Åke Rundgren

Incidence of hip fracture in Western Sweden 1974-1982: Comparison of rural and urban populations

Several epidemiological studies in northern Europe have shown that fractures in the elderly exceed the expected increase in the aging populations. We have compared the incidence of hip fracture in the rural county of Skaraborg and the city of Göteborg in Sweden. After adjustment for age changes in the population, the incidence of hip fracture in Skaraborg County was lower than in Göteborg during the period 1974-1984. The non-age-related increase in the incidence of fractures found in the city was not confirmed in the rural area.

The effect of tobacco smoking on the bone mineral content of the ageing skeleton

The relationship between the bone mineral content (BMC) of the heel bone and cigarette smoking has been determined in representative samples of 409 men and 559 women at the age of 70, 75 and 79 in a longitudinal and cohort comparison study. The BMC was measured by dual photon absorptiometry with stationary geometry over the dorsal aspect of the heel bone. The mean values of the BMC for smokers compared to non-smokers were for men about 10-20% lower and for women 15-30% lower in all age groups studied. The difference in body weight between smokers and non-smokers could not explain the lower values of BMC for the smokers. No difference was found in physical activity between the groups.

Urinary incontinence in the elderly with implications for hospital care consumption and social disability

837 geriatric patients were investigated on admission and 6 months later. Relatives and other involved persons were interviewed about background factors of importance for the patients need of care. Every second male and every third female patient was urinary incontinent and it was evident that this was important for admission to hospital. A close relation was found between urinary incontinence and dementia, but the prevalence of somatic diseases was not greater than among continent patients. Six months after admission patients with urinary incontinence had a higher mortality rate or were living in nursing homes to a greater extent than continent patients. The study suggests that in many geriatric patients urinary incontinence is more closely related to general functional impairment than to specific medical conditions of the uro-genital organs and the central nervous system.

Prevalence of vertebral fractures in 85-year-olds. Radiographic examination of 462 subjects.

Radiographic examinations for the presence of vertebral fracture between Th4-L5 were performed in a random sample of 85-year-old women (n 304) and men (n 158) who participated in a longitudinal population study. A moderate vertebral fracture was defined as an anterior/posterior vertebral height ratio of 0.66 or less. A severe vertebral fracture was defined as a compression of vertebral height of more than 33 percent both at the anterior and posterior edges compared to the posterior edge of the adjacent vertebral body. The prevalence of vertebral fractures was 25 percent in women and 13 percent in men. The ratio between moderate and severe grades of vertebral fracture was 1.5 for women and 2.1 for men. The most common site for vertebral fracture was L1 in women and Th12 in men. Women with vertebral fracture at 85 years of age had more back pain.

Zopiclone to Geriatric Patients

Zopiclone was given for 14 nights to 68 geriatric patients (mean age 81 years) with sleep problems. The patients were randomly allocated to four treatment groups: 3.75 mg, 5.0, 7.5, or 10.0 mg of zopi

Osteoporosis and back pain in the elderly. A controlled epidemiologic and radiographic study.

The incidence of back pain was investigated in hip fracture patients, 50–99 years of age, and in 70-, 75-, and 81-year-old controls from the same population. The prevalence of vertebral fractures were evaluated from spinal radiographs. Eighty hip fracture patients and 103 controls, all between 70 and 75 years of age, were included in the radiographic study. The incidence of back pain of the controls was twice that of the hip fracture patients, 45–48% compared with 23–20%, respectively, for both female and male subjects. Conversely, vertebral fractures were radiographically shown in 43% of the hip fracture patients and in 22% of the controls. Thus, the major explanation for longstanding back pain in the elderly does not appear to be related to spinal osteoporosis.

Accidents in the institutionalized elderly: A risk analysis

abstractAmong a total of 4,862 admittances to a Swedish geriatric hospital and its associated nursing homes, 827 accidents occurred in 588 patients during one year.The purpose of the present study was to establish the direct causes of these accidents and to identify possible risk factors.Information was collected from medical records, interviews with patients and staff, examination of the mental and physical state of the patients, and through reconstruction of the accidents.The investigation embraced 270 patients with 308 major accidents (fractures, sprains, open wounds, concussions and injuries to ligaments), and 318 patients with 519 minor accidents (bruises, contusions, abrasions and minor burns).Injury-free patients with nearest lower bed number in relation to patients with major accidents formed a control group. Patients with previous injuries, balance disturbances, and polypharmacy were at high risk, and intrinsic factors such as dizziness and impaired balance proved to be more significant as direct causes for the occurrence of accidents than environmental factors.The estimated risk for a patient with all these risk factors to have an accident during one year was 94%. (Aging 3: 181-192, 1991)

Prevalence of fractures among 10 000 women from the 1900 to 1940 birth cohorts resident in Gothenburg

The prevalence of fractures in women aged 45-86 years resident in the city of Gothenburg, Sweden, was investigated by means of a postal questionnaire. A sample of 10,000 women from seven birth cohorts (1900-1940) was obtained at random from the population register. The response rate was 70.1% in the 1900-1920 and 81.0% in the 1930 and 1940 birth cohorts. When the prevalence of fractures sustained between 25 and 46 years of age was analyzed a higher figure emerged for women from the 1930 and 1940 birth cohorts than for those from the 1900-1920 cohorts, indicating an increasing incidence of fractures over time. There was a significant independent correlation between early menopausal age and a high rate of fractures. Menopausal age decreased with increasing tobacco consumption. There was also a significant independent correlation between tobacco-smoking and a high fracture rate. The prevalence of tobacco-smoking increased from 30.0 to 38.1% between the 1930 and 1940 birth cohorts, which may further increase the fracture risk in future years. Despite increasing vitality and longevity among the elderly in Gothenburg, there are indications that the number of fractures will increase in the future.

Accidents in the institutionalized elderly: injuries and consequences

A total of 308 major and 519 minor accidents involving 588 patients occurred during one year at a somatic long- term care hospital and its associated nursing homes. In relation to the number of patients, the incidence of accidents was nearly three times higher in the nursing homes than in the hospital. The most prevalent injuries in female patients were fractures and hematomas, while open wounds were more frequent among male patients. Hip fractures were about as common in women as in men, while fractures of the extremities were three times more frequent in women. The majority of the accidents occurred during daytime, in the patient’s room and in many cases soon after admission. Most of the injuries were caused by falls and in more than 90% no staff was present. Accidents were reported most frequently in October — December, and least often in July — September. Two thirds of the severely injured had to be transferred to an emergency hospital for surgery or other treatment. Patients who had had major accidents also had a higher mortality rate six months after the accidents as compared to a control group. The medical and functional consequences for the patients were considerable. Measures to reduce the number of accidents among geriatric patients are therefore urgently needed. (Aging Clin. Exp. Res. 4: 125- 133, 1992)

Functional capacity among the elderly in Sweden.

The author describes Swedish experience with an increasingly large elderly population, concentrating on problems relating to ADL, hygiene, housing and locomotion.