Seija Arve

Serum testosterone but not leptin predicts mortality in elderly men

8. Kalmijn S, Feskens EJ, Launer LJ et al. Glucose intolerance, hyperinsulinaemia and cognitive function in a general population of elderly men. Diabetologia 1995; 38: 1096–102. 9. Suzuki M, Umegaki H, Uno T et al. Association between insulin resistance and cognitive function in elderly diabetic patients. Geriatr Gerotol Int 2006; 6: 254–9. 10. Van Harten B, de Leeuw FE, Weinstein HC et al. Brain imaging in patients with diabetes: a systematic review. Diabetes Care 2006; 29: 2539–48. 11. Akisaki T, Sakurai T, Takata T et al. Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese elderly diabetes intervention trial (J-EDIT). Diabetes Metab Res Rev 2006; 22: 376–84. 12. Araki A, Ito H. Asymptomatic cerebral infarction on brain MRI images and cognitive function in elderly diabetic patients. Geriatr Gerotol Int 2002; 2: 206–14. 13. Folstein MF, Folstein SE, McHigh PR. ‘Mini-Mental State’: a practical method of grading the cognitive function of patients for the clinician. J Psychiatr Res 1978; 12: 189–98. 14. Mohs RC, Rosen WG, Davis KL. The Alzheimer’s disease assessment scale: an instrument for assessing treatment efficacy. Psychopharmacol Bull 1983; 19: 448–50. 15. Shinagawa F, Kobayashi S, Fujita K et al. Japanese Manual for the Wechsler Adult Intelligence Scale-Revised. Tokyo: Nihon-bunka-kagaku-sya, 1990; 115–8. 16. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935; 18: 643–62. 17. Fazekas F, Chawluk JB, Alavi A et al. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 1987; 149: 351. 18. Greene DA, Sima AA, Stevens MJ et al. Complications: neuropathy, pathogenetic considerations. Diabetes Care 1992; 15: 1902–25. 19. Mediratta S, Fozailoff A, Frishman WH. Insulin resistance in systemic hypertension: pharmacotherapeutic implications. J Clin Pharmacol 1995; 35: 943–56. 20. Hassing LB, Hofer SM, Nilsson SE et al. Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: evidence from a longitudinal study. Age Ageing 2004; 33: 355–61. 21. Schwartz MW, Figlewicz DP, Baskin DG et al. Insulin in the brain: a hormonal regulator of energy balance. Endocr Rev 1992; 13: 387–41. 22. Yu Y, Kastin AJ, Pan W. Reciprocal interactions of insulin and insulin-like growth factor I in receptor-mediated transport across the blood-brain barrier. Endocrinology 2006; 147: 2611–5. 23. Qiu WQ, Folstein MF. Insulin, insulin-degrading enzyme and amyloid-beta peptide in Alzheimer’s disease: review and hypothesis. Neurobiol Aging 2006; 27: 190–8. 24. Vermeer SE, Prins ND, Den Heijer T et al. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 2003; 27: 1215–22. 25. Gold G, Kovari E, Herrmann FR et al. Cognitive consequences of thalamic, basal ganglia, and deep white matter lacunes in brain aging and dementia. Stroke 2005; 36: 1184–8.

Coexistence of lowered mood and cognitive impairment of elderly people in five birth cohorts.

Using Goldberg’s General Health Questionnaire (GHQ) to identify potential cases of mental disorders, we screened 246 randomly; selected persons among the 116 616 people older than 65 in the metropolitan zone of Guadalajara; 86 subjects (35%) qualified as “cases”; this figure is much higher than that reported (20.8%) in the adult population in a previous study. Among the cases, 69% were female, 66% were widowed, and 50% were divorced; 44% had not finished gradeschool, 42% had no scholastic education, 54% were unemployed, and 40% worked at home. Factors associated with anxiety and severe depression, sleep disorders, psychosomatic symptoms, and problems in interpersonal relations were studied.

Personal resources supporting living at home as described by older home care clients.

