Margareta Grafström

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.

Health and social consequences for relatives of demented and non-demented elderly. A population-based study

A population-based study was performed to investigate the subjective and objective burden due to caring for a demented relative. All the relatives of the subjects with cognitive impairment, detected in a district of Stockholm, living at home, were included in the study. When compared with relatives of elderly, mentally healthy persons living at home in the same district, they had high ORs for subjective burden and for use of psychotropic drugs. Spouses were the most stressed. However, the ORs for use of medical facilities and somatic drugs were close to unity, showing that caring for a demented person did not affect the physical health of the relative. A second comparison between relatives of demented persons living at home and in institutions, showed that the relatives of institutionalized subjects were less frequently spouses and had more problems with their physical health, but both groups had similar subjective feeling of stress.

Family burden in the care of the demented and nondemented elderly--a longitudinal study.

This study describes how the situation will change with time when a close relative cares for a demented or nondemented elderly. The changes over a period of time in cognitive and behavioral deterioration, perceived burden, and social support were examined in a population-based, longitudinal study. Spouses and adult children were interviewed at a 2.5-year interval. Although the support from social services had not increased, the relatives reported less burden and decreased behavioral problems in the demented elderly group. They also reported improved physical health. On the contrary, this long-term follow-up indicated a small increase in social limitation and deteriorated physical health in the group of relatives of mentally healthy elderly. One-third of the demented elderly were admitted to an institution during Time 1 and Time 2, and this may be one reason for the decreased burden.

Abuse is in the eye of the beholder

In a population-based study 219 family members of cognitively impaired elderly (casegroup) and 255 family members of cognitively healthy elderly (control-group) were interviewed about their situation as a caregiver to an old person. Twenty-six family members in the case-group reported abusive behavior in the care of the elderly at home. These family members are compared with 154 family members in the control-group, reporting other coping strategies than abusive. In the abusive group most of the elderly were in a mild stage of dementia, and the family members reported more strain in the care situation. The family members were older, judged their health as deteriorated, and were mostly living together with the dependent elderiy.

The interplay of institution and family caregiving: relations between patient hassles, nursing home hassles and caregivers' burnout

This population‐based study investigated the relationship between stresses (hassles) and burnout for 30 family caregivers and their institutionalized demented elderly. The Burnout Measure, the Patient Hassles Scales and the Nursing Home Hassles Scale were used. Hassles included: patient hassles (cognitive, behavior, basic ADL) and nursing home hassles (caregiver – staff, patient – staff, practical/logistical). The caregivers characteristics are described in relation to burnout and the caregivers most frequent hassles are discussed. All subscales except basic ADL were correlated to burnout. However, regression analysis showed the nursing home hassles to be the most important stresses explaining variance in burnout among family caregivers. Copyright

The social consequences for families with alzheimer's disease patients : Potential impact of new drug treatment

The social consequences of Alzheimers disease are highlighted in this review with regard to impact on family situation, a changing treatment context caused by demographic changes, reorganization of long‐term care, a financial crisis in the public health systems and the introduction of antidementia drugs. In the early phase of dementia there may be significant consequences for the patients and the family members which are largely unrecognized by the healthcare system. As the disease progresses, the impact on caregivers in terms of physical and emotional burden, financial and employment status may be enormous. The current care provision in Sweden, the UK and The Netherlands is described. Innovative care alternatives and strategies may improve the situation. The introduction of antidementia drugs such as the acetylcholine esterase inhibitors may also contribute to improved circumstances for patients and caregivers. There is still a great need for further research in this field. Copyright

The Circle Model—support for relatives of people with dementia

Home care for cognitively impaired elderly puts tremendous stress and burden on their families. Therefore it is important to search for effective care models in order to provide support for this group. In this study, an intervention model—the Circle Model—was developed, tested and evaluated in six places in Sweden. The model is unique in that family caregivers and volunteers were trained together in study circles. After their training, the volunteers replaced the caregivers in the homes on a regular basis, which permitted the caregivers some relief from the demands of caregiving. Interviews were conducted with the participants to gather information about their training and relief care experiences. The caregivers reported that the study circle provided opportunity to exchange experiences with other people in similar situations. They felt a spirit of community with other relatives, and were able to increase their knowledge in care providing and coping strategies. The emphasis in temporary relief care by the volunteers was placed on providing the relatives with feelings of security and relaxation. The satisfaction among the Circle Model participants was reciprocal. The volunteers also reported high satisfaction and appreciation of the knowledge which they acquired from the caregivers. The Circle Model brings new dimensions to the home care situation and should be seen as a complement to social services support.Copyright

Daughters and sons as caregivers for their demented and non-demented elderly parents. A part of a population-based study carried out in Sweden

The study focuses on adult children (n = 81) having the main responsibility for parents with dementia (study group). They were compared with children (n = 102) of non-demented parents (reference group). The children were interviewed about burden experienced. The interviews also secured information about the childrens co-operation with the informal and formal network and their willingness to remain as caregivers during the progression of the disease or ageing process. The results showed that the daughters reported feeling more affection in their caregiving role than the sons. About one third of the participants in the study could not get relief from someone else. Eighty-nine per cent of the children in the study group and 76% of the children in the reference group were not willing to care for their parents in the family home during the progression of the disease, even if they were employed as caregivers.

Dementia, delirium and other comorbid conditions in acute hip fracture care : Traditions, attitudes and local policies rather than actual state guide diagnose making?

In the elderly, hip fracture is a common disease. Previous studies show that more than half of these patients has a co-existing dementia and/or delirium diagnose. We found a cognitive disorder diagnose code registered in only 11% of 14,993 hip fracture patients, 65 years or older, in Stockholm, Sweden during 1994–1999. Although most common in the clinical setting, acute confusional state (delirium) was hardly ever diagnose-coded (1%). Furthermore, the share of dementia/delirium registrations ranged from 6 to 17% between hospitals and within a single hospital from 1 to 20 %. The lack of pattern in diagnosis coding became even more evident in the patients who were transferred from acute care to geriatric rehabilitation — it was unusual that the diagnosis was given at both specialities. Also regarding secondary diagnoses on the whole, large differences on hospital level was found (range 0.4 – 2.2/patient). The over all impression of the findings was that recording of comorbid conditions in acute somatic care depends on other factors than the patients actual state such as traditions, attitudes and local policies (or the lack thereof). In conclusion, significant conditions crucial for planning, treatment and prognosis in the hip fracture population are virtually invisible in this administrative database.