Henrik Ekström

Accidental falls, health-related quality of life and life satisfaction: A prospective study of the general elderly population.

As the physical consequences of accidental falls in the elderly are well-researched, the long-term associations between falls and quality of life and related concepts are less known. The aim of this study was to prospectively examine the long-term relations between falls and health-related quality of life (HRQoL) and life satisfaction (LS) over six years in the general elderly population. One thousand three hundred and twenty-one subjects (aged 60-93 years), from the general population in the south of Sweden, were included in a baseline assessment and a follow-up after six years. HRQoL was measured with the SF-12 and LS with the life satisfaction index A (LSI-A). The differences in mean scores between fallers at baseline (n=113) and non-fallers were statistical analyzed. Furthermore, the prediction of falls on the outcomes was analyzed using a multivariate linear regression model adjusted for multiple confounding factors. Fallers scored significant lower in HRQoL and LS at baseline and after six years, compared to non-fallers, especially in the SF-12 physical component (p=<0.001). In the linear regression analysis, one or more falls at the baseline predicted a significant reduction in the SF-12 physical component at the follow-up assessment (B-Coefficient -1.8, 95% CI -3.4 to -0.2). In conclusion, falls predict a long-term reduction in the physical component of HRQoL in the general elderly population. Over six years, fallers had a notable chronic lowered score in both HRQoL and LS, compared to non-fallers. This long-term depression of elderly fallers in these aspects may be more extent than previous assumed.

Falls in the general elderly population: a 3- and 6- year prospective study of risk factors using data from the longitudinal population study 'Good ageing in Skane'.

BackgroundAccidental falls in the elderly are a major health problem, despite extensive research on risk factors and prevention. Only a limited number of multifactorial, long-term prospective studies have been performed on risk factors for falls in the general elderly population. The aim of this study was to identify risk factors predicting falls in a general elderly population after three and six years, using a prospective design.MethodsThe prevalence of 38 risk factors was recorded at a baseline assessment of 1763 subjects (aged 60–93 years). The incidence of one or more falls was recorded after three and six years. The predicted risk of falling, after exposure to the various risk factors, was analysed in a multiple logistic regression model, adjusted for age and sex, and presented as odds ratios (OR). A principal component analysis (PCA), including the statistical significant factors, was also performed to identify thematic, uncorrelated components associated with falls.ResultsThe use of neuroleptics (OR 3.30, 95% CI: 1.15–9.43), heart failure with symptoms (OR 1.88, 95% CI: 1.17–3.04) and low walking speed (OR 1.77, 95% CI: 1.28–2.46) were prominent individual risk factors for falls. In the PCA, three main components predicting falls were identified: reduced mobility, OR 2.12 (95% CI 1.54–2.91), heart dysfunction, OR 1.66 (95% CI 1.26–2.20) and functional impairment including nocturia, OR 1.38 (95% CI 1.01-1.88).ConclusionsThree main components predicting falls were identified in a general elderly population after three and six years: reduced mobility, heart dysfunction and functional impairment including nocturia. The use of neuroleptic drugs was also a prominent individual risk factor, although the prevalence was low. Heart failure with symptoms was a significant risk factor for falls and may be of clinical importance as the prevalence of this condition in the elderly is increasing worldwide. There is need for further research on the relation between heart failure and falls in the elderly, as the treatment for this condition is poorly documented in this demographic. The findings of this study may be valuable in the development of intervention programmes aimed at sustainable, long-term reduction of falls in the elderly.

Pain and fractures are independently related to lower walking speed and grip strength: Results from the population study "Good Ageing in Skåne".

