Pernilla Hillerås

Life Satisfaction among the Very Old: A Survey on a Cognitively Intact Sample Aged 90 Years or Above

The purpose of the study was to measure life satisfaction and the factors believed to influence it. The study involved 105 very old people, ninety years and above, who were not cognitively impaired, living in the inner part of Stockholm, Sweden. In order to assess life satisfaction, the Life Satisfaction Index-B (LSI-B) and Life Satisfaction Index-Z (LSI-Z) were used. Information about life events, activities, personality and social contacts were collected in order to determine their relative influence on life satisfaction. Factors associated with life satisfaction were also investigated in a content analysis to find out what the elderly themselves believe gives them life satisfaction. Results showed that health and an emotionally stable personality were, independently of other factors, the most important factors for life satisfaction among the very old.

Negative and Positive Affect among the Very Old: A Survey on a Sample Age 90 Years or Older

The purpose of the study was to measure positive affect (PA) and negative affect (NA), and the factors that might influence these in the very elderly. The study involved 105 people, 90 years and older, who were not cognitively impaired, living in the inner part of Stockholm. The Positive and Negative Affect Schedule was translated and used to measure affect. Results showed that PA and NA were virtually uncorrelated. Furthermore, it was also demonstrated that the factors that influence affect in the very elderly are similar to those influencing affect in younger ages and that personality traits are the major correlates of affect.

Factors influencing well-being in the elderly

One of the aims of research on well-being is to discover the factors that either increase or decrease well-being, in both young and old people. Many factors have been studied in relation to well-being, but only some have been found to be associated with it. These factors are demographic (age, sex, culture, marital status), social (socioeconomic status, having children, religion, social contacts) or are related to personality, life events, health, and activities. However, some of these factors have a stronger association than others. This article gives a brief review of this research with special focus on the elderly.

Disability in activities of daily living among the elderly

The rise in number and proportion of older people, and the functional disability that is associated with increasing age, generate concern regarding the societal consequences of a large number of disabled elderly persons. Therefore, measuring disability in terms of activities of daily living has become routine in surveys of older people in most studies on ageing. Despite methodological obstacles, research into functional ability in the elderly has progressed during the past few decades. A high prevalence of functional disability in the elderly is consistently reported, although considerable variation has been found among studies. In contrast to functionally independent elderly, disabled elderly have been found to make increased use of home help services, and have higher institutionalization rates and premature mortality. Factors that are consistently reported as being associated with increased functional disability are older age, female sex, lower educational level, lack of exercise, chronic disease and impaired cognition. Among the chronic diseases, dementia is a progressive and disabling condition that accounts for a large proportion of the disability in elderly populations. A combination of various strategies must be employed in the approach to reduction of disability in the elderly population. More research is needed to gain a better understanding of risk and protective factors, so that we will be able to detect persons at early stages of disability, and to plan for services or rehabilitation for severely disabled persons.

How do older people experience their management of medicines

AIM The aim of this study was to describe how older people living at home in Stockholm, Sweden, experienced the management of their own medication regimen from their own perspective. BACKGROUND Very old people tend to use more medicines, and without proper medication, many of them would not function well and would not be able to remain in their own homes. METHODS This qualitative study involved audiotaped interviews with 25 very old persons. INCLUSION CRITERIA aged >or=85 years, mini-mental state examination >or=24, living at home, taking medicines regularly. Data collected May-June 2005, analysed using content analysis. DESIGN Descriptive study. RESULTS Findings revealed that most participants managed their medicines by themselves and were very content with this. Older people who received some help with their medicines were also very pleased with that help. The most important components for older people were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back up. CONCLUSION Our results indicate that most of the participants were very pleased with their medicine management, either on their own or they were able to get some help. There was, however, a need for assistance in delivering the medicines to their homes. RELEVANCE TO CLINICAL PRACTICE Understanding how older people experience their management of medicines and to reveal the components which may affect them in this situation is important to improve nursing care. To observe the life of an older person as a whole is important in nursing care, so that the persons behaviour can be understood, as how older people manage to handle their medicines may have an impact on their autonomy and on health-care resource use.

Impact of changes in life circumstances on subjective well-being in an adult population over a 3-year period.