This study describes the personal resources of older (> or = 75 years) home care clients in Finland and their perceptions of factors that enhance and constrain their ability to live independently at home. The data were collected by unstructured interviews with 21 older home care clients. Inductive content analysis were used to analyse the data. The resources of older people consisted of a sense of control over ones life and a determination to remain active. Factors enhancing older peoples resources were their involvement in leisure activities and social networks, factors undermining their resources were conditions on living imposed by outsiders, declining health and loneliness. The results show that home care professionals do not yet have sufficient skills and abilities to identify and support older peoples existing resources. As well as having access to necessary resources, it is also crucial that older people know how to use them.

Serum lipids and their association with mortality in the elderly: a prospective cohort study

Background and aims: To determine whether high levels of serum total cholesterol and low levels of high-density lipoprotein cholesterol (HDL-c) are associated with increased mortality in the elderly. Methods: Prospective cohort study of 1032 non-institutionalized people aged 70 in the city of Turku, Southern Finland. The cohort population was recruited as part of a larger longitudinal aging study, the Turku Elderly Study. Fasting serum levels of total cholesterol, HDL-c and triglycerides were measured, and the amount of low-density lipoprotein cholesterol was calculated at baseline. The cohort was followed for mortality for 12 years, and the causes of death were recorded and further classified into cardiovascular and other causes of death. The hazard ratios of dying for subjects in various cholesterol quartiles were computed by the Cox proportional hazards model, adjusting for cardiovascular risk factors and pre-existing medical conditions. Results: Low levels of serum total cholesterol and HDL-c were associated with a greater risk of death over a follow-up of 12 years. After adjustment for several cardiovascular risk factors, the association between total cholesterol and survival changed. All-cause mortality seemed to be highest in the highest quartile of total cholesterol and nearly as high in the lowest quartile of total cholesterol, suggesting a U-shaped connection, but the differences were not statistically significant. However, cardiovascular mortality was significantly lowest in the lowest quartile of total cholesterol and significantly highest in the lowest quartile of HDL-c. Conclusions: High levels of serum total cholesterol and particularly low levels of HDL-c seem to be risk factors for cardiovascular mortality even in the elderly population.

Multiprofessional collaboration promoting home care clients' personal resources: perspectives of older clients

Home care can be decisive in supporting older people in the home environment. However, one professional in home care cannot take the whole responsibility for promotion alone; on the contrary multiprofessional collaboration is needed. The aim of the study is to describe the experiences of multiprofessional collaboration in promoting personal resources among older home care clients (75+ years) in Finland. The data were collected by unstructured interviews with 21 older home care clients. Their mean age was 83.5 years, ranging from 75 to 91, with 17 female and four male participants. Inductive content analysis was used to analyze the data. The interviewees described the work of professionals from four perspectives: expertise, communication, decision-making and responsibility. Multiprofessional collaboration promoted the personal resources of interviewees with physical, psychological and social support. This study showed that the professionals worked as being expert-oriented: in the multiprofessional collaboration, each expert took care of his/her own part of the clients situation. This included the risk,, that the clients overall situations remained uncharted. However, the clients overall situation is a very important aspect when professionals suppport older people living in their own homes as long as possible. This study revealed the need for developing collaboration skills between social and health care professionals so that the staffs serve the needs of aged clients better together.

Positive life orientation in old age: a 15-year follow-up.

BACKGROUND Positive life orientation (PLO) is considered an important dimension of successful aging. AIM To investigate how self-reported PLO changed among home-dwelling people from age 70 to 80 and 85 years. STUDY DESIGN A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. SUBJECTS AND METHODS The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (N=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. PLO was assessed with the following items: life satisfaction, feeling needed, having plans for the future, having zest for life, feeling depressed, and suffering from loneliness. We created a PLO score from the answers to these questions, where 1 represented the best PLO and 0 the poorest. RESULTS At baseline, the participants showed rather high levels of positive life orientation (PLO total score 0.83). PLO declined markedly after the 70-year-old participants reached the age of 80 and 85 years (p<.001). However, depressive feelings remained quite stable. The decrease was similar among men and women except for the items suffering from loneliness and feeling needed. At age 70 and 80 years women suffered more from loneliness than men, while men experienced feeling needed more than women. CONCLUSIONS Positive life orientation declines during old age, especially from age 70 to 80 years. Thereafter the decline is less steep except for changes in future plans and feeling needed.

