Sirkka-Liisa Kivelä

Incremental effectiveness of pneumococcal vaccine on simultaneously administered influenza vaccine in preventing pneumonia and pneumococcal pneumonia among persons aged 65 years or older.

The effectiveness of simultaneously administered influenza and pneumococcal vaccines vs. influenza vaccine alone in preventing pneumonia, pneumococcal pneumonia and pneumococcal bacteraemia among the elderly was studied. The vaccines were offered to all persons aged 65 years or older (N=43,500) living in 35 administrative districts in Northern Finland. A total of 26,925 persons (62%) decided to participate. Allocation to the vaccination groups took place by year of birth (odd/even). The total follow-up of those vaccinated consisted of 38,037 person years. The incremental effectiveness of the pneumococcal vaccine was -20 (95% CI -50- + 10%) for pneumonia, -20 (95% CI -90- + 20%) for pneumococcal pneumonia and + 60% (95% CI -40- +90%) for pneumococcal bacteraemia. Thus the pneumococcal polysaccharide vaccine did not offer any additional protection from pneumonia among elderly people in Finland although it reduced the incidence of bacteraemia.

Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study.

Background: In order to identify the risk factors essential for preventing major injurious falls, the associations between injurious falls and certain factors were assessed among disabled and independent elderly, respectively, who had fallen during a 2-year period. Methods: A prospective population-based study was conducted in five rural northern Finnish municipalities. The series consisted of all inhabitants aged 70 years or over, initially 979 persons. During a 2-year follow-up period, all injurious falls were recorded on the basis of telephone contacts, diary reporting and a review of the medical records of the participants. Results: Thirty percent of the subjects having fallen sustained a major injury. The multivariate model applied to the disabled elderly showed the following variables to be related to a high risk for major injurious falls: divorced, widowed or unmarried marital status (odds ratio = 2.2), a low body mass index (odds ratio = 3.1), incomplete step continuity (odds ratio = 2.2), poor distant visual acuity (odds ratio = 2.3) and the use of long-acting benzodiazepines (odds ratio = 2.4). Among the independent elderly, the risk of a fall resulting in major injury was high among the subjects who had peripheral neuropathy (odds ratio = 2.5) or were suffering from insomnia (odds ratio = 4.1). Conclusions: The risk factors for major injuries in fall occurrences differ between the disabled and independent elderly. Preventive measures should be targeted according to the disabilities of the population.

Incidence of Injury-Causing Falls Among Older Adults by Place of Residence: A Population-Based Study

OBJECTIVE: To describe the incidence and associated factors of injury‐causing falls by place of residence.

Fracture risk associated with a fall according to type of fall among the elderly.

Abstract: The kinetic energy and direction of a fall contribute to the occurrence of fracture. However, the fracture risk associated with different types of fall, different amounts of energy and different landing directions is poorly understood. u2003We recorded all falls and fall-related fractures over 7 years in an aged semi-rural home-dwelling population (n= 980), using intensive fall recording. The falls were classified according to type and place of occurrence into slip falls (SLFs), trip falls (TRFs), other extrinsic falls on the level (OEFs), intrinsic falls on the level (IFs), stair falls (STFs), falls from an upper level (ULFs) and nondefined falls (NDFs) occurring indoors or outdoors. Incidences of falls and fractures were calculated for the whole follow-up period. The population was clinically examined to assess general risk factors of fracture, after which the risk of fracture was determined in the first fall according to the different fall types. Comparison was made with intrinsic falling on the level. The overall incidences of indoor and outdoor falls were 328 (95% CI 314–345) and 198 (186–210) per 1000 person-years (PY), respectively, and those of fractures 23 (19–27) and 11 (8–14) per 1000 PY, respectively. Indoor SLFs, TRFs, OEFs, IFs, STFs, ULFs and NDFs occurred relatively evenly throughout the study period. The crude and adjusted relative fracture risks were greater in SLFs, OEFs and STFs compared with IFs. Indoor falls and fractures are more common than those occurring outdoors in aged home-dwelling persons. The kinetic energies produced in SLFs, OEFs and STFs may be higher than those generated in IFs, leading to increased risk of fracture.

