Mats Thorslund

Mobility limitations in the Swedish population from 1968 to 1992: Age, gender and social class differences

Mobility limitations are closely related to disability in old age. The study of mobility limitations in the population may improve the understanding of the development of disability, as well as gender and class patterns in disability in old age. Representative samples of the Swedish population between the ages of 18 and 75 years were interviewed in 1968, 1974, 1981, and 1991. A further sample of people aged 76+ years was interviewed in 1992. The questionnaire included the ability to walk 100 meters, to walk up and down stairs, and to run 100 meters. Mobility limitations begin to appear around age 40 years, and increase with age. In 1992 nearly none in the oldest age group (85+) could run 100 meters, and less than half could walk 100 meters, or go up and down stairs without difficulty. Between 1968 and 1991, the proportion of people with mobility limitations was reduced by one third, with the most prominent reduction among the oldest age groups. Women were more likely to report mobility limitations compared to men at all waves; however, the gender difference decreased between 1968 and 1991. Blue-collar workers had more mobility limitations than white-collar workers, and this discrepancy did not decrease over time. Mobility limitations often begin early in life, and differences between cohorts, men and women, and social classes can be seen well before the age of 50. The results suggest that gender differences in functional limitations among elderly people may decrease in the future, while social class inequalities are likely to persist.

Priorities in care and services for elderly people: a path without guidelines?

The growing gap between demands and resources is putting immense pressure on all government spending in Sweden. The gap is especially apparent in care and services for elderly people in light of the rapid aging of the population. The article considers the decisions and priorities concerning resource allocation in the welfare sector in general and in elderly care in particular. The aim is to describe the political and administrative setting and to provide a conceptual structure that outlines the nature of the problem. Various levels of decision making are identified and discussed in the context of political accountability. Current transitions in elderly care are described with respect to service provision, marketisation, coverage rates, and eligibility standards. Basic principles of distribution are highlighted in order to clarify some central concepts of efficiency and justice, and a number of strategies for actual prioritising are identified. The article concludes with an endorsement of more conscious decisions in resource allocation. Existing knowledge and information concerning the effects of various strategies must be utilised, and the values and assumptions used for setting priorities must be made explicit.

Musculoskeletal pain and analgesic therapy in a very old population.

The aim of this study was to examine the prevalence of musculoskeletal pain and use of analgesic drugs in a population of very old people. The investigation is based on data from the Kungsholmen project. Of the 2638 inhabitants aged 75 or more in a parish of central Stockholm 1800 were examined. Of the subjects. 60% reported trouble with pain at musculoskeletal locations, while only 40% of the pain reporting subjects used analgesics, one third of which were non-prescription minor analgesics. Prescription analgesics (non-steroidal antiinflammatory drugs or centrally acting drugs) were used by one fourth of the pain reporting subjects, and taken on a regular basis in only half of the cases. Potent opioids were used by less than 1% of the population. There was no increase in pain with increasing age, but an increase in use of minor analgesics with age >85. Women more often reported pain and had a higher consumption of analgesics. Light opioids were more often used by subjects with multifocal pain. Subjects living in sheltered accommodation used more analgesics, particularly light opioids, than did those living in their own homes or in institutions. Subjects with low or intermediate educational status more often reported pain and used light opioids to a larger extent than did the highly educated. These results indicate that musculoskeletal pain is relatively common among the very old, but does not seem to be a severe problem for the majority, considering the low proportion of subjects using prescription analgesics regularly. However, the very low use of potent opioids indicates that some of the elderly suffering from cancer and other severe pain causing diseases might be undertreated.