A collaborative approach to home care delivery for older clients: perspectives of home care providers.

A collaborative approach to home care (HC) delivery for older clients has taken centre stage (Nies, 2006). In Finland, public home help and home health care services have been combined to form the home care unit, whose goal is to provide a collaborative approach to care delivery through cooperation and sharing of responsibilities. In this model, the general practitioner (GP), home care nurses (HCN) and home help workers (HHW) care for shared clients. GPs and HCNs provide health care, such as monitoring of clients’ health status, and HHWs assist with personal care tasks such as dressing, washing and meal preparation. As the needs of older clients are multiple, collaboration is needed as one professional group cannot take sole responsibility (Nies, 2006). This paper reports on a study undertaken to examine home care unit care providers’ perspectives of the collaborative approach to HC delivery for older clients.

Prognosis of depression with and without dementia in old age

Prognostic significance of depression with and without dementia in terms of survival was investigated in a prospective study of persons aged 70 years (n=1032), using mini-mental state examination (MMSE), self-rating depression scale of Zung, clinical dementia rating (CDR), DSM-III criteria of major depression, clinical depression (CD) and the date and causes of death during the 5-year follow-up. The Zung-score (>40 pts) and CD were associated with slightly increased 5-year mortality. The 5-year mortality was significantly increased in the combination group (MMSE-score <24, Zung-score >40). Excess mortality of depressed subjects was found in all categories of death except malignancy and the most significant increase was found in the rate of pulmonary diseases. The data indicate that lowered mood, measured with the Zung-test, is an independent risk indicator of death in the general aged population, but depression is hardly an independent risk condition of cognitive decline.

Depressive symptoms among older people: a 15-year follow-up

Background and aims: Depressive symptoms are common symptoms impairing the quality of life of older people. This population-based birth year cohort study investigated the prevalence of depressive symptoms and factors associated with them among home-dwelling older people. Study Design: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. Methods: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (n=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. All examinations included an identical study protocol; the participants’ self-reported health status/habits and depressive symptoms were investigated via a questionnaire. Afterwards, thorough clinical examinations including the Zung depression scale were conducted by a nurse and physician/geriatrician. Results: The mean of the Zung depression scale total score was 34 (SD 7.7) at the age of 70 and a significant increase was found in both re-examinations. At the age of 80 the mean of the Zung score was 35.8 (SD 7.5) while it was 37.6 (SD 8.9) at the age of 85 years. A similar increasing trend was found in the proportion of persons classified into the high Zung score group (≧45 points) indicating more depressive symptoms over the 15 year follow-up. Univariate and multivariate analyses showed that mostly functional and social factors were associated with subjectively reported depressive symptoms, while few associations were evidenced between depressive symptoms and medical conditions or poor health. Conclusions: Our findings revealed an increase in prevalence of depressive symptoms throughout the course of the investigation. Our findings suggest that even in the absence of a diagnosis of major depression, depressive symptoms assume importance in the evaluation of the health status and need for health care services among older people.

Physical functioning, health and survival : a ten-year follow-up study

Background and aims: Cutbacks in human resources are putting home care personnel under increasing pressure in their work. Home health care personnel need to know how they can prevent undesirable conditions and support older people towards successful aging. The aim of this ten-year follow-up study was to identify factors associated with increased mortality among 70-year-old subjects living in the community. Methods: Data were collected in 1991 by a postal questionnaire sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. Results: Many health-related factors, such as smoking, poor subjective health, and mobility, were related to an increased level of mortality. In addition, several diseases (e.g., diabetes, angina pectoris, cancer) at age 70 were associated with increased mortality over ten years. Difficulties in daily activities at age 70 also increased the risk of mortality. Conclusions: The findings offer useful clues for planning health care services and preventive interventions provided by home health care personnel. Home health care personnel should give special attention to older people who feel ill or very ill.