Factors predicting fractures during falling impacts among home-dwelling older adults.

OBJECTIVE: To investigate the predictors of fractures during falling impacts among home‐dwelling older adults.

The impact of vaccination strategy and methods of information on influenza and pneumococcal vaccination coverage in the elderly population.

We compared the coverage achieved with either an age-based, free-of-charge vaccination program offering influenza vaccine alone or with pneumococcal vaccine with a restricted risk disease-based influenza vaccination program supplemented by self-funded immunization. We also compared two means of informing the public, either using mailed personal reminders or through the mass media only. Forty-one administrative districts with a total of 41,500 persons aged 65 years or older participated in the study during three consecutive seasons from 1992 to 1994. The average vaccination coverage achieved by the risk disease-based program was 20%, by the age-based program with mass media information, 52%, and by the age-based program with mailed personal reminders 82%. The availability of free-of-charge vaccines is thus not sufficient to ensure a high vaccination rate. The effect of the personal reminders was restricted to the year they were sent. The addition of pneumococcal vaccine to the age-based influenza vaccination program had little influence on the acceptance rate.

Orthostatic Hypotension and Cognitive Decline in Older People

OBJECTIVES: To establish the role of orthostatic hypotension (OH) as a risk factor for cognitive decline among home‐dwelling and institutionalized older people and to describe other predictors of cognitive decline.

Prevalence of depression in an aged population in Finland

The prevalence of depression by sex, age and certain sociodemographic variables was investigated among elderly Finns (65 years or over) living in the semi-industrialized town of Ähtäri (n=1225). The prevalence of depression, determined using the DSM-III criteria, was 16.5% for the total population, 14.4% for the men and 17.9% for the women. Dysthymic disorder was the commonest category of depression in both sexes, with atypical depression the second most common category among the men and major depression among the women. A few cases of cyclothymic disorder were diagnosed in each sex, but no cases of bipolar depression. The occurrence of depression was not associated with sex, but it was related to older age, widowhood and lower educational level in the men, although not in the women. In both sexes, a high risk of depression was associated with being in long-term institutional care and receiving home nursing and/or a home help. The occurrence of depression was not related to earlier occupation.

Major depression as a predictor of premature deaths in elderly people in Finland: a community study.

In order to analyse the survival of elderly Finnish people with major depression, a total of 29 elderly (≥65 years) subjects suffering from major depression (DSM‐III criteria) and 853 non‐depressed elderly subjects were followed up for 6 years. The Kaplan‐Meier survival curves showed the survival of patients suffering from major depression to be poorer than that of non‐depressed subjects. When age, sex, marital status, level of education, smoking habits, physical health, functional abilities and major depression were introduced into the Cox model, advanced age, male sex, smoking, poor physical health, reduced functional abilities and the occurrence of major depression were found to be related to higher levels of mortality. The results suggest that major depression in the elderly predicts higher mortality which is not explained by their poor baseline level of physical health alone.

The prevalence and associates of depressive disorders in the oldest-old Finns.

Aim: To describe the prevalence and associates of major depression and minor depression among the Finnish non-demented population aged 85 years and older (nu2009=u2009339). Methods: DSM-III-R criteria were used in diagnosing major depression and dementia. Minor depression was diagnosed by the physician in those who did not fulfil the DSM-III-R criteria for major depression, but had still at least two depressive symptoms. In the first phase, cross-tabulation was used to determine relative risks (RR) and their 95% confidential intervals (95% CI). An additive logistic regression model was then used to find the independent associates of depressive disorders. Results: The prevalence of major depression was 8.1% in men and 4.9% in women, and that of minor depression 18.9% in men and 18.5% in women. In men major depression was associated independently with poor physical health and in women with rare contact with family or friends and poor physical health. Minor depression was associated independently with poor physical health and previous myocardial infarction in men and with poor physical health, a poor ability to walk, and smoking in women. Conclusions: The prevalence of depressive disorders is quite high among the oldest-old Finns. The factors associated with major and minor depression are largely similar. Although the results suggest that psychosocial stress factors affect the development of both major and minor depression in the oldest-old, no conclusions about causality can be made.