatric Medicine, NEUROTEC, Karolinska Institutet, Stockholm.
    Winblad, Bengt
    Stockholm Gerontology Research Center and Division of Geriatric Medicine, NEUROTEC, Karolinska Institutet, Stockholm.
    Fratiglioni, Laura
    Stockholm Gerontology Research Center and Division of Geriatric Medicine, NEUROTEC, Karolinska Institutet, Stockholm.
    Institutionalization in the elderly: The role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study2001In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 54, no 8, p. 795-801Article in journal (Refereed)
    Abstract [en]

    A population-based study of 1810 persons, aged 75+, was investigated to evaluate the role of dementia and other chronic diseases as determinants of institutionalization in the elderly. The study population was examined at baseline and after a 3-year interval. After adjustment for sociodemographic characteristics, functional dependence, dementia, cerebrovascular disease and hip fracture were associated with living in an institution at baseline. Additionally, functional dependence, hip fracture and dementia were also associated with moving to an institution during the 3-year follow-up. In a similar analysis, including only nondemented subjects, the Mini-Mental State Examination emerged as one of the strongest determinants. The population attributable risk percentage of institutionalization during the 3-year follow-up due to dementia was 61%. This study confirms that dementia and cognitive impairment are the main contributors to institutionalization in the elderly, independently of their sociodemographic status, social network, or functional status.

  • 4.
    Angleman, Sara B
    et al.
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden / Stockholm Gerontology Research Center, Sweden.
    Santoni, Giola
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.
    Von Strauss, Eva
    The Swedish Red Cross University College. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.
    Fratiglioni, Laura
    The Swedish Red Cross University College. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.
    Temporal Trends of Functional Dependence and Survival Among Older Adults From 1991 to 2010 in Sweden: Toward a Healthier Aging2015In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 70, no 6, p. 746-752Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Declines in functional dependence among older adults were observed before the 1990s, but there is uncertainty about subsequent trends. Our study aimed to verify the temporal trends in disability during 1991-2010 in an older Swedish population and to estimate the associated changes in survival.

    METHODS: Functional status in octogenarians and nonagenarians was assessed at seven occasions with intervals of 2-3 years. Sample size varied at each assessment with an average of 646 (range 212-1096). Disability was defined as difficulty in one or more of personal activities of daily living. We compared prevalence and incidence, as well as mortality, and survival associated with disability over the 20-year period.

    RESULTS: Sex-standardized prevalence of disability remained steady over time with a tendency toward a gradual decline, and a statistically significant decrease was present among nonagenarians. Sex-standardized cumulative incidence also remained steady. The proportion of people with prevalent disability who died <3 years remained stable, as did the survival time of people with incident disability. In contrast, among nondisabled persons, 3-year mortality decreased significantly, and for octogenarians median survival time was 1.3 years longer at the more recent assessment than a decade earlier.

    CONCLUSIONS: Both prevalence and incidence of disability remained stable over the last two decades in this urban Swedish population, with a trend toward a slow decline. Mortality remained steady among disabled persons but decreased among persons without disability, suggesting that increased life expectancy during the last two decades may be essentially driven by longer lives of functionally independent people.

  • 5.
    Craftman, Åsa G
    et al.
    Sophiahemmet University College.
    von Strauss, Eva
    The Swedish Red Cross University College. Aging Research Center (ARC), Karolinska Institutet.
    Lundell Rudberg, Susanne
    Sophiahemmet University College.
    Westerbotn, Margareta
    Sophiahemmet University College.
    District nurses’ perceptions of the concept of delegating administration of medication to home care aides working in the municipality: A discrepancy between legal regulations and practice2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 3-4, p. 569-578Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  To describe district nurses’ perceptions of the concept of delegating medication management to unlicensed personnel working in municipal social care.

    Background.  The delegation of medical tasks involves responsibility and is regulated by law to avoid damage and injuries and to protect the patient. The delegation of the administration of medication is a multifaceted task. The delegating district nurse is responsible for the outcome and should also follow up the delegated task.

    Design.  A descriptive qualitative study, involving semi-structured interviews and content analysis.

    Methods.  Twenty district nurses were interviewed. The interviews were audio taped. The data were collected from April 2009–August 2010 and analysed using content analysis.

    Results.  The findings revealed that the statutes of delegation appear to be incompatible with practice, however, mostly due to lack of time. Communication between district nurses and home care aides, as well as tutoring, was regarded as important. The district nurses found it imperative to be available to the home care aides and made an effort to create a trusting atmosphere.

    Conclusions.  District nurses cannot manage their workload without delegating the administration of medication in the present organisational model of health care and social care. The statutes regarding delegating medicine tasks are also cumbersome and difficult to incorporate for district nurses who are responsible for the delegation.

    Relevance to clinical practice.  The findings elucidate the current situation as regards district nurses and the need to delegate the administration of medication. Health care and social care for home-dwelling older patients, as well as statutes, needs to be evaluated and updated to meet and be prepared for the increasing demands of care.

  • 6.
    Craftman, Åsa Gransjön
    et al.
    Sophiahemmet University; Aging Research Center (ARC), Karolinska Institutet.
    Johnell, Kristina
    Aging Research Center (ARC), Karolinska Institutet.
    Fastbom, Johan
    Aging Research Center (ARC), Karolinska Institutet.
    Westerbotn, Margareta
    Department of Research, Education, Development and Innovation, Education Center, SÖS.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine. Aging Research Center (ARC), Karolinska Institutet.
    Time trends in 20 years of medication use in older adults: Findings from three elderly cohorts in Stockholm, Sweden.2015In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 63, p. 28-35Article in journal (Refereed)
    Abstract [en]

    New drugs and expanded drug indications are constantly being introduced. Welfare states strive to provide equity in drug treatment for all of its citizens and todaýs healthcare systems spend financial resources on drugs for the elderly in a higher rate than for any other age group. Drug utilization in elderly persons has an impact in health and wellbeing in older people.

    THE PURPOSE OF THE RESEARCH: It was to describe the changes in medication use including people aged 78 years and over regardless of residence and other characteristics over 20 years.

    MATERIALS AND METHODS: The study population consisted of 4304 participants in three population-based cross-sectional surveys conducted in the Kungsholmen area of central Stockholm, Sweden. The participant's current drug utilization was reviewed by physicians following standardized protocols. Data were statistical analyzed. Logistic regression models was used to estimate odds ratios and 95% confidence intervals for use of analgesics and psychotropic drugs in the cohorts of 2001 and 2007, controlling for age, gender, education and cognition.

    THE PRINCIPAL RESULTS AND MAJOR CONCLUSIONS: Results shows that the prevalence of medication use and polypharmacy in older adults has increased dramatically the late 1980s to the 2000s in central Stockholm, Sweden. In particular, the use of analgesics increased significantly, while some drug groups decreased, i.e., antipsychotics. Women used more medication than men in all three cohorts. Older adults living in service buildings used the largest amount of drugs in 1987, whereas those living in institutions were the most frequent users in 2001 and 2007.

  • 7.
    Forsell, Y
    et al.
    Stockholm Gerontology Research Centre, Karolinska Institute.
    Jorm, A F
    von Strauss, Eva
    Winblad, B
    Prevalence and correlates of depression in a population of nonagenarians1995In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 167, no 1, p. 61-64Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Clinicians see many more nonagenarian patients now and there is a need for epidemiological data relating to this group. The aim of the present study was to investigate the prevalence of depressive symptoms and syndromes in this age group.

    METHOD The DSM-IV and the ICD-10 criteria for depression were used and correlated with physical health, disability in daily life, gender, use of drugs, social circumstances and cognitive dysfunction. Data were derived from 329 persons aged 90 and over, registered in a parish of Stockholm, who had been extensively examined by physicians and nurses.

    RESULTS/CONCLUSIONS The prevalence of Major Depressive Episode as defined in DSM-IV was 7.9%; and of mild, moderate and severe Depressive Episode (combined); as defined in ICD-10 9.1%. No gender difference was found. Disability in daily life and the use of psychotropic drugs were found to correlate with depressive symptoms and syndromes.

  • 8.
    Fratiglioni, L
    et al.
    Stockholm Gerontology Research Center and Department of Geriatric Medicine, Karolinska Institute, Stockholm .
    Viitanen, M
    Stockholm Gerontology Research Center and Department of Geriatric Medicine, Karolinska Institute, Stockholm .
    von Strauss, Eva
    Stockholm Gerontology Research Center and Department of Geriatric Medicine, Karolinska Institute, Stockholm .
    Tontodonati, V
    Stockholm Gerontology Research Center and Department of Geriatric Medicine, Karolinska Institute, Stockholm .
    Herlitz, A
    Stockholm Gerontology Research Center and Department of Geriatric Medicine, Karolinska Institute, Stockholm .
    Winblad, B
    Stockholm Gerontology Research Center and Department of Geriatric Medicine, Karolinska Institute, Stockholm .
    Very Old Women at Highest Risk of Dementia and Alzheimer's Disease: Incidence Data from the Kungsholmen Project, Stockholm1997In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 48, no 1, p. 132-138Article in journal (Refereed)
    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.

  • 9. Fratiglioni, L
    et al.
    Viitanen, M
    von Strauss, Eva
    Winblad, B
    Late-onset Alzheimer’s disease: Incidence data from the Kungsholmen Project1997In: Alzheimer’s disease: biology, diagnosis and therapeutics / [ed] K Iqbal, B Winblad, T Nishimura, M Takeda, HM Wisniewski, John Wiley & Sons, 1997, p. 49-53Chapter in book (Other academic)
  • 10. Fratiglioni, L
    et al.
    von Strauss, Eva
    Qiu, C X
    Epidemiology of the dementias of old age2008In: The Oxford Textbook of Old Age Psychiatry / [ed] Dening T, Jacoby R, Oppenheimer C, and Thomas A, Oxford: Oxford University Press, 2008, p. 391-406Chapter in book (Other academic)
  • 11. Fratiglioni, Laura
    et al.
    von Strauss, Eva
    Multisjuklighet och demens: Vad kan förebyggas?2006Report (Other academic)
    Abstract [sv]

    Andelen äldre ökar i hela världen. Det återspeglar en förbättrad hälsa och en starkare samhällsekonomi. Samtidigt innebär det att allt fler drabbas av åldersrelaterade sjukdomar. Denna rapport är ett led i Statens folkhälsoinstituts arbete med att generellt öka kunskapen om vikten av förebyggande insatser bland äldre. Här belyses i vilken utsträckning multisjuklighet och demenssjukdomar kan förebyggas. Rapporten vänder sig till politiker och tjänstemän i kommuner och landsting samt företrädare för pensionärsorganisationer som arbetar med folkhälsoarbete bland äldre. Multisjuklighet är det vanligaste sjukdomspanoramat hos äldre. Kvinnor och personer med låg utbildning är mest drabbade. I dag vet man inte hur multisjuklighet kan förebyggas, men effekterna av multisjuklighet kan underlättas med mer samordnade insatser av samhället.Demens tillhör våra vanligaste folksjukdomar, men är ovanligt före 60 års ålder. Vid 95 års ålder har 50 procent av befolkningen en demenssjukdom. Demens förkortar livet och orsakar funktionellt beroende och flytt till särskilt boende. I nuläget finns det två möjliga strategier för att minska risken för demens. Vi vet att det är viktigt med god kontroll av blodtrycket både i medelåldern och vid högre åldrar. Vi vet också att det är värdefullt med ett mentalt aktivt och socialt integrerat liv i ålderdomen.Rapporten har skrivits av professor Laura Fratiglioni och docent Eva von Strauss på Aging Research Center, Karolinska Institutet, och Stiftelsen Stockholms Läns Äldrecentrum på uppdrag av Statens folkhälsoinstitut.

  • 12. Fratiglioni, Laura
    et al.
    von Strauss, Eva
    Winblad, Bengt
    Åldrandets epidemiologi med fokus på fysisk och mental funktionsförmåga2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, no 6, p. 552-558Article in journal (Refereed)
    Abstract [en]

    In the past decades, the »graying« of the population has emerged as a world-wide phenomenon, leading to an increased interest in research on aging. Many population-based studies have been initiated in several countries, such as the Kungsholmen Project in Stockholm, Sweden. These studies have shown that older adults can be recruited to participate in intensive physiological and clinical evaluations, and that longitudinal surveys are well accepted by the elderly. Comorbidity and physical and mental functioning have emerged as important variables for describing health status and identifying risk factors. Dementia arose as one of the most common diseases in the very old, as dementia prevalence nearly doubles every fifth year. Some risk factors for Alzheimer’s disease have been identified and interesting working hypotheses have been suggested. The natural history of the dementias have been sufficiently outlined for allocating medical and social resources, and for counseling patients and relatives.

  • 13.
    Fratiglioni, Laura
    et al.
    Karolinska Institutet, Aging Research Center.
    Winblad, Bengt
    Karolinska Institutet, Aging Research Center.
    von Strauss, Eva
    Karolinska Institutet, Aging Research Center.
    Prevention of Alzheimer's disease and dementia: Major findings from the Kungsholmen Project2007In: Physiology and Behavior, ISSN 0031-9384, E-ISSN 1873-507X, Vol. 92, no 1-2, p. 98-104Article in journal (Refereed)
    Abstract [en]

    The aging of the population is a worldwide phenomenon, and studying age-related diseases has become a relevant issue from both a scientific and a public health perspective. This review summarises the major findings concerning prevention of Alzheimer's disease (AD) and other dementias from a population-based study, the Kungsholmen Project. The study addresses risk- and protective factors for AD and dementia from a lifetime perspective: at birth, during childhood, in adult life, and in old age. Although many aspects of the dementias are still unclear, some risk factors have been identified and interesting hypotheses have been suggested for other putative risk or protective factors. At the moment it is also possible to delineate some preventative strategies for dementia.