Background Earlier reports on reduced physical performance and osteoporosis-related fractures have mostly been short-term studies. The aim of this investigation was to examine the effects of fractures on physical functioning 3 years after trauma, the latter being stratified for pain. Participants and methods The study consisted of a population-based case-control study including 289 subjects from the “Good Ageing in Skåne” project. Men and women with fractures, aged 60–93 years, were divided into one group with pain (FP, n = 71) and one without pain (FnP, n = 53). Fractures included vertebrae, hip, pelvis or ankle according to the national medical register. A third group of subjects without fractures or pain (CnP, n = 165) was used as control. Pain during the previous month, health variables, lifestyle, medication, use of a walking aid, and sociodemographic variables were self-reported. Walking 15 m, 2 × 15 m, and timed get-up-and-go (TUG)—all at self-selected and maximum speed—and maximum handgrip strength were assessed objectively. Results Among the FP patients, almost half of the group suffered pain on a daily basis. The subjects in the CnP and FnP groups performed significantly better than the FP patient group in all functional tests. Median time for walking a distance of 15 m at self-selected speed was 16, 13 and 12 sec for the CnP, FnP and FP groups, respectively. Both fracture and pain independently explained lower walking speed (self-selected and maximum) as well as TUG, adjusted for age, sex and co-morbidity in a multiple regression model. Those who had sustained fractures more than 3 years previously performed significantly better in walking 15 m and 2 × 15 m at both self-elected and maximum speed than those with a more recent fracture, irrespective of pain. Interpretation After 3 years, patients who had sustained a fracture but who experienced no pain performed almost as well as control subjects. Pain and fracture were independently influenced by physical function.

Effects of Walking Speed and Results of Timed Get-Up-and-Go Tests on Quality of Life and Social Participation in Elderly Individuals With a History of Osteoporosis-Related Fractures

Objectives: To investigate the relationships between physical performance, quality of life (QoL), and social participation among elderly men and women with a history of osteoporosis-related fractures. Method: The study was a population-based cross-sectional study including 155 participants aged 60 to 93 years from the Swedish longitudinal investigation, “Good Aging in Skåne.” The participants had suffered fracture of the vertebrae, hip, pelvis, or ankle. Physical performance was expressed as walking speed (WS) and timed get-up-and-go (TUG). QoL was measured as using the Health Related Quality of Life (HRQoL) and Life Satisfaction (LS) scales. Social participation was defined as taking part in social, cultural, and leisure activities. Results: Lower WS and/or TUG were associated with lower HRQoL, lower LS, and a reduction in social participation, after adjustment for confounding factors. Discussion: Measurements of WS and TUG could be used to determine QoL and social participation in elderly people having sustained fractures.

Associations between cognitive abilities and life satisfaction in the oldest-old. Results from the longitudinal population study Good Aging in Skåne

Objectives To describe change in functional ability in the oldest-old population during 3 years and examine its relation to life satisfaction (LS). A total of 681 individuals aged 78 and older from the population-based study Good Aging in Skåne took part. Methods Functional ability was assessed using Sonn and Åsberg’s Activities of Daily Living (ADL) scale and related to LS assessed by Neugarten et al’s Life Satisfaction Index A (LSI-A). Results Fifty-one percent of 87–93-year-olds reported ADL decline during 3 years. Individuals reporting impaired ADL had a mean LSI-A value of 23.0 compared to 26.4 in those unchanged. ADL decline had a stronger negative effect on LS in the younger group (78–84 years), r = 0.207, P < 0.001. In a multiple regression model, one score’s decline in ADL capacity corresponded to 1.5 scores lower LS (P < 0.001). Discussion Effort put into keeping the oldest old on a high level of functional ability has the potential to maintain the LS of this population.

Home and Health in the Third Age — Methodological Background and Descriptive Findings

Background: The understanding of the complex relationship between the home environment, well-being and daily functioning in the third age is currently weak. The aim of this paper is to present the methodological background of the Home and Health in the Third Age Study, and describe a sample of men and women in relation to their home and health situation. Methods and Design: The study sample included 371 people aged 67–70, living in ordinary housing in the south of Sweden. Structured interviews and observations were conducted to collect data about objective and perceived aspects of home and health. Results: The majority of the participants were in good health and had few functional limitations. Women had more functional limitations and reported more symptoms than men. Environmental barriers were found in every home investigated; the most were found in the kitchen and hygiene area. Environmental barriers were more common in multi-family than in one-family dwellings. Discussion: This study will increase our knowledge on home and health dynamics among people in the third age. The results have potential to contribute to societal planning related to housing provision, home care and social services for senior citizens.

Factors associated with life satisfaction in Parkinson's disease

To identify factors associated with life satisfaction (LS) in people with Parkinsons disease (PD), including a specific focus on those with late‐stage PD.

Both deterioration and improvement in activities of daily living are related to falls: a 6-year follow-up of the general elderly population study Good Aging in Skåne.