DRUG USE PATTERNS IN A VERY ELDERLY POPULATION : A SEVEN-YEAR REVIEW

AbstractObjective: To determine the extent and rate of drug use and to evaluate the patterns of drug use over time in a very elderly population, we analysed drug use data from phases I (1987–1989) and IV (1994–1996) of the Kungsholmen project, an ongoing longitudinal study on aging in Stockholm, Sweden.n Study Participants: Complete drug information was obtained from 1001 subjects in the 1987–1989 study period, and 681 subjects in 1994–1996. The participants were predominantly women and the average age was 85.8 years in 1987–1989 and 86.9 years in 1994–1996.n Results: The proportion of users increased from 87.6 to 94.1% and the overall average number of drugs used per subject increased significantly (p < 0.001) from 3.4 to 4.6. Significant differences (p < 0.05) were noted in all age groups and in all types of housing. The frequency of use increased for all classes of drugs. The most frequently used in both study periods were drugs for the nervous system, cardiovascular system, and alimentary tract and metabolism. With regard to therapeutic categories of drugs, the use of vitamins, antithrombotic agents, antianaemic preparations, ACE inhibitors, antibacterials, analgesics, psychoanaleptics, and antiglaucoma preparations increased significantly (p < 0.05). The increased use of these drugs indicated heightened awareness of the most common and preventable medical conditions affecting the elderly and the use of newer classes of drugs. This also study confirmed a high prevalence of drug use and polypharmacy even in the very elderly, and the importance of evaluating the effects and appropriateness of drug use in this population.

Beyond benevolence – solidarity and welfare state transition in Sweden

For many decades the Swedish welfare system has served as an archetype of the modern comprehensive welfare state. When economic recession hit Sweden in the beginning of the 1990s, a period of half a century of continuous expansion and reforms in the welfare sector came to an end. The economic downturn enforced rationing measures in most welfare programs and was accompanied by a move towards privatisation of local welfare services and an endeavour to initiate market incentives in the care-giving systems. The focus was increasingly directed on welfare as a financial burden, and the issue of how diminishing resources should be allocated ranked high on the political agenda. In this article we depart from the concept of solidarity and discuss the development of Swedish welfare and welfare opinion. First, we articulate various representations of the concept of solidarity – societal cohesion, individual support for comprehensive welfare and the amount of universality in the provision of care. Second, we describe some fundamental traits in the route taken by Swedish welfare during the 1990s, focusing especially on care of elderly and the demographic challenge of an ageing population. Third, we summarise the evolution of public opinion regarding welfare provision and discuss the determinants of its variations. The article concludes with a discussion of how the (once salient) features of universalism have been affected by the development during the past decade, and the role of popular support in the route ahead for Swedish welfare.

Nursing load in different care alternatives in Sweden during 18 years.

In a repeated cross-sectional study, changes in nursing load and changes in care organisation (1978-1996) were studied in Sundsvall, Sweden. A total of 4555 nursing load measurements on elderly people were performed on four occasions (1978, 1988, 1993 and 1996). The nursing load has increased considerably at the nursing homes and at the homes for the aged during the whole period. In home care, the nursing load did not increase between 1978 and 1993, but it increased considerably between 1993 and 1996. The mean age of the residents, the number of persons with dementia, as well as the mean age, also increased. Between 1978 and 1996, the number of institutional resources decreased by 38%, while home care resources increased by 421%. The considerable increase in nursing load presents a worrying scenario when it is combined with the expected increase of the oldest old.

‘Misplacement’ of elderly people in the caring organisation: reasons and alternatives

The degree of misplacement in the care organisation was studied in a repeated cross-sectional study (788 persons in 1993 and 1538 in 1988, 65 years and older) in Sundsvall, an industrial city in the middle of Sweden. The overall misplacements were 23% both in 1988 and 1993. Misplacements were most frequent in the homes for the aged (about 50%). At the nursing homes, misplacement decreased from 27 to 12% between 1988 and 1993, while it has increased in home care from 8 to 27%. Almost half of the misplacements in home care needed nursing home or psychogeriatric care. The main conclusion is that the care organisation is not working optimally. The number of misplacements reflects an exhausted care situation. The concept of misplacement is probably valuable, but its usefulness must be evaluated in further studies.