OBJECTIVES Mental health problems are a major issue worldwide, and there is a need to further explore factors that may increase or decrease peoples subjective well-being (SWB). The main aim of the present study was to extend knowledge concerning changes in cohabitation, social support or financial situation and their influence on SWB, after controlling for personality (i.e. neuroticism), in a 3-year follow-up of an adult population-based sample. The change in overall well-being was also studied during the 3- year interval. STUDY DESIGN Longitudinal design. METHODS A random sample of Swedish citizens, aged 20-64 years, residing in Stockholm County received a questionnaire by post, comprising items pertaining to demographics, personality, social support and SWB. All the respondents received a second questionnaire 3 years later. In total, 8324 subjects were included in the present study. RESULTS The overall well-being of the study sample was relatively stable. Separate analyses of the three life circumstances indicated that, after controlling for personality, positive and negative changes in each sphere of life still affected SWB. CONCLUSIONS Despite personality and the stability of SWB, these results indicate that changes in financial situation, social support and cohabitation influence SWB. It is important for society and the healthcare services to be aware that a negative change in any of these life circumstances may lead to decreased well-being for a period of at least 3 years.

Nonagenarians: a qualitative exploration of individual differences in wellbeing

This paper focuses on the subjective experience of extreme old age for 12 people scoring high and low respectively, on wellbeing measures. The purpose was to illustrate and expand upon the quantitatively derived findings from a previous study of nonagenarians living in Stockholm, using a qualitative approach inspired by grounded theory. The results suggest that outlook on life, social and emotional ties, engagement with the outside world and physical capability are important contributors to subjectively experienced wellbeing in this age group.

Pain reporting by very old Swedish community dwellers: the role of cognition and function.

Background and aims: Pain is a common and unpleasant problem among elderly people and affects the possibility for them to remain living in their own homes. The aims of this study were therefore to report the prevalence of pain reporting and pain treatment, and their association with functional and cognitive status in a very old population. Methods: Cross-sectional population-based study. Participants were 333, aged 84 years or older, living at home alone or with someone in Kungsholmen, in central Stockholm, Sweden. Information on pain was obtained from interviews. The Mini-Mental State Examination (MMSE) measured cognitive status and the index of basic Activities of Daily Living (ADL) functional status. Descriptive statistics were used to describe the population and logistic regression models to investigate factors associated with pain reporting and pain treatment. Results: The prevalence of pain was 46%, and the prevalence of pain treatment 71%. Results from logistic regression analysis including all variables in the model showed that pain reporting was not associated with age, gender or living conditions. However, pain reporting was correlated with cognitive and functional status. There was no association between pain treatment and age, gender, living conditions, cognitive or functional status. Conclusions: Pain is common among the oldest old. Our results indicate that cognitive and functional status affect pain reporting. Poor cognitive status was associated with less pain reporting, whereas poor functional status was associated with more pain reporting.

Factors influencing the handling of medicines among very old people living at home in an urban area

Background and aims: Elderly people in Sweden live longer in their own homes, some of them with good health, and others with chronic conditions that require medical treatment. Thus, the aim of this study was to investigate factors influencing elderly people’s handling of their medicines. Methods: Cross-sectional population-based study. Participants were 333, aged 84+ years, living in their own homes. Information on regular drug use was obtained from interviews. Descriptive statistics were used to describe the population, and logistic regression models were used to investigate the factors associated with receiving help in handling medicines. The Mini-Mental State Examination (MMSE) measured cognitive status, and the basic Activities of Daily Living (ADL) assessed functional status. Results: Most participants were women living alone. 88% of this population took medicines on a regular basis and 23% of them received help with medicine handling. Using logistic regression models controlling for sociodemographic variables, cognitive and functional status, female (OR=2.8, 95% CI=1.2–6.5) was the only variable associated with regular use of medicines. Older age and functional disability in ADL increased the risk of receiving help with medicines, while higher cognitive status decreased the odds of receiving help. The only factor related to receiving help from a family member was living alone (OR=0.05; 95% CI=0.01–0.40). Conclusions: This study indicates that cognitive and functional problems require increased help with handling medicines. These results stress the need for ongoing vigilance of, and support for, people with this high-risk profile.

Human-figure drawing (HFD) in the screening of cognitive impairment in old age

Objective –The aim of the study is to test the hypothesis that freehand human-figure drawing (HFD), can be used as a complementary screening instrument to differentiate between demented elderly people and healthy elderly controls in population based studies Method –HFD was examined in 668 elderly (⩾ 75 years of age) participants from an epidemiological study in Stockholm, who were asked to draw a human figure. The drawings were analysed on the content of body details and structural characteristics. Result –The results show quite clearly that the body details and the height decrease with decreasing cognitive function, whereas the centredness (the distance in cm from the centre of the figure to the centre of the paper) increases with decreasing cognitive functioning. Demented people place their figures in the upper left: corner of the sheet, compared with the mostly well centred figures of non-demented people. Age, on the other hand, has an influence on the HFD as after 90 years of age most of the variable show regressive changes. Conclusion –The HFD can help to differentiate between demented and non-demented subjects as well as between dementia of different severity. The HFD does not help us, however, to discriminate between Alzheimers disease and vascular dementia. Age has an influence on the HFD in the sense that after 90 years most of the variables regress to a smaller or more primitive form.