Vibeke Horstmann

Person—environment fit predicts falls in older adults better than the consideration of environmental hazards only

Objective: To test the hypotheses that the empirical consideration of objective person—environment fit in the home environment is a stronger predictor of indoor falls among older adults than the assessment of environmental barriers only, and that perceived aspects of home play a role as predictors for falls. Design: Survey study with data collection at home visits, followed up by self-reports about falls at home visits one year later. Setting: Urban districts in Sweden, Germany, Latvia. Participants: Eight hundred and thirty-four single-living, older adults (75—89 years), in ordinary housing. Measurements: An assessment of objective person—environment fit in the home environment (housing enabler), a self-rating of the perceived home environment (usability in my home) and retrospective self-reports on indoor falls. Results: The participants reporting falls tended to be frailer than the non-fallers. The number of environmental barriers in the home was similar for the fallers and non-fallers; the magnitude of person—environment fit problems was higher among the fallers. The person—environment fit problem variable was a stronger fall predictor (odds ratio (OR) = 1.025; P=0.037) than number of environmental barriers (n.s.), even after controlling for confounders. Fallers also experienced lower usability of their home. Conclusion: The results suggest that much of the inconclusiveness of the data in the relationship between environmental hazards and falls in the previous falls literature could be due to the neglect of person—environment fit assessment. The effectiveness of environmental interventions based on the notion of person—environment fit compared with traditional home hazard checklists remains to be tested.

The long-term course of depressive disorders in the Lundby Study

BACKGROUND The Lundby Study is a longitudinal cohort study on a geographically defined population consisting of 3563 subjects. Information about episodes of different disorders was collected during field investigations in 1947, 1957, 1972 and in 1997. Interviews were carried out about current health and past episodes since the last investigation; for all subjects information was also collected from registers, case-notes and key informants. This paper describes the course and outcome of 344 subjects who had their first onset of depression during the follow-up. METHOD In this study individuals who had experienced their first episode of depression were followed up. Their course was studied with regard to recurrence of depression related to duration of follow-up, transition to other psychiatric disorders including alcohol disorders, as well as incidence and risk factors of suicide. RESULTS Median age at first onset of depression was around 35 years for individuals followed up for 30-49 years. The recurrence rate was about 40% and varied from 17% to 76% depending on length of follow-up. Transition to diagnoses other than depression was registered in 21% of the total sample, alcohol disorders in 7% and bipolar disorder in 2%. Five per cent committed suicide; male gender and severity of depression were significant risk factors. CONCLUSION The low rates of recurrence and suicