Kjerstin Ericsson

Influence of social network on occurrence of dementia: a community-based longitudinal study

BACKGROUND Few data are available on the effect of social ties on dementia development. This study explored whether single social network components and different degrees of the social connections affect dementia incidence. METHODS A community-based cohort of 1203 non-demented people, living at home in the Kungsholmen district of Stockholm, Sweden, and who had good cognition, was followed for an average period of 3 years. On the basis of medical and psychological data, 176 patients were diagnosed with dementia according to the criteria of the third edition revision of the Diagnostic and Statistical Manual of Mental Disorders. Information on social network was obtained by personal interview by trained nurses at baseline. The covariates included in the analysis were age, sex, education, cognitive and functional status, depressive symptoms, and vascular diseases. FINDINGS Those individuals living alone, and those without any close social ties, both had an adjusted relative risk for developing dementia of 1.5 (95% CI 1.0-2.1 and 1.0-2.4, respectively). Compared with married people living with someone, single people and those living alone had an adjusted relative risk of 1.9 (95% CI 1.2-3.1). Infrequent contacts with network resources did not increase the risk of the disease if such contacts were experienced as satisfying. When all components were combined in an index, a poor or limited social network increased the risk of dementia by 60% (95% CI 1.2-2.1), and a significant gradient was found for the four degrees of social connections (p=0.0009). INTERPRETATION An extensive social network seems to protect against dementia. Confirmation of this finding and further investigation to clarify the mechanisms are worthwhile due to the implications for prevention.

Prevalence of Alzheimer's disease and other dementias in an elderly urban population Relationship with age, sex, and education

We studied the prevalence of different types of dementia in an elderly population in Stockholm, Sweden, in relation to age, sex, and education. The study confirmed Alzheimers disease (AD) as the most frequent type of dementia and the positive association of dementias with age, even in the most advanced ages. In contrast to previously reported data, we found the same proportion of AD and vascular dementia in the different age strata, and no sex differences regarding the prevalence of different dementia types. Finally, less educated people had a higher prevalence of all dementias, due essentially to a higher prevalence of alcoholic dementia and unspecified type of dementia. The prevalence of AD was similar across different levels of education.

Social and emotional loneliness among non-demented and demented elderly people

There is a lack of studies about loneliness and cognitive functioning among elderly people and, above all, among those with cognitive impairment. The aim of this study is to investigate loneliness, both social and emotional, in non-demented and demented elderly people. The study is based on 589 persons, who answered the question about social loneliness (often being lonely) in the Kungsholmen longitudinal project. All subjects were examined extensively to reach a diagnosis and to determine the dementia level. Data were collected through structured interviews on subjective social loneliness as well as emotional loneliness (feelings of loneliness, from often to never) and background variables (age, sex, housing and housing conditions). Non-demented elderly subjects reported themselves to be lonely significantly less often compared to demented subjects, but there were no differences in the emotional experience of loneliness. Social loneliness was more common in the different levels of dementia and increased with reduced cognitive functioning, while emotional loneliness decreased. Living together with someone and living in ones own apartment showed a positive influence on feelings of loneliness.

The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese

In order to assess the prevalence of the functional disability defined by activity of daily living (ADL) and instrumental activity of daily living (IADL) and associated factors in elderly Chinese, a population-based cross-sectional study was performed in urban, plain rural and mountain rural regions of Beijing. Of the 3440 subjects, 1707 are males and 1733 are females, with mean age of 71.4+/-7.7 years. Demographic, socio-economic and health aspects were obtained by trained interviewers. The results showed functional disability prevalence was 6.5% on ADL and 7.9% on IADL. Among the three representative areas in Beijing, the plain rural had the highest disability rate, increasing with the progression of age. Bathing and doing heavy housework were the two most difficult functional tasks. The functional disabilities were associated with gender and marital status. Our data suggest that plain rural elderly are most likely to generate functional disability, and bathing and doing heavy housework are two promising predictors to monitor the development of functional disability in the elderly.

Loneliness and Living Conditions of the Oldest Old

This paper describes 211 of the oldest old, 90 years or older, in a broad perspective based upon well-being, living conditions and the living situation during a period of two and a half years. The subjects were interviewed, and at the first contact four out of five old persons were living in their own homes, 66% regarded themselves as healthy and three out of five depended on help for primary ADL. Approximately one of two experienced loneliness, the same proportion in each age group 90, 91 etc. Slight relations were found between experienced loneliness and age and subjective health. Slight relations were also found between subjective health and cognitive impairments. During the follow-up period 43% of the old people had died, and all were being cared for in institutions in their final stage of life.

Reliability and Validity of the Hierarchic Dementia Scale

The aim of the study was to apply a method for measuring cognitive functioning in severely demented patients. Reliability and validity of the Hierarchic Dementia Scale (HDS) were tested. Fifty patients with dementia of the Alzheimers type (DAT), multi-infarct dementia (MID), and dementia of mixed type (MIX) were studied. The interrater reliability was satisfactory as estimated by means of a kappa coefficient. The test retest reliability was rs = .96. The concurrent validity of the HDS, as measured by the correlation between the HDS and the MMSE, was rs = .86, and between the HDS and the CDR was rs = -.71. The results indicate that HDS is a useful and valid instrument for determination of the heterogeneous cognitive deficits in severe dementia.

Two studies of the new nursing education in Sweden: 1. The place of gerontology and geriatrics 2. Student characteristics and expectations

In the autumn of 1993, a new system of nursing education started in Sweden. A questionnaire was sent to the presidents of all the colleges of nursing, health and the caring sciences, and questions were asked about the part played by gerontology and geriatrics in the new curricula. The responses showed a considerable variety in the amounts of theoretical and clinical education given at the colleges. During the first or second week of their education, the students admitted to three colleges in the Mälaren area answered a questionnaire containing questions about their educational backgrounds, their working experiences in the health care system, why they chose nursing education, their ideas of the tasks that a registered nurse primarily carries out, and their preferences for work after graduation. The result shows a correlation between working experience and the reasons for studies. The students stated a preference for working in emergency care rather than in geriatric care after graduation from college.

ADL capacity and loneliness among elderly persons with cognitive impairment.

Advancing age brings a natural weakening of functions, making the individual rely more on support from the community and next-of-kin. The purpose of this study was to investigate, in relation to subjective loneliness, the ADL dependence of elderly persons with and without impaired cognitive capacity. 264 persons were interviewed. The Mini-Mental State Examination was used as a screening instrument for obtaining a cognitively-impaired and a normal group of elderly. Persons with impaired cognitive capacity who experienced loneliness had the greatest ADL dependence.

Dental Management of Alzheimer Patients: A Predictive Test of Dental Cooperation in Individualized Treatment Planning

The aim of the study was to investigate a possible relationship in Alzheimer patients between the stage of dementia, cognitive and functional capacity, and behavior as a dental patient. A special index for assessing behavior in the dental setting was used. The 40 participants were inmates of a nursing home and fulfilled the criteria for Alzheimers disease in accordance with DSM-III-R. A deficiency in the dental behavior index (DBI) of 50% or less did not correlate with cognitive, functional, or graphic capacity. These subjects were generally aware of earlier regular dental treatment and behaved as if dental visits were familiar to them, although their cognitive, functional, and graphic capacities were more impaired than disclosed by the dental behavior index. A deficiency in the dental behavior index of 50% or more was more correlated with the other capacity assessments. Finding a proper treatment level for an Alzheimer patient is a delicate task in which it is essential to balance awareness of various aspects of impairment and realistic anticipation of benefit. The dental behavior index can be an appropriate instrument in this complex process.

Copying and handwriting ability in the screening of cognitive dysfunction in old age

Geometric copying and handwriting tests are often assessed in the screening of cognitive deficiency in the elderly. The aim of the study was to show the regression of geometrical copying and handwriting with increasing cognitive impairment in old age. The study is population-based and includes 668 subjects aged 75 years and older, living in an inner-city area of Stockholm. The subjects were asked to copy a cube, two pentagons, a rhombus, two intersecting rectangles, and a circle. They were also asked to write a complete sentence spontaneously, a sentence from dictation and their name. Geometric copying and handwriting skills decreased in direct proportion to decreased cognitive functioning. The skills most sensitive to small changes in cognition were copying the cube and the pentagons. Other skills were less sensitive to small changes: writing a complete sentence, copying a rhombus, two rectangles and writing ones name. However, copying and handwriting appear to complement each other. Copying of the rectangles and rhombus is more useful than the other figures because these two can be discriminated throughout different stages of dementia. Sentence writing from dictation and signature can be used to evaluate severely impaired subjects because these skills seem to be retained longer than the spontaneous sentence writing.