  • 14. Gip, C
    et al.
    Viitanen, M
    von Strauss, Eva
    Winblad, B
    Fratiglioni, L
    Prevalence of dementia in nonagenarians1997In: Alzheimer’s disease: biology, diagnosis and therapeutics / [ed] K Iqbal, B Winblad, T Nishimura, M Takeda, HM Wisniewski, John Wiley & Sons, 1997, p. 45-48Chapter in book (Other academic)
  • 15.
    Gransjön Craftman, Åsa
    et al.
    Sophiahemmet University; Aging Research Center (ARC) Karolinska Institutet and Stockholm University.
    Hammar, Lena M
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet; School of Health Care and Social Welfare, Mälardalen University; .
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine. Aging Research Center (ARC) Karolinska Institutet and Stockholm University.
    Hillerås, Pernilla
    Sophiahemmet University; Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Westerbotn, Margareta
    Sophiahemmet University; Division of Caring Science, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Unlicensed personnel administering medications to older persons living at home: a challenge for social and care services2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, p. 201-210Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge.

    AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care.

    METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis.

    RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality.

    CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients.

    IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

  • 16.
    Gransjön Craftman, Åsa
    et al.
    Sophiahemmet University and Aging Research Center (ARC), Karolinska Institutet and Stockholm University.
    Westerbotn, Margareta
    Sophiahemmet University and Division of Nursing, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine. Aging Research Center (ARC), Karolinska Institutet and Stockholm University .
    Hillerås, Pernilla
    Sophiahemmet University and Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Marmstål Hammar, Lena
    School of Health, Care, and Social Welfare, Mälardalen University.
    Older people's experience of utilisation and administration of medicines in a health- and social care context.2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 760-768Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care.

    AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care.

    DESIGN: A qualitative descriptive study.

    METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used.

    FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process.

    CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine.

    RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

  • 17. Hassing, L
    et al.
    Small, B J
    von Strauss, Eva
    Fratiglioni, L
    Bäckman, L
    Mortality-related differences and changes in episodic memory among the oldest old: evidence from a population-based sample of nonagenarians2002In: Aging, Neuropsychology and Cognition, ISSN 1382-5585, E-ISSN 1744-4128, Vol. 9, no 1, p. 11-20Article in journal (Refereed)
    Abstract [en]

    We examined cross-sectional differences and longitudinal changes in episodic memory performance related to impending death among a group of very old people, aged 90–101 years. Participants were assessed at 3 measurement points across a 6-year interval. Three groups were identified: those who survived the entire follow-up period (n =40), those who died before the first follow-up (n =44), and those who died after the first follow-up (n =14). Participants completed a battery of episodic memory tasks consisting of face recognition, word recognition, word recall, and object recall with selective reminding. Those who survived performed better than those who were going to die in object recall at baseline. A Cox regression analysis, controlling age, revealed that object recall performance was significantly related to subsequent mortality status. Longitudinal analyses demonstrated significant 3-year decline for both face recognition and object recall, but no evidence of differential decline as a function of mortality group. Thus, longitudinal changes in memory preceding death were not as pronounced as the corresponding cross-sectional differences in this very old sample. In general, the results suggest that mortality-related memory deficits are present in extreme old age, although these deficits are relatively small and task-specific.

  • 18. Holm Pedersen, P
    et al.
    Engholm Norstedt, K
    Holm Pedersen, J
    von Strauss, Eva
    Karolinska instiutet.
    Slaughter, A
    Reid, B C
    Katz, R V
    Kungsholmen elders oral health study: Baseline periodontal disease findings1996In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 75, no SI, p. 898-898Article in journal (Refereed)
  • 19.
    Huang, Wenyong
    et al.
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm.
    Qiu, Chengxuan
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm.
    von Strauss, Eva
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm.
    Winblad, Bengt
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm.
    Fratiglioni, Laura
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm.
    APOE Genotype, Family History of Dementia, and Alzheimer Disease Risk: A 6-Year Follow-up Study2004In: Archives of Neurology, ISSN 0003-9942, E-ISSN 1538-3687, Vol. 61, no 12, p. 1930-1934Article in journal (Refereed)
    Abstract [en]

    Background Both family aggregation and apolipoprotein E (APOE) ε4 allele are well-known risk factors for dementia, but the relation between these two factors remains unclear.

    Objective To explore whether the risk of dementia and Alzheimer disease (AD) due to a positive family history is explained by APOE genotypes.

    Design Community-based cohort study.

    Setting The Kungsholmen district of Stockholm, Sweden.

    Participants A total of 907 nondemented people 75 years or older, followed up for 6 years to detect incident dementia and AD cases according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition.

    Main Outcome Measures Risk of dementia and AD by Cox proportional hazards models after controlling for several potential confounders.

    Results Subjects who had at least 2 siblings with dementia were at an increased risk of AD. Individuals with both APOE ε4 allele and at least 2 affected first-degree relatives had a higher risk of dementia and AD compared with those without these 2 factors. Similar results were obtained for history of dementia separately in parents or siblings. Among the ε4 allele carriers, subjects with 2 or more first-degree demented relatives had increased risk of dementia and AD, whereas no increased risk was detected among non–ε4 carriers.

    Conclusions Family history of dementia was associated with an increased risk of dementia and AD in this very old population, but only among APOE ε4 carriers. This suggests the existence of other genetic or environmental risk factors that may be active in the presence of the APOE ε4 allele.

    The role of both family history of dementia and the apolipoprotein E (APOE) gene in the development of Alzheimer disease (AD) has been extensively investigated. There is strong evidence to suggest that APOE ε4 allele carriers, as well as subjects with a family history of dementia, have an increased risk of AD.Familial aggregation and genetic risk factors appear to be most influential in AD at relatively early ages.However, there are reports supporting an effect of both familial aggregation and APOE ε4 even in late-onset AD,although a lower effect in comparison with early-onset cases has been detected.

    It is hypothesized that APOE ε4 allele might explain the association between family history of dementia and AD. Previous studies have tried to evaluate this hypothesis, but to what extent familial aggregation is due to the association between the ε4 allele and AD remains equivocal. Some studies indicated that ε4-positive patients with AD tended to have a higher rate of family history of dementia than ε4-negative patients. Conversely, patients with family history of AD are also more likely to carry the ε4 allele than patients without family history.Other studies, however, showed that the APOE ε4 allele was not related to familial aggregation of AD.

    Most previous analyses have been hospital-based case-control studies. Because of ascertainment bias and severe truncation of data, these studies might overestimate the effects of family history and APOE ε4 allele, especially in very old people. Only a small-scale prospective study has examined both family history of dementia and APOE ε4 allele in relation to AD risk among people 75 years or older.

    In a previous study within the Kungsholmen Project, a strong familial aggregation was detected among prevalent cases of late-onset AD, but the contribution of the APOE ε4 allele was not considered. In the present study, we examined the 6-year follow-up data from the same project to explore whether the risk of dementia and AD due to a positive family history is explained by APOE genotypes.

