Helena Hörder

Self-respect through ability to keep fear of frailty at a distance: Successful ageing from the perspective of community-dwelling older people

With population ageing, there is an increased interest in how to promote a good old age. A predominant concept in these discussions is successful ageing, which is mainly based on researchers’ definitions. This article aims to explore successful ageing from the perspective of community-dwelling older people (24 persons aged 77–90 years). Individual open interviews were conducted and analysed according to qualitative content analysis. An overarching theme was formulated as “self-respect through ability to keep fear of frailty at a distance”. This embraced the content of four categories: “having sufficient bodily resources for security and opportunities”, “structures that promote security and opportunities”, “feeling valuable in relation to the outside world”, and “choosing gratitude instead of worries”. Ageing seems to be a dynamic process rather than a static structure and might therefore be susceptible to actions. Paying attention to attitudes and treating the older person with respect, particularly with regard to worries about increasing vulnerability, can lead to better ways of promoting successful ageing.

Physical activity and physical functioning in Swedish and Iranian 75-year-olds - A comparison

BACKGROUND AND PURPOSE The pattern of population aging is highly complex and contextually based. Cross-national comparisons are helpful to explore related factors. Two cross-sectional studies designed to compare physical activity level, physical functioning and certain health related factors in 75-year-old women and men in Sweden and Iran. MATERIALS AND METHODS Cohorts of 637 Swedish and 851 Iranian 75-year-olds were investigated with the same methods regarding physical activity level, physical functioning and health related factors. RESULTS There were differences in physical activity level (p<0.001), self-reported physical functioning (p<0.001) objective physical functioning (p<0.001), health status (p<0.001) and most socio-demographic aspects between the two countries. Here the Swedish cohort had the advantage. There was no difference between the countries regarding prevalence of vertigo or falls. The only variables where the Iranian cohort had advantage over the Swedes were grip strength and smoking habits. There were larger gender differences in walking habits, self-selected walking speed, timed chair stand, and one-leg stance in Iran, and in grip strength in Sweden, all to the disadvantage of women. CONCLUSIONS Iranian 75-years-olds had a lower physical activity level, a worse lower extremity physical function but a better grip strength, a worse physical health status, but smoked less than their Swedish counterparts. Despite this, there were no differences regarding vertigo or falls. In most aspects, the magnitude of gender differences was about the same and in disadvantage of women, although there were larger differences in Iran in some lower extremity functions.

Secular trends in frailty: a comparative study of 75-year olds born in 1911–12 and 1930

BACKGROUND while there is a trend towards a compression of disability, secular trends in physiological frailty have not been investigated. The aim of this paper was to report physiological frailty in two cohorts of 75-year olds examined in 1987 and 2005. METHODS a repeated cross-sectional study : Two population-based birth cohorts of community-dwelling 75-year olds from Gothenburg, Sweden, born in 1911-12 (n = 591) and 1930 (n = 637) were examined with identical methods in 1987 and 2005. Measures were three frailty criteria from Frieds frailty phenotype: low physical activity, slow gait speed and self-reported exhaustion. RESULTS seventy-five-year olds examined in 2005 were less frail according to the criteria low physical activity compared with those examined in 1987 (3 versus 18%, P < 0.001).This was seen both in women and in men, and among those with basic and more than basic educational level. Further, men with basic education were less frail in 2005 compared with those in 1987 in slow gait speed (non-significant when adjusted for body height) and low self-rated fitness, while no cohort differences were seen in men with more than basic education. Women with more than basic education were less frail in 2005 compared with those in 1987 in slow gait speed and self-rated fitness, while no cohort difference was seen in women with basic education. CONCLUSION less 75-year olds were physiologically frail in 2005 compared with those in 1987, with the exception of women with low educational level, suggesting that this is a disadvantaged group that needs to receive particular attention with regard to physiological frailty.

Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women

Objective To investigate whether greater cardiovascular fitness in midlife is associated with decreased dementia risk in women followed up for 44 years. Methods A population-based sample of 1,462 women 38 to 60 years of age was examined in 1968. Of these, a systematic subsample comprising 191 women completed a stepwise-increased maximal ergometer cycling test to evaluate cardiovascular fitness. Subsequent examinations of dementia incidence were done in 1974, 1980, 1992, 2000, 2005, and 2009. Dementia was diagnosed according to DSM-III-R criteria on the basis of information from neuropsychiatric examinations, informant interviews, hospital records, and registry data up to 2012. Cox regressions were performed with adjustment for socioeconomic, lifestyle, and medical confounders. Results Compared with medium fitness, the adjusted hazard ratio for all-cause dementia during the 44-year follow-up was 0.12 (95% confidence interval [CI] 0.03–0.54) among those with high fitness and 1.41 (95% CI 0.72–2.79) among those with low fitness. High fitness delayed age at dementia onset by 9.5 years and time to dementia onset by 5 years compared to medium fitness. Conclusions Among Swedish women, a high cardiovascular fitness in midlife was associated with a decreased risk of subsequent dementia. Promotion of a high cardiovascular fitness may be included in strategies to mitigate or prevent dementia. Findings are not causal, and future research needs to focus on whether improved fitness could have positive effects on dementia risk and when during the life course a high cardiovascular fitness is most important.

Association between APOE Genotype and Change in Physical Function in a Population-Based Swedish Cohort of Older Individuals Followed Over Four Years

The association between decline in physical function and age-related conditions, such as reduced cognitive performance and vascular disease, may be explained by genetic influence on shared biological pathways of importance for aging. The apolipoprotein E (APOE) gene is well-known for its association with Alzheimer’s disease, but has also been related to other disorders of importance for aging. The aim of this study was to investigate possible associations between APOE allele status and physical function in a population-based longitudinal study of older individuals. In 2005, at the age of 75, 622 individuals underwent neuropsychiatric and physical examinations, including tests of physical function, and APOE-genotyping. Follow-up examinations were performed at age 79. A significantly larger decline in grip strength (p = 0.015) between age 75 and 79 was found when comparing APOE 𝜀4 allele carriers with non-carriers [10.3 (±10.8) kg versus 7.8 (±10.1) kg]. No association was seen with decline in gait speed, chair-stand, or balance. The association with grip strength remained after correction for cognitive and educational level, depression, cardiovascular disease, stroke, and BMI.

Self-rated health and its association with mortality in older adults in China, India and Latin America—a 10/66 Dementia Research Group study

Abstract Background empirical evidence from high-income countries suggests that self-rated health (SRH) is useful as a brief and simple outcome measure in public health research. However, in many low- and middle-income countries (LMIC) there is a lack of evaluation and the cross-cultural validity of SRH remains largely untested. This study aims to explore the prevalence of SRH and its association with mortality in older adults in LMIC in order to cross-culturally validate the construct of SRH. Methods population-based cohort studies including 16,940 persons aged ≥65 years in China, India, Cuba, Dominican Republic, Peru, Venezuela, Mexico and Puerto Rico in 2003. SRH was assessed by asking ‘how do you rate your overall health in the past 30 days’ with responses ranging from excellent to poor. Covariates included socio-demographic characteristics, use of health services and health factors. Mortality was ascertained through a screening of all respondents until 2007. Results the prevalence of good SRH was higher in urban compared to rural sites, except in China. Men reported higher SRH than women, and depression had the largest negative impact on SRH in all sites. Without adjustment, those with poor SRH showed a 142% increase risk of dying within 4 years compared to those with moderate SRH. After adjusting for all covariates, those with poor SRH still showed a 43% increased risk. Conclusion our findings support the use of SRH as a simple measure in survey settings to identify vulnerable groups and evaluate health interventions in resource-scares settings.

Face and content validity and acceptability of the Swedish ICECAP-O capability measure: cognitive interviews with 70-year-old persons

This study is part of a project that aims to culturally adapt the Investigating Choice Experiments for the Preferences of Older People-CAPability Index (ICECAP-O) for use in research and health and social care in Sweden. The objective was to evaluate face and content validity and acceptability. Eighteen 70-year-old community-dwelling persons participated in cognitive interviews. A standardized classification scheme was used to quantify any identified response problems, and a thematic analysis was applied to capture participants’ perceptions of included attributes and experiences of completing the measure. The results show that three participants (18%) had problems completing ICECAP-O, and that judged problems occurred for five (6%) of participants responses in the standardized classification scheme. Most participants perceived the attributes as understandable even though the meaning of Control brought some uncertainty. ICECAP-O seems to measure what it is supposed to measure, quality of life (QoL) with a capability approach, and acceptability is satisfactory. ICECAP- O has potential for becoming a valuable addition to the supply of QoL measures in research and health and social care in Sweden. However, we recommend further research on more diverse groups of older persons.