Objectives To determine the relationship between long-term change in activities of daily living (ADL) and falls in the elderly and to identify characteristics of groups at risk for falls. Methods This was a 6-year, prospective cohort study using data from the Good Aging in Skåne study in southern Sweden, involving 1,540 elderly subjects, including the oldest-old (age, 60–93 years). The subjects were recruited from the general population. ADL was measured at a baseline and follow-up assessment, using Sonn and Åsberg’s revised scale and the ADL staircase. Falls were recorded in a period of 6 months before the follow-up assessment. The association between falls and change in ADL was calculated using adjusted, multiple logistic regression analysis and presented in odds ratios (ORs). Results Thirteen percent of the study population reported one or several falls in the measured period. Over the course of 6 years, one in four participants changed their ADL status, and parts of this category had an increased risk for falls compared with those who stayed independent in ADL or who had no change in the ADL staircase. Groups with different characteristics had a prominent risk for falls: those with a reduction of two to eight steps in the ADL staircase (OR, 4.05; 95% confidence interval [CI], 1.62–10.11) and those becoming independent from dependency in instrumental ADL (OR, 4.13; 95% CI, 1.89–9.00). The former group had advanced age with a greater burden of cognitive impairment, gait disability, arrhythmia, and fall risk medications. The latter group had a higher prevalence of ischemic heart disease and low walking speed. Conclusion Both deterioration and improvement in ADL over the course of 6 years increased the risk for falls in a general elderly population. Interventional efforts may require different strategies, as groups with different characteristics were at risk. Those at risk with improved ADL function may have a history of sufficient burden of comorbidity combined with obtained mobility for exposure to a fall event.

Does informal support influence social participation of fractured elderly people

This population-based cross-sectional study describes social participation expressed as the accomplishment of social, cultural, and leisure activities resulting from informal support given by relatives or friends, formal support given by the municipality or county, or a combination of the two, among 452 individuals aged 60-93 years suffering from osteoporosis-related fractures. A fourth group of individuals with fractures without any support was used as a reference group. Fractures included were humeral, wrist, vertebral, hip, pelvic and ankle fractures. Questionnaires were used to collect sociodemographic data and information on social participation, social support, and covariates. The results showed that a smaller proportion of those with only formal support took part in social, cultural, or leisure activities, compared to participants with informal support alone, both informal and formal support or those without any kind of support. The associations between categories of activity and kind of support were further tested in a logistic regression model adjusting for possible confounders. Odds ratios (ORs) for taking part in social, cultural, and leisure activities were significantly lower for participants with formal support and a combination of informal and formal support, while participants receiving informal support did not show a significantly reduced OR for taking part in any category of activity, compared to the reference group. In conclusion; informal support of older people with fractures is an important means of facilitating social participation and an active lifestyle. Attention should be paid to the vulnerable situation of those who rely solely on formal support.

Use, non-use and perceived unmet needs of assistive technology among Swedish people in the third age.

Abstract Purpose: To describe the most prominent use of or perceived unmet need of assistive technology (AT) and to compare the characteristics of users, non-users and those expressing perceived unmet need with respect to overall health, independence in everyday life, environmental barriers and socio-demographic features. Method: The study is based on data collected in the “Home and Health in the Third Age Project”. In all, 371 individuals participated and data were collected during home visits in southern Sweden by interviewers trained specifically for this project. The data collection comprised well-proven self-report scales and observational formats on the home environment and health indicators as well as questions about basic demographics and socio-structural data. Results: The proportion of users constituted almost half of the total sample. The most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need concerned AT for communication, in total 8%. Those cohabiting were to a higher extent users of AT for furnishing/adaptation, compared to those who lived alone. A higher perceived unmet need was seen among those who lived alone compared with cohabiting people. Conclusions: These findings are of importance for future planning and development of policy to improve health services for the new generation of elderly. Implications for Rehabilitation In order to support the ageing process, the need for assistive technology has to be monitored in the third age. Assistive technology for furnishings and adaptation are frequently used by individuals in their third age and are important to support ageing in the home. Not only do health aspects impact the use of assistive technology, but gender, living conditions and social situation also matter – older men especially need to be monitored thoroughly according to their perceived unmet needs as well as do older persons living alone.