Katarina Wilhelmson

Burden of illness and suicide in elderly people: case-control study

Abstract Objectives: To study the association between physical illness and suicide in elderly people. Design: Case-control with illness determined from interviews with relatives of people who committed suicide and with control participants and from medical records. Setting: Gothenburg and two surrounding counties (210 703 people aged 65 years and over). Participants: Consecutive records of people who had committed suicide and had undergone forensic examination (46 men, 39 women) and living control participants from the tax register (84 men, 69 women). Main outcome measures: Physical illness rated in 13 organ systems according to the cumulative illness rating scale-geriatrics; serious physical illness (organ category score 3 or 4); overall score for burden of physical illness. Results: Visual impairment (odds ratio 7.0, 95% confidence interval 2.3 to 21.4), neurological disorders (3.8, 1.5 to 9.4), and malignant disease (3.4, 1.2 to 9.8) were associated with increased risk for suicide. Serious physical illness in any organ category was an independent risk factor for suicide in the multivariate regression model (6.4, 2.0 to 20.0). When the sexes were analysed separately, serious physical illness was associated with suicide in men (4.2, 1.8 to 9.5) as was high burden of physical illness (2.8, 1.2 to 6.5). Such associations were not seen in women, possibly because of the small sample size. Conclusions: Visual impairment, neurological disorders, and malignant disease were independently associated with increased risk of suicide in elderly people. Serious physical illness may be a stronger risk factor for suicide in men than in women.

Predictors of Suicide in the Old Elderly

Background: Seniors aged 75 and above have the highest suicide rates of all age groups in most industrialized countries. However, research concerning risk factors for suicide in the old elderly is sparse. Objective: The purpose was to determine predictors for suicide among the old elderly (75+). Data concerning the young elderly (65–74 years) are shown for comparison. Methods: 85 consecutive cases of suicide that occurred in western Sweden and 153 control persons with the same sex, birth year, and zip code as the suicide cases were randomly selected from the tax register. The old elderly group included 38 cases and 71 controls; the young elderly group included 47 cases and 82 controls. Data concerning the suicide cases were collected through interviews with close informants; controls were interviewed in person. The interview included questions on past-year life events and mental and physical health. Medical records were reviewed for cases and controls. The Cumulative Illness Rating Scale – Geriatrics was used to rate illness burden. Results: Family conflict, serious physical illness, loneliness, and both major and minor depressions were associated with suicide in the 75+ group. Economic problems predicted suicide in the younger but not in the older elderly. Old elderly suicide victims with depression (major or minor) were less likely to have received depression treatment than their younger counterparts. Conclusions: Better recognition and treatment of both major and minor depression should constitute an important target for the prevention of suicide in the old elderly. Intervention studies with large numbers of senior participants are sorely needed.

Life events and psychosocial factors in elderly suicides – a case–control study

BACKGROUND Stressful life events, such as family conflicts, separation, bereavement, somatic illness and financial problems are common antecedents of suicide. Studies on suicide among younger persons dominate the literature, despite the fact that a large proportion of suicides occur among elderly persons. METHODS The occurrence of stressful life events was investigated among elderly suicide cases and population controls. The study was conducted in the southwestern part of Sweden and included 85 persons (46 males and 39 females) 65 years and above who had committed suicide from January 1994 to May 1996. Population controls (84 males and 69 females) were randomly selected. Interviews were carried out with the controls and with informants for the suicide cases. Questions on sociodemographic background, mental and somatic health status, and life events (0-6, 7-12 and 13-24 months preceding suicide/interview) were included in the interviews. RESULTS Somatic illness, family discord and financial trouble were significant risk factors during all three time periods. Other risk factors were mental disorder, lower education, feelings of loneliness and previous suicide in the family. Factors associated with a decreased risk included active participation in organizations and having a hobby. Variables that remained in the multivariate logistic regression model were mental disorder (men, odds ratio (OR) = 62.4, 95% CI 17.9-217.5; women, OR = 55.9, 95% CI 14.1-222.3) and family discord (men, OR = 10.0. 95% CI 1.7-59.8; women, OR = 9.2, 95% CI 1.9-44.8). CONCLUSIONS Mental disorder and family discord were the two major risk factors for suicide among elderly men and women.

Elderly people's perspectives on quality of life

Quality of life has become increasingly important as an outcome in medical research. The influence of health status is often emphasised, but other dimensions are important. In order to improve quality of life, there is a need to know what people themselves consider important to their perception of quality of life. The aim of this study was to investigate what older people consider to be important for their quality of life, and to explore the impact of gender, education and health status on individual perceptions. The study was of 141 randomly selected people aged from 67 to 99 years that formed a control sample for a study of suicide among older people. They were interviewed in person about their health, socio-demographic background and, using an open-ended question, what they considered to constitute quality of life. Their answers were grouped into eight categories, with social relations being the most frequent response, followed by health, activities, functional ability, wellbeing, personal beliefs and attitudes, their own home and personal finances. In addition, they were asked to choose from a ‘show card’ three items that they regarded as important to quality of life. Functional ability was the most frequently selected domain, followed by physical health, social relations and being able to continue to live in ones present home. Our conclusion is that social relations, functional ability and activities influence the quality of life of elderly people as much as health status.

Health-promoting interventions for persons aged 80 and older are successful in the short term-results from the randomized and three-armed Elderly Persons in the Risk Zone study

To examine the outcomes of the Elderly Persons in the Risk Zone study, which was designed to evaluate whether it is possible to delay deterioration if a health‐promoting intervention is made when an older adult (≥80) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty, self‐rated health, and activities of daily living (ADLs) at 3‐month follow‐up.

Long-Term Outcome for ADL Following the Health-Promoting RCT—Elderly Persons in the Risk Zone

PURPOSE To examine independence in activities of daily living (ADL) at the 1- and 2-year follow-ups of the health-promoting study Elderly Persons in the Risk Zone. DESIGN AND METHOD A randomized, three-armed, single-blind, and controlled study. A representative sample of 459 independent and community-dwelling older adults, 80 years and older, were included. A preventive home visit was compared with four weekly multiprofessional senior group meetings including a follow-up home visit. RESULTS Analysis showed a significant difference in favor of the senior meetings in postponing dependence in ADL at the 1-year follow-up (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.19-3.10) and also in reducing dependence in three (OR = 0.52, 95% CI = 0.31-0.86) and four or more ADL (OR = 0.40, 95% CI = 0.22-0.72) at the 2-year follow-up. A preventive home visit reduced dependence in two (OR = 0.40, 95% CI = 0.24-0.68) and three or more ADL (OR = 0.37, 95% CI = 0.17-0.80) after 1 year. IMPLICATIONS A long-term evaluation of Elderly Persons in the Risk Zone showed that both senior meetings and a preventive home visit reduced the extent of dependence in ADL after 1 year. The senior meetings were superior to a preventive home visit since additional significant effects were seen after 2 years. To further enhance the long-term effects of the senior meetings and support the process of self-change in health behavior, it is suggested that booster sessions might be a good way of reinforcing the intervention.

Positive health outcomes following health-promoting and disease-preventive interventions for independent very old persons: long-term results of the three-armed RCT Elderly Persons in the Risk Zone

UNLABELLED The aim of this study was to analyze the long-term effect of the two health-promoting and disease-preventive interventions, preventive home visits and senior meetings, with respect to morbidity, symptoms, self-rated health and satisfaction with health. The study was a three-armed randomized, single-blind, and controlled trial, with follow-ups at one and two years after interventions. A total of 459 persons aged 80 years or older and still living at home were included in the study. Participants were independent in ADL and without overt cognitive impairment. An intention-to-treat analysis was performed. The result shows that both interventions delayed a progression in morbidity, i.e. an increase in CIRS-G score (OR=0.44 for the PHV and OR=0.61 for senior meetings at one year and OR=0.60 for the PHV and OR=0.52 for the senior meetings at two years) and maintained satisfaction with health (OR=0.49 for PHV and OR=0.57 for senior meetings at one year and OR=0.43 for the PHV and OR=0.28 for senior meetings after two years) for up to two years. The intervention senior meetings prevented a decline in self-rated health for up to one year (OR=0.55). However, no significant differences were seen in postponing progression of symptoms in any of the interventions. This study shows that it is possible to postpone a decline in health outcomes measured as morbidity, self-rated health and satisfaction with health in very old persons at risk of frailty. Success factors might be the multi-dimensional and the multi-professional approach in both interventions. TRIAL REGISTRATION NCT0087705.

Improved health among 70-year olds: comparison of health indicators in three different birth cohorts.

Background and aims: Whether or not there has been a “compression of morbidity” in older ages has been vividly debated during the last decades. Previous studies have found indications of both improved and deteriorated health among elderly persons. Few studies have analyzed how changes in health indicators are influenced by social background factors. The aim of this study was to analyze the differences in morbidity — measured as self-assessed health, number of symptoms, number of diseases and physical function — in three different cohorts of 70-year olds, with special regard to the impact of social factors. Methods: We used data from random samples of 70-year-old people born in 1901/02 (cohort 1), 1906/07 (cohort 2), and 1911/12 (cohort 3). In the three cohorts there were 973, 1036 and 619 participants, respectively. They had a medical examination and were interviewed regarding social background, social network, self-assessed health, need of care, and number of diseases. Results: There were fewer 70-year olds not feeling healthy in the two younger cohorts (OR=0.68; CI=0.56-0.83, and OR=0.67; CI=0.53–0.84 respectively) and fewer with many symptoms. There were also indications of better physical functioning in the younger cohorts. Women seemed to have gained more than men, while the institutionalized persons had a deterioration. Conclusions: There are indications of good years being added, but not for the institutionalized persons.

Cohort differences in obesity-related health indicators among 70-year olds with special reference to gender and education

The aim of this study was to describe cohort differences in health indicators among four birth cohorts of 70-year old men and women from Göteborg, Sweden, born in 1901/2, 1905/6, 1911/12, and 1922. With special reference to gender, education, and obesity, it is hypothesized that changes in health among elderly men and women may not be occurring in a uniform manner. The variables studied were: systolic and diastolic blood pressures, triglycerides, cholesterol, height, weight, body mass index, waist–hip ratio, physical inactivity, current smoking, and alcohol consumption, plus selected prevalent diseases. Logistic and linear regression models were used to test for secular trends and effect modification by gender. Most trends in metabolic and lifestyle indicators varied in relation to gender as well as education. For instance, later-born male cohorts were more overweight than earlier-born groups while the later-born female cohorts had similar relative weights but a more centralized fat patterning. These cohort differences further varied by education where later-born men with less education and later-born women with higher education tended to be more overweight, compared to earlier-born cohorts. Finally, significant cohort differences in previously diagnosed myocardial infarction, stroke, and diabetes mellitus at age 70 were observed in men only. Interaction terms revealed that the gender difference was statistically significant only in the case of diabetes mellitus. In conclusion, secular trends in many obesity-related health indicators among 70-year old Swedish cohorts were dependent on both gender and socio-economic factors.

Mortality in three different cohorts of 70-year olds: The impact of social factors and health

Background and aims: Little is known about changes in mortality among elderly over time, especially in subgroups differing in social and other background factors. The aim of this study was to analyze differences in mortality in three different cohorts of 70- year olds regarding social factors, social network, self-assessed health and number of diseases. Methods: We used data from 3 random samples of 70- year olds born in 1901/02 (N=973), 1906/07 (N=1036) and 1911/12 (N=619). At age 70 all participants were given medical examinations and interviewed regarding social background, social network, self-assessed health, need of care and number of diseases. Death records were obtained up to and including 1998. Results: The youngest cohorts had significantly decreased mortality compared to the oldest cohort (RR 0.86; CI 0.78-0.95 and RR 0.88; CI 0.78-0.995 respectively). There were no differences between the two youngest cohorts. Decrease in morality in the younger cohorts was found among those who lived in their own home, did not feel tired, were non-or ex-smokers and had one or more diseases. Conclusions: There was a small difference in total mortality between these cohorts of 70- year olds. There were differences in development of mortality in subgroups distributed by health and social factors, indicating more years of life, partly due to life-style factors such as non-smoking.