Ulf Jakobsson

Old people in pain: A comparative study

To investigate the prevalence of pain in older people (75+), compare those in pain to those without regarding demographics, social network, functional limitations, fatigue, sleeping problems, depressed mood and quality of life (QOL), and identify variables associated with pain, a cross-sectional, prospective survey was conducted in an age-stratified sample of 4,093 people aged 75-105 years old. Those reporting pain (n=1,654) were compared with those who did not (n=2,439). Pain was more common with higher age, as were all complaints among those in pain and among those without, except sleeping problems. Lower QOL was found with higher age, as well as with pain. Pain was found to be associated with functional limitations, fatigue, sleeping problems, depressed mood, and QOL. These data highlight the importance of identifying old people in pain. Those who are older and those affected by pain are at greater risk of also being troubled by other problems, such as functional limitations and lowered QOL.

Overall and health related quality of life among the oldest old in pain

Objectives: To compare the oldest old (85 years and above) in pain with those with no pain across gender, regarding demographic data, living conditions, social network/support, walking/mobility problems, fatigue, sleeping problems, depressed mood and quality of life (QoL). The aim was also to test how these variables were related to QoL among the oldest old in pain. Methods: The study comprised 1622 people aged 85–105 years, of whom 47% reported pain. SF-12 and the LGC questionnaire were used to measure QoL. Multiple linear regression analysis was used to identify factors associated with QoL. Results: Functional limitations, fatigue, sleeping problem and depressed mood were significantly more prevalent and QoL was significantly lower among those in pain than those not in pain, and among women compared to men. These complaints, along with financial problems, living in sheltered housing and living alone, were associated with low QoL among those in pain. Conclusion: Pain is common among the oldest old and coexists with several other complaints that together negatively affect QoL. By identifying those in pain and coexisting factors, actions can be taken to contribute to QoL, also in late life.

Comparing the educational environment (as measured by DREEM) at two different stages of curriculum reform

Background: The medical programme at Lund University, Sweden, has undergone curricular reform over several stages, which is still ongoing. Students have been somewhat negative in their evaluations of the education during this time. Aim: To find out how the students perceived the educational climate using the Dundee Ready Education Environment Measure (DREEM), and to compare the findings taken at two given points in time. Method: The DREEM instrument was distributed in semesters 2, 6 and 10 in 2003 and 2005, to a total of 503 students. Results: The students rated their climate as positive. The total DREEM score (145) was somewhat higher than other published results and in the same range as for other reformed curricula. There was hardly any difference between the genders in their perceptions of the climate. Certain items were rated low and became subject of development between the measurements. These items concerned a perceived lack of a support system for stressed students and a lack of feedback and constructive criticism from teachers. Some improvement was detected in 2005. Conclusion: The educational climate was high in a reformed curriculum and could be maintained high during on-going curricular reform. Educational development resulted in better results on some items.

Using the 12-item Short Form health survey (SF-12) to measure quality of life among older people.

Aims: To present descriptive data, study psychometric abilities, and investigate the characteristics of non-respondents to SF-12. Method: The study had a randomized sample (n=4278; age: 75–105) stratified in four age groups. Factor analyses were performed to investigate the factor structure of the instrument, and convergent and discriminant validity was assessed by correlation between summary scores and by means of various measures (such as symptoms and ADL). Mean scores and Cronbach’s alpha were computed for the total sample and for each stratum. Respondents and non-respondents to SF-12 were compared regarding various measures. A multiple logistic regression analysis was conducted to identify determinants for respondents/non-respondents. Results: Mean scores in the total sample were 37.5 SD 11.9 for the physical component summary score (PCS) and 50.3 SD 11.5 for the mental component summary score (MCS). Both PCS and MCS decreased significantly with higher age. The instrument showed acceptable convergent/discriminant validity and Cronbach’s alpha, but the factor solution did not follow the intended structure of the instrument. Completion rate for all 12 items was 85.5% in the total sample, and the characteristics of non-respondents to SF-12 were higher age, being female, living alone, living in special accommodation, being worried about health, being in need of help with activities of daily living, reporting fewer symptoms, and having a smaller social network than respondents. Conclusions: The instrument generally showed acceptable validity and reliability, except for its factor structure. Furthermore, new determinants for non-respondents of SF-12 were found, such as type of living conditions, being worried about health, and social network.

Loneliness, fear, and quality of life among elderly in Sweden: a gender perspective.