  • 20.
    Lagergren, Mårten
    et al.
    Stockholm Gerontology Research Center.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Sjölund, Britt-Marie
    Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University.
    Berglund, Johan
    Blekinge Institute of Technology.
    Fratiglioni, Laura
    Stockholm Gerontology Research Center; Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University .
    Nordell, Eva
    Division of Geriatric Medicine, Department of Health Sciences, Lund University and Skåne University Hospital.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine. Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University.
    Wimo, Anders
    Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University; Department of Neurobiology, Alzheimérs Disease Research Center, Care Sciencesand Society, Karolinska Institutet.
    Elmståhl, Sölve
    Division of Geriatric Medicine, Department of Health Sciences, Lund University and Skåne University Hospital.
    Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden.2015In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 28, no 1, p. 147-158Article in journal (Refereed)
    Abstract [en]

    The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001-2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70-90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40-50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern-it was almost 100 % in all areas for IADL dependency, but only 50-60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

  • 21.
    Lambert, M. A.
    et al.
    Department of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK.
    Bickel, H.
    Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar, Munchen, Germany.
    Prince, M.
    King's College London, Institute of Psychiatry, London, UK.
    Fratiglioni, L.
    Karolinska Institutet, Stockholm.
    von Strauss, Eva
    Karolinska Institutet, Stockholm.
    Frydecka, D.
    Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.
    Kiejna, A.
    Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.
    Georges, J.
    Alzheimer Europe, Luxembourg.
    Reynish, E. L.
    Department of Geriatric Medicine, NHS Fife, Kirkcaldy, UK.
    Estimating the burden of early onset dementia: systematic review of disease prevalence2014In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 21, no 4, p. 563-569Article, review/survey (Refereed)
    Abstract [en]

    Dementia is more common in older age but a number of people develop symptoms at a younger age and are said to have early onset dementia (EOD). Those with EOD face different challenges to those with onset later in life. It has been difficult to quantify this disease burden. This is a systematic review of papers reporting on the prevalence of EOD. A search of Medline and Embase was performed. This was followed by a hand search of the references of these papers. Eleven suitable studies were included. All of the data was from more economically developed countries. The studies were heterogeneous in their design hindering direct comparison. The majority of the papers looked at all types of dementia although many gave a breakdown of the prevalence of different subgroups. A variety of diagnostic criteria was employed. Figures of 38 to 260 per 100 000 are quoted by papers looking at various different types of dementia together with an onset of between 30 and 64 or up to 420 per 100 000 for those aged 55–64. Prevalence rises as age approaches 65. Epidemiological data for prevalence rates for EOD are sparse. EOD remains a rare condition with low case numbers. Assimilation and comparison of results from existing studies is difficult due to methodological heterogeneity. Cross-national standardization of methodology should be a priority for future research in this area.

  • 22.
    Marengoni, A
    et al.
    NVS Department, Aging Research Center, Karolinska Institutet.
    von Strauss, Eva
    NVS Department, Aging Research Center, Karolinska Institutet.
    Rizzuto, D
    NVS Department, Aging Research Center, Karolinska Institutet.
    Winblad, B
    NVS Department, Aging Research Center, Karolinska Institutet.
    Fratiglioni, L
    NVS Department, Aging Research Center, Karolinska Institutet.
    The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons: A community-based, longitudinal study2009In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 265, no 2, p. 288-295Article in journal (Refereed)
    Abstract [en]

    Objective.  We aimed to disentangle the effect of chronic multimorbidity and disability on 3-year functional decline and survival in the elderly.

    Design.  Prospective cohort study with a mean of follow-up of 2.8 years.

    Setting.  Swedish elderly persons from the Kungsholmen Project (1987–2000).

    Subjects.  A total of 1099 subjects, 77–100 years old, living in the community and institutions.

    Main outcome measurements.  Medical diagnoses (based on clinical examination, drug use, medical records and blood tests), and functional assessment (according to Katz Index) at baseline were investigated in relation to functional decline and death occurring during follow-up.

    Results.  At baseline, 12.1% of participants had disability, and 52.3% were affected by multimorbidity. During follow-up, 363 persons died and 85 worsened in functioning. The number of chronic conditions incrementally increased the risk of functional decline [hazard ratio (HR) increased from 1.5 in subjects with one disease to 6.2 in persons with 4+ diseases]. However, this was not the case for mortality, as the HR of death was the same for people with one disease as well as 4+ diseases (HR = 2.3). Baseline disability had the highest impact on survival, independently of number of diseases [HR = 8.1; 95% confidence interval (CI) = 4.8–13.7 in subjects with one disease and HR = 7.7; 95% CI = 4.7–12.6 in those with 2+ diseases].

    Conclusions.  In the elderly subjects, chronic disability rather than multimorbidity emerged as the strongest negative prognostic factor for functionality and survival.

  • 23.
    Mecocci, P
    et al.
    Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
    von Strauss, Eva
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Neurotec, Karolinska Institutet, Stockholm.
    Cherubini, A
    Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
    Ercolani, S
    Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
    Mariani, E
    Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
    Senin, U
    Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
    Winblad, B
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Neurotec, Karolinska Institutet, Stockholm.
    Fratiglioni, L
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Neurotec, Karolinska Institutet, Stockholm.
    Cognitive Impairment Is the Major Risk Factor for Development of Geriatric Syndromes during Hospitalization: Results from the GIFA Study2005In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 20, no 4, p. 262-269Article in journal (Refereed)
    Abstract [en]

    Objective: To detect the main factors associated with the occurrence of specific geriatric syndromes (namely pressure sores, fecal incontinence, urinary incontinence and falls) in elderly patients during hospitalization. Design: Observational prospective study. Setting: Eighty-one community and university hospitals throughout Italy. Participants: 13,729 patients aged 65 years and more, consecutively admitted to medical or geriatric acute wards during 20 months in the period between 1991 and 1998. Measurements: Occurrence of pressure sores, fecal incontinence, urinary incontinence and falls during the stay in hospital. Results: Pressure sores were already present in 3% of hospitalized subjects, fecal incontinence in 7.3%, while urinary incontinence, evaluated on a subgroup of total population (4,268 subjects), had a prevalence of 22.3%. During hospitalization (mean stay of 15 days), 74 subjects developed new pressure sores, 55 became fecal and 35 urinary incontinent, and 279 subjects had at least one episode of fall. In multivariate analyses, cognitive impairment, advanced age (85+ years), length of stay (more than 3 weeks) and severe disability were the main independent predictors of development of the four geriatric syndromes, with cognitive impairment as the most significant risk factor for all the four outcomes (OR 4.9, 95% CI 2.4–9.9 for pressure sores; OR 6.3, 95% CI 3.0–13.0 for fecal incontinence; OR 5.3, 95% CI 2.3–12.0 for urinary incontinence; OR 1.6, 95% CI 1.2–2.3 for falls). Conclusion: Very old people have a significant increased risk of several geriatric syndromes during the stay in hospital, particularly if it is long and they are cognitively impaired. A standardized comprehensive geriatric evaluation at admission could be helpful in detecting all subjects at risk and preventing the development of hospital-acquired geriatric syndromes.

     

  • 24. Mecocci, P
    et al.
    von Strauss, Eva
    Cherubini, A
    Ercolani, S
    Senin, U
    Winblad, B
    Fratiglioni, L
    Cognitive impairment is the major risk factor of adverse events in hospitalised elderly patients2004In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 25, no SUPP/2, p. 21-21Article in journal (Refereed)
  • 25. Morse, D E
    et al.
    Holm-Pedersen, P
    Holm-Pedersen, J
    Katz, R V
    Viitanen, M
    von Strauss, Eva
    Winblad, B
    Dental caries in persons over the age of 80 living in Kungsholmen, Sweden: findings from the KEOHS Project2002In: Community Dental Health, ISSN 0265-539X, Vol. 19, no 4, p. 262-267Article in journal (Refereed)
    Abstract [en]

    Objectives: The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, communitydwelling persons over the age of 80 living in Kungsholmen, an area in central Stockholm. This paper reports findings regarding the prevalence and severity of dental caries among the dentate participants. Basic research design: Caries examinations were conducted on eligible persons participating in the Kungsholmen Project, an ongoing, longitudinal study of older adults. Setting: Caries examinations were carried out between 1994 and 1996 at two local clinics by three standardised examiners using defined visual, tactile criteria. Participants: Among 296 potentially eligible participants, 159 were examined, and a total of 129 had at least one tooth. Main outcome measures: The caries examination identified decayed and filled surfaces and missing teeth. Results: Of the dentate subjects examined, 80% had teeth in both arches; 98% had at least one coronal filling; 81% had one or more restored root surfaces. Depending upon age and gender, between 36% and 56% of those examined had untreated coronal caries, and between 54% and 75% had untreated root caries. Conclusions: These findings document the substantial and ongoing impact of dental caries in a sample of generally healthy, community-dwelling older adults and underscore the importance of continued caries prevention and treatment in the aged.

  • 26.
    Morse, Douglas E.
    et al.
    New York University College of Dentistry, Department of Epidemiology & Health Promotion, New York, NY USA.
    Holm-Pedersen, Poul
    Copenhagen Gerontological Oral Health Research Center, University of Copenhagen School of Dentistry, Copenhagen, Denmark.
    Holm-Pedersen, Jytte
    Formerly Division of Prosthodonties. School of Dentistry, Karolinska Institutet, Huddinge.
    Katz, Ralph V.
    New York University College of Dentistry, Department of Epidemiology & Health Promotion, New York, NY USA.
    Viitanen, Matti
    Aging Research Center (ARC), Division of Geriatric Epidemiology & Medicine, NEUROTEC, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm.
    von Strauss, Eva
    Aging Research Center (ARC), Division of Geriatric Epidemiology & Medicine, NEUROTEC, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm.
    Winblad, Bengt
    Aging Research Center (ARC), Division of Geriatric Epidemiology & Medicine, NEUROTEC, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm.
    Prosthetic crowns and other clinical risk indicators of caries among old-old Swedish adults: Findings from the KEOHS Project. Kungsholmen Elders Oral Health Study2002In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 19, no 2, p. 73-79Article in journal (Refereed)
    Abstract [en]

    Objectives: The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects.

    Design: In this cross-sectional study, dentate KEOHS subjects received a caries assessment using defined visual, tactile criteria.

    Setting: Examinations were carried out in two local clinics by standardized examiners.

    Subjects: One hundred twenty-nine dentate persons were examined.

    Main Outcome Measures: The examination identified decayed and filled surfaces, prosthetic crowns, and missing teeth.

    Results: More root than coronal surfaces had untreated decay, and secondary root caries contributed the greatest number of decayed surfaces. Ninety percent of the examined dentate subjects had at least one prosthetic crown. Root surfaces exposed to crown margins were more likely to have caries than root surfaces not so exposed, particularly among women. The presence of untreated coronal caries (yes/no) was positively associated with having untreated root caries and an intermediate number (14–20) of teeth, but inversely associated with having 4+ prosthetic crowns. Active root caries (yes/no) was positively associated with having untreated coronal caries, 14–20 teeth, and 4+ prosthetic crowns. Nearly 20% of ident2ified root lesions were present at or below the gingival margin, and most (88%) were secondary caries associated with crown margins (65%) or other restorations (23%).

    Conclusions: Our findings suggest that some dental characteristics, including the presence of prosthetic crowns, are risk indicators for the presence of untreated coronal and root caries.

  • 27.
    Ngandu, T
    et al.
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    von Strauss, Eva
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    Helkala, E L
    Public Health and General Practice, University of Kuopio, Finland.
    Winblad, B
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    Nissinen, A
    Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki.
    Tuomilehto, J
    Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki.
    Soininen, H
    Departments of Neuroscience and Neurology, University of Kuopio, Finland.
    Kivipelto, M
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    Education and dementia: What lies behind the association?2007In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 69, no 14, p. 1442-1450Article in journal (Refereed)
    Abstract [en]

    Background: Low education seems to be associated with an increased risk of dementia and Alzheimer disease (AD). People with low education have unhealthier lifestyles and more cardiovascular risk factors, but it is unclear how this affects the association between education and dementia.

    Methods: Participants of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study were derived from random, population-based samples previously studied in a survey in 1972, 1977, 1982, or 1987. After an average follow-up of 21 years, 1,449 individuals (72%) aged 65 to 79 participated in a re-examination in 1998.

    Results: Compared to individuals with formal education of 5 years or less, those with 6 to 8 years of education had OR of 0.57 (95% CI 0.29 to 1.13), and those with 9 years of education or more had OR of 0.16 (95% CI 0.06 to 0.41) for dementia. The corresponding ORs for AD were 0.49 (0.24 to 1.00) and 0.15 (0.05 to 0.40). The associations remained unchanged after adjustments for several demographic, socioeconomic, vascular, and lifestyle characteristics. The results were similar among both men and women. ApoE4 did not modify the association, but the risk of dementia and AD was very low among ApoE4 noncarriers with high education.

    Conclusions: The association between low education and dementia is probably not explained by the unhealthy lifestyles of the less educated compared with higher educated persons. Higher educated persons may have a greater cognitive reserve that can postpone the clinical manifestation of dementia. Unhealthy lifestyles may independently contribute to the depletion of this reserve or directly influence the underlying pathologic processes.

    GLOSSARY: AD = Alzheimer disease; CAIDE = Cardiovascular Risk Factors, Aging and Dementia; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; MMSE = Mini-Mental State Examination; NINCDS-ADRDA = National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association; SBP = systolic blood pressure.

                    

  • 28.
    Nordberg, G
    et al.
    Aging Research Center (ARC); Division of Geriatric Epidemiology, Neurotec, Karolinska Institute; Stockholm Gerontology Research Center.
    von Strauss, Eva
    Aging Research Center (ARC); Division of Geriatric Epidemiology, Neurotec, Karolinska Institute; Stockholm Gerontology Research Center.
    Kåreholt, I
    Aging Research Center (ARC); Division of Geriatric Epidemiology, Neurotec, Karolinska Institute; Department for Social Work, Stockholm University.
    Johansson, L
    The National Board of Health and Welfare, Stockholm.
    Wimo, A
    Aging Research Center (ARC); Division of Geriatric Epidemiology, Neurotec, Karolinska Institute; Stockholm Gerontology Research Center; HC Bergsjö.
    The amount of informal and formal care among non-demented and demented elderly persons: result from a Swedish population based study2005In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 17, no Suppl. 2, p. 334-335Article in journal (Refereed)
  • 29.
    Nordberg, G
    et al.
    Aging Research Center (ARC), Stockholm.
    von Strauss, Eva
    Aging Research Center (ARC), Stockholm.
    Kåreholt, I
    Aging Research Center (ARC), Stockholm.
    Johansson, L
    The National Board of Health and Welfare, Stockholm.
    Wimo, A
    Aging Research Center (ARC), Stockholm.
    The amount of informal and formal care among non-demented and demented elderly persons: - results from a Swedish population-based study2005In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 20, no 9, p. 862-871Article in journal (Refereed)
    Abstract [en]

    Background

    Developed countries are experiencing a dramatic increase in the proportion of elderly persons, as well as a progressive aging of the elderly population itself. Knowledge regarding the amount of formal and informal care and its interaction at population-based level is limited.

    Objectives

    To describe the amount of formal and informal care for non-demented and demented persons living at home in a population-based sample.

    Methods

    The population consisted of all inhabitants, 75 + years, living in a rural community (n = 740). They were clinically examined by physicians and interviewed by nurses. Dementia severity was measured according to Washington University Clinical Dementia Rating Scale (CDR). Informal and formal care was examined with the RUD (Resource Utilization in Dementia) instrument.

    Results

    The amount of informal care was much greater than formal care and also greater among demented than non-demented. There was a relationship between the severity of the congnitive decline and the amount of informal care while this pattern was weaker regarding formal care. Tobit regression analyses showed a clear association between the number of hours of informal and formal care and cognitive decline although this pattern was much stronger for informal than formal care.

    Conclusions

    Informal care substitutes rather than compliments formal care and highlights the importance of future studies in order to truly estimate the amount of informal and formal care and the interaction between them. This knowledge will be of importance when planning the use of limited resources, and when supporting informal carers in their effort to care for their intimates.

  • 30.
    Nordberg, Gunilla
    et al.
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    Wimo, Anders
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    Jönsson, Linus
    European Health Economics, Stockholm.
    Kåreholt, Ingernar
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    Sjölund, Britt-Marie
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    Lagergren, Mårten
    Stockholm Gerontology Research Center, Stockholm.
    von Strauss, Eva
    Aging Research Center (ARC), Karolinska Institutet, Stockholm.
    Time use and costs of institutionalised elderly persons with or without dementia: results from the Nordanstig cohort in the Kungsholmen Project - a population based study in Sweden2007In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 22, no 7, p. 639-648Article in journal (Refereed)
    Abstract [en]

    Background

    The aging of the population has become a worldwide phenomenon. This leads to increased demand for services and with limited resources it is important to find a way to estimate how resources can be match to those with greatest need.

    Aims

    To analyse time use and costs in institutional care in relation to different levels of cognitive and functional capacity for elderly persons.

    Methods

    The population consisted of all institutionalised inhabitants, 75 + years, living in a rural community (n = 176). They were clinically examined by physicians and interviewed by nurses. Staff and informal care-giving time was examined with the RUD (Resource Utilization in Dementia) instrument.

    Results

    Tobit regression analyses showed that having dementia increased the amount of ADL care time with 0.9 h when compared to those not having dementia, whereas each loss of an ADL function (0–6) added 0.6 h of ADL care time. Analysing the total care time use, the presence of dementia added more than 9 h, while each loss of one ADL function added 2.9 h. There were some informal care contributions, however with no correlation to severity in dependency. The estimated cost for institutional care increased with more than 85% for people being dependent in 5–6 ADL activities compared to persons with no functional dependency, and with 30% for persons with dementia compared to the non-demented.

    Conclusion

    There is a variation in time use in institutional settings due to differences in ADL dependency but also whether dementia is present or not. This variation has implications for costs of institutional care.

  • 31.
    Okenwa-Emegwa, Leah
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Paillard-Borg, Stéphanie
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine. Swedish Red Cross University College.
    A global workspace is the emerging reality for future public health workforce2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 3, p. 132-140Article in journal (Refereed)
    Abstract [en]

    There is an urgent need to train public health professionals at undergraduate level who can face global challenges that are due to longstanding conflicts, increasing number of displaced people, natural disasters, and growing inequalities between and within countries. Future public health professionals will lead activities ranging from national and international community planning, strategic work geared towards integration of migrants and crisis management of refugees, and humanitarian services. Consequently, the need for public health professionals with deep and wide theoretical and practical competencies in global contexts has become most relevant. In response to this need, The Swedish Red Cross University College has created such a programme leading to a Bachelor degree in Public Health Science, specialization Global Health.

  • 32.
    Okenwa-Emegwa, Leah
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Paillard-Borg, Stéphanie
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Framtidens hälsovetare verkar på en global arena.2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 3, p. 318-326Article in journal (Refereed)
    Abstract [sv]

    Det föreligger ett akut behov att utbilda folkhälsovetare på grundnivå och som kan möta de globala utmaningarna. Hälsoutmaningarna förändras i takt med långvariga konflikter, människor på flykt, stora katastrofer och en ökande ojämlikhet mellan och inom länder, i en omvärld som är i ständig rörelse. Dagens och morgondagens folkhälsovetare ska kunna arbeta med olika aktörer på skilda arenor; med hälso- och sjukdomsprevention kommunalt, regionalt, nationellt (regering, myndigheter) och internationellt (europeiskt och globalt). Det innefattar även integrationsarbete, internationellt biståndsarbete och humanitärt arbete. Behovet av professionella folkhälsovetare med breda och djupa teoretiska och praktiska kompetenser i globala sammanhang har därför blivit högst relevant. Därför agerar nu Röda Korsets Högskola och startar ett folkhälsovetenskapligt program på kandidatnivå med global inriktning.

  • 33.
    Paillard-Borg, Stephanie
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Saaristo, P.
    Int Federat Red Cross & Red Crescent Soc IFRC, Water Sanitat & Emergency Hlth Unit, Geneva, Switzerland..
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Humanitarian nursing in a viral haemorrhagic fever outbreak: before, during and after deployment2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, p. 203-203Article in journal (Other academic)
  • 34.
    Paillard-Borg, Stéphanie
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Holmgren, Jessica
    The Swedish Red Cross University College, Department of Health Sciences.
    Saaristo, P.
    International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Health Sciences.
    Heroes and pariahs: Nurses in a viral haemorrhagic fever outbreak2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no S3, p. 319-319Article in journal (Other academic)
  • 35. Qiu, C
    et al.
    Kivipelto, M
    von Strauss, Eva
    The Swedish Red Cross University College.
    Epidemiology of Alzheimer's disease: occurrence, determinants, and strategies toward intervention2009In: Dialogues in Clinical Neuroscience, ISSN 1294-8322, E-ISSN 1958-5969, Vol. 11, no 2, p. 111-128Article in journal (Refereed)
    Abstract [en]

    More than 25 million people in the world today are affected by dementia, most suffering from Alzheimer's disease. In both developed and developing nations, Alzheimer's disease has had tremendous impact on the affected individuals, caregivers, and society. The etiological factors, other than older age and genetic susceptibility, remain to be determined. Nevertheless, increasing evidence strongly points to the potential risk roles of vascular risk factors and disorders (eg, cigarette smoking, midlife high blood pressure and obesity, diabetes, and cerebrovascular lesions) and the possible beneficial roles of psychosocial factors (eg, high education, active social engagement, physical exercise, and mentally stimulating activity) in the pathogenetic process and clinical manifestation of the dementing disorders. The long-term multidomain interventions toward the optimal control of multiple vascular risk factors and the maintenance of socially integrated lifestyles and mentally stimulating activities are expected to reduce the risk or postpone the clinical onset of dementia, including Alzheimer's disease.

  • 36.
    Qiu, Chengxuan
    et al.
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institute and the Stockholm Gerontology Research Center.
    Karp, Anita
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institute and the Stockholm Gerontology Research Center.
    von Strauss, Eva
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institute and the Stockholm Gerontology Research Center.
    Winblad, Bengt
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institute and the Stockholm Gerontology Research Center.
    Fratiglioni, Laura
    Aging Research Center, Division of Geriatric Epidemiology and Medicine, Department of Neurotec, Karolinska Institute and the Stockholm Gerontology Research Center.
    Bellander, Tom
    Department of Environmental Health, Stockholm County Council.
    Lifetime principal occupation and risk of Alzheimer's disease in the Kungsholmen project2003In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 43, no 2, p. 204-211Article in journal (Refereed)
    Abstract [en]

    Background

    Some studies suggest that manual work is associated with dementia. This study is aimed at identifying the specific occupational categories that may be related to dementia.

    Methods

    A cohort of 913 non-demented subjects aged 75 + years was longitudinally examined twice over 6 years to detect incident dementia using the DSM-III-R diagnostic criteria. The lifetime longest occupations of all subjects were divided into different categories according to the occupation-based classification system. Data were analyzed with Cox models.

    Results

    During the follow-up period, 260 subjects were diagnosed with dementia (197 with Alzheimer's disease). Manual work was associated with an increased risk of dementia, and the association was dependent on educational level. Compared with non-manual work, manual work involving goods production had a multi-adjusted relative risk (95% CI) of 1.6 (1.0–2.5, P = 0.046) for Alzheimer's disease and 1.4 (0.9–2.1) for dementia.

    Conclusions

    An association between goods production, manual work and Alzheimer's disease found in this study suggests that factors in the mid-twentieth century goods production environment may be involved in the development of Alzheimer's disease.

  • 37.
    Qiu, Chengxuan
    et al.
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet–Stockholm University.
    von Strauss, Eva
    The Swedish Red Cross University College. Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet–Stockholm University.
    Bäckman, Lars
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet–Stockholm University.
    Winblad, Bengt
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet–Stockholm University.
    Fratiglioni, Laura
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet–Stockholm University.
    Twenty-year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden2013In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 80, no 20, p. 1888-1894Article in journal (Refereed)
    Abstract [en]

    Objective: To explore whether prevalence, survival, and incidence of dementia have changed from 1987–1994 to 2001–2008 in Stockholm, Sweden.

    Methods: This study is based on 2 cross-sectional surveys of people aged 75 years or over conducted in central Stockholm: the Kungsholmen Project (KP) (1987–1989, n = 1,700) and the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) (2001–2004, n = 1,575). In both surveys we diagnosed dementia according to DSM-III-R criteria, following the identical diagnostic procedure. Death certificates were used to determine survival status of KP participants as of December 1994 and SNAC-K participants as of June 2008. We used logistic and Cox models to compare prevalence and survival, controlling for major confounders. We inferred incidence of dementia according to its relationship with prevalence and survival.

    Results: At baseline, 225 subjects in KP and 298 in SNAC-K were diagnosed with dementia. The age- and sex-standardized prevalence of dementia was 17.5% (12.8% in men; 19.2% in women) in KP and 17.9% (10.8% in men; 20.5% in women) in SNAC-K. The adjusted odds ratio of dementia in SNAC-K vs KP was 1.17 (95% confidence interval 0.95–1.46). The multiadjusted hazard ratio of death in SNAC-K vs KP was 0.71 (0.57–0.88) in subjects with dementia, 0.68 (0.59–0.79) in those without dementia, and 0.66 (0.59–0.74) in all participants.

    Conclusions: Prevalence of dementia was stable from the late 1980s to the early 2000s in central Stockholm, Sweden, whereas survival of patients with dementia increased. These results suggest that incidence of dementia may have decreased during this period.

  • 38. Qiu, Chengxuan
    et al.
    von Strauss, Eva
    Fastbom, Johan
    Winblad, Bengt
    Fratiglioni, Laura
    Low blood pressure and risk of dementia in the Kungsholmen project: a 6-year follow-up study2003In: Archives of Neurology, ISSN 0003-9942, E-ISSN 1538-3687, Vol. 60, no 2, p. 223-228Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have reported a higher prevalence of dementia in persons with low blood pressure.

    Objective: To examine whether low blood pressure is prospectively associated with the occurrence of Alzheimer disease and dementia in elderly people.

    Subjects and Methods: A community-based, dementia-free cohort (n = 1270) aged 75 to 101 years was longitudinally examined twice within 6 years to detect incident dementia using the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria. Cox proportional hazards models were used to analyze blood pressure in association with dementia after adjustment for several potential confounders.

    Results: During the 6-year period, 339 subjects were diagnosed with dementia, including 256 persons with Alzheimer disease. Subjects with very high systolic pressure (&gt;180 vs 141-180 mm Hg) had an adjusted relative risk of 1.5 (95% confidence interval [CI], 1.0-2.3; P =.07) for Alzheimer disease, and 1.6 (95% CI, 1.1-2.2) for dementia. Low systolic pressure (&lt;/=140 mm Hg) was not related to incident dementia. In contrast, high diastolic pressure (&gt;90 mm Hg) was not associated with dementia incidence, whereas extremely low diastolic pressure (&lt;/=65 vs 66-90 mm Hg) produced an adjusted relative risk of 1.7 (95% CI, 1.1-2.4) for Alzheimer disease and 1.5 (95% CI, 1.0-2.1; P =.03) for dementia. The latter association was pronounced particularly in persons who used antihypertensive drugs.

    Conclusions: Both low diastolic and high systolic pressure are associated with an increased risk of Alzheimer disease and dementia in this elderly population. The atherosclerotic process may explain the observed associations. In addition, low diastolic pressure may increase dementia risk by affecting cerebral perfusion.

  • 39. Qiu, Chengxuan
    et al.
    von Strauss, Eva
    Winblad, Bengt
    Fratiglioni, Laura
    Decline in blood pressure over time and risk of dementia: a longitudinal study from the Kungsholmen project2004In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 35, no 8, p. 1810-1815Article in journal (Refereed)
    Abstract [en]

    Background and Purpose—Low blood pressure has been related to an increased risk of dementia. We sought to verify blood pressure variations before and after a dementia diagnosis and to relate blood pressure decline to subsequent Alzheimer disease and dementia.

    Methods—A community dementia-free cohort aged _75 years (n_947) underwent follow-up examinations twice over a period of 6 years to detect dementia cases (Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised [DSM-III-R] criteria, n_304). Blood pressure variation before and after dementia diagnosis was verified with linear mixed-effects models. Using the dementia-free cohort identified at first follow-up (n_719), the association between blood pressure decline from baseline to first follow-up and subsequent risk of dementia was examined.

    Results—Blood pressure markedly decreased over 3 years before dementia diagnosis and afterward, whereas no substantial decline was present 3 to 6 years before the diagnosis. However, among subjects with baseline systolic pressure _160 mm Hg, systolic pressure decline _15 mm Hg occurring 3 to 6 years before diagnosis was associated with relative risks (95% CI) of 3.1 (1.3 to 7.0) for Alzheimer disease and 3.1 (1.5 to 6.3) for dementia. There was a dose–response relationship between systolic pressure decline and dementia risk in subjects with vascular disease.

    Conclusions—Blood pressure starts to decrease only 3 years before dementia diagnosis and continues to decline afterward. A greater decline in systolic pressure occurring 3 to 6 years before diagnosis is associated with an increased risk of dementia only in older people with already low blood pressure or affected by vascular disorders.

  • 40. Qiu, CX
    et al.
    von Strauss, Eva
    Fastbom, J
    Winblad, B
    Fratiglioni, L
    Low blood pressure and risk of incident Alzheimer's disease and dementia in the Kungsholmen Project2002In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 23, no 1 Suppl. 1, p. 419-419Article in journal (Refereed)
  • 41. Qiu, CX
    et al.
    von Strauss, Eva
    Winblad, B
    Fratiglioni, L
    Decline in blood pressure over time and risk of dementia in the Kungsholmen project2004In: International Journal of Psychology, ISSN 0020-7594, E-ISSN 1464-066X, Vol. 39, no 5-6 Suppl. S, p. 175-175Article in journal (Refereed)
    Abstract [en]

    Aim-To examine the relationship between blood pressure decline and dementia risk. Methods-A community-based dementia-free cohort (n=947, 75+ years) was followed to detect dementia. Data were analyzed with Cox models. Results-Blood pressure markedly decreased before dementia diagnosis and continued to decline thereafter. Diastolic pressure decline was not predictive of dementia. Systolic pressure decline ⩾15 mm Hg was associated with an increased risk of dementia among people with baseline systolic pressure <160 mm Hg. Conclusions-Blood pressure decreases from the preclinical phase of dementia. A greater decline in systolic pressure is associated with dementia risk in selective subgroups of aging population.

  • 42.
    Sjölund, Britt-Marie
    et al.
    Aging Research Center, Karolinska Institutet.
    Nordberg, Gunilla
    Alzheimer Disease Research Center, Karolinska Institutet,.
    Wimo, Anders
    Aging Research Center, Karolinska Institutet.
    von Strauss, Eva
    The Swedish Red Cross University College. Aging Research Center, Karolinska Institutet.
    Morbidity and physical functioning in old age: Differences according to living area2010In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 58, no 10, p. 1855-1862Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe differences in morbidity and functional status according to living area.

    DESIGN: Community-based survey.

    SETTING: A community-based prospective cohort, the Kungsholmen-Nordanstig Project.

    PARTICIPANTS: Adults aged 75 and older living in an urban area of central Stockholm (n=1,222) and in the rural community of Nordanstig in northern Sweden (n=919).

    MEASUREMENTS: Physicians clinically examined all participants using the same standardized protocols in both living areas; trained nurses directly assessed disability.

    RESULTS: Cardiovascular disease was the most common disorder in both living areas (39.9% in the urban area and 45.2% in the rural area). There were great area differences in the prevalence of stroke (7.4% and 14.0%), diabetes mellitus 6.3% and 16.1%), and Parkinson's disease (1.0% and 3.7%). It was more common to have two or more diseases than no diseases in the rural area than in the urban area (odds ratio=1.9, 95% confidence interval=1.4–2.4). Significant living area differences (urban vs rural) in population attributable risk (PAR) was found 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).

    CONCLUSION: Differences were found in disability, morbidity, and disease patterns according to living area. The rural elderly population was more disabled and had more diseases than the urban elderly population, despite being slightly younger than the urban cohort. There were significant area differences in the PAR of how specific chronic conditions influenced the risk of disability.

  • 43.
    Sjölund, Britt-Marie
    et al.
    Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University; Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle.
    Wimo, Anders
    Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University; Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Engström, Maria
    Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle; Department of Public Health and Caring Sciences, Uppsala University.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine. Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University.
    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 Project2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, article id e0138901Article in journal (Refereed)
    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.

  • 44.
    Sjölund, Britt-Marie
    et al.
    Aging Research Center (ARC), Karolinska Institutet-Stockholm University.
    Wimo, Anders
    Aging Research Center (ARC), Karolinska Institutet-Stockholm University.
    Qiu, Chengxuan
    Aging Research Center (ARC), Karolinska Institutet-Stockholm University.
    Engström, Maria
    University of Gävle.
    von Strauss, Eva
    The Swedish Red Cross University College. Aging Research Center (ARC), Karolinska Institutet-Stockholm University.
    Time trends in prevalence of activities of daily living (ADL) disability and survival: Comparing two populations (aged 78+ years) living in a rural area in Sweden2014In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, no 3, p. 370-375Article in journal (Refereed)
    Abstract [en]

    The aim was to study time trends in prevalence of disability in ADL and survival among men and women 78 years and older comparing two cohorts. The study was a time trend study based on two population-based community cohorts, the Nordanstig Project (NP), collected 1995–1998 and the Swedish National Study on Aging and Care in Nordanstig (SNAC-N), collected 2001–2003. The participants were people aged 78 years and older from the NP cohort (N = 303) and from the SNAC-N cohort (N = 406). All were clinically examined by physicians and nurses using standardized protocols. Disability was defined as a need for assistance in one or more ADL activities. The prevalence of disability and survival were compared using logistic and Cox models. The prevalence of ADL disability was stable for men, while women became more disabled in ADL during the time period, OR 2.36 (1.12–4.94). There was no significant difference in survival time between the cohorts in either ADL disabled persons or non-disabled persons. There was a tendency for increased survival for non-disabled persons in SNAC-N compared with NP, although 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. The time trends for ADL disability found in the study show that ADL disability had increased in women but not in men. More studies are needed to identify risk factors for ADL disability with a view to preventing it in time.

  • 45. Small, Brent J.
    et al.
    Fratiglioni, Laura
    von Strauss, Eva
    Bäckman, Lars
    Terminal Decline and Cognitive Performance in Very Old Age: Does Cause of Death Matter?2003In: Psychology and Aging, ISSN 0882-7974, E-ISSN 1939-1498, Vol. 18, no 2, p. 193-202Article in journal (Refereed)
    Abstract [en]

    Presents a study that examined cognitive decline in a population-based cohort of older adult, initially 75 to 95 years of age. Methodology; Baseline demographic characteristics and mini-mental state examination performance of surviving and deceased participants; Causes of death across sample and time of testing.

  • 46.
    von Strauss, Eva
    Karolinska Institutet.
    Being old in our society: health, functional status, and effects of research2000Doctoral 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.

  • 47.
    von Strauss, Eva
    The Swedish Red Cross University College.
    Enkla träningsprogram för demenssjuka förbättrar fysisk hälsa och lindrar depression2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 13, p. 1173-1173Article in journal (Other academic)
  • 48. von Strauss, Eva
    Kungsholmsprojektet: Åldrande och förekomst av demens hos 90 åringar och äldre1999In: Incitament, ISSN 1103-503X, Vol. 8, no 4, p. 46-50Article in journal (Other academic)
  • 49. von Strauss, Eva
    Äldre kvinnor mår sämre än jämnåriga män2000Report (Other academic)
  • 50. von Strauss, Eva
    et al.
    Aguero-Torres, H
    Winblad, B
    Fratiglioni, L
    Incidence of Alzheimer's disease and other dementia disorders: Findings from a population-based study of the oldest old in Stockholm, Sweden2002In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 23, no 1, p. S289-S289Article in journal (Refereed)
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