Background and aims: The aim of this work was to study feelings of loneliness and fear among elderly people (75+) in a gender perspective, and to explore their causes. Methods: A cross-sectional study (postal questionnaire) with a randomised and age-stratified sample (n=4277) was used to study the variables of interest. Because the variables were compared between men and women, weighted values for means, standard deviations, and ratios were used. Multiple logistic regression analysis was used to identify the causes of loneliness and fear. Results: Findings showed that loneliness and fear were both more frequently reported by women than men. Loneliness was significantly associated with gender, marital status, living in special accommodation, fear, and need of help with activities of daily living (IADL). Fear was significantly associated with gender, number of children, having someone to trust, loneliness, and being in need of help with IADL. Those who reported loneliness and/or fear had significantly lower health-related quality of life than those who did not. Many of the elderly feared violence/crime, but only a few had been exposed to violence/crime. Conclusions: Loneliness and fear are common among elderly people. Both variables seem to be related to each other and were both found to be “threats” to a good life in old age. However, to minimize these “threats” and perhaps improve these people’s quality of life, action can be taken in the care for elderly people such as involving the social network and reducing the need of help with IADL.

Prevalence and predictors of falls and dizziness in people younger and older than 80 years of age-A longitudinal cohort study.

The objectives were to investigate the prevalence and predictors for falls and dizziness among people younger and older than 80 years of age. The sample was drawn from the Swedish National study on Aging and Care (SNAC) and comprised 973 and 1273 subjects with data on the occurrence of falls and dizziness respectively at baseline. Follow-ups were made after 3- and 6-years. Data included socio-demographics, physical function, health complaints, cognition, quality of life and medications. The prevalence of falls was 16.5% in those under aged 80 and 31.7% in those 80+ years while dizziness was reported by 17.8% and 31.0% respectively. Predictors for falls in those under aged 80 were neuroleptics, dependency in personal activities of daily living (PADL), a history of falling, vision impairment and higher age, and in those 80+ years a history of falling, dependency in instrumental activities of daily living (IADL), fatigue and higher age. Factors predicting dizziness in those under aged 80 were a history of dizziness, feeling nervous and reduced grip strength and in those 80+ years a history of dizziness and of falling. Predictors for falls and dizziness differed according to age. Specific factors were identified in those under aged 80. In those 80+ years more general factors were identified implying the need for a comprehensive investigation to prevent falls. This longitudinal study also showed that falling and dizziness in many older people are persistent and therefore should be treated as chronic conditions.

The epidemiology of chronic pain in a general population: results of a survey in southern Sweden

Objectives: The aim was to investigate the prevalence of chronic pain in different age groups and pain locations, as well as to identify variables associated with chronic pain. Methods: This cross-sectional survey had a randomized age-stratified sample comprising 826 respondents aged 18–102 years. Comparisons were made across age groups and pain locations. Multiple logistic regression analysis was used to identify variables associated with chronic pain. Results: The overall pain prevalence rate was 46%, with a variance of 27–55% across age groups. The prevalence increased up to the 60–74-year age group, after which it remained more or less constant. The pain sites differed across age groups. Forty-six per cent of the respondents had not received any diagnosis or did not know the reason for their pain, while 21% had no pain management. Several complaints (e.g. appetite loss, constipation, fatigue, depressed mood) were both more prevalent and more severe among those in pain than those with no pain. The regression analysis showed that body mass index (BMI), fatigue, sleep, and mobility problems were significantly associated with chronic pain. Conclusions: Chronic pain is common and constitutes a major public health problem. Interventions should not only be focused on the pain per se but should also include coexisting factors.

Pain management in elderly persons who require assistance with activities of daily living: a comparison of those living at home with those in special accommodations

Objectives: To describe and compare the methods of pain management used by elderly individuals with chronic pain and requiring assistance with activities of daily living, depending on whether they live alone, with someone, at home or in special accommodations.

Psychometric evaluation of the Dundee Ready Educational Environment Measure: Swedish version

Background: The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem sparse, for all known versions of the instrument. Aim: The aim was to psychometrically evaluate the Swedish version of the DREEM instrument. Method: A total of 503 students (undergraduate medicine), aged 19–46 years, in semesters 2, 6 and 10 were included in the study. Validity was evaluated through analysis of construct validity and reliability. Results: The instrument had in general both acceptable validity and reliability. Due to a rather poor model fit in the confirmatory factor analysis, an explorative factor analysis was also employed which suggested a new five-factor solution for the instrument. Conclusions: The Swedish version of the DREEM instrument is shown to be valid and reliable, except for the factor structure. The new five-factor solution found in this study is not proven to be a superior measurement model compared with the original, but could be seen as an alternative model to the original, where the strong and weak areas are somewhat more easily identified.

Sleep and Television and Computer Habits of Swedish School-Age Children

The aim of this study was to investigate sleep, television and computer habits and enjoyment and feelings of tiredness in school of school-age children and adolescents in Sweden. An instrument found to be valid and reliable here was distributed to 3,011 children aged 6, 7, 10, 14, and 16 years. Those sleeping less than the median length of time reported a significantly lower degree of enjoyment of school. Short sleep was found to be associated with having a bedroom TV, spending more than 2 hr a day at the TV or the computer, being tired in school, and having difficulties both in waking up and in sleeping. Discussing sleep and media habits with schoolchildren and their parents regarding matters of optimal sleep and of how media habits affect sleep and learning is seen to be an important task of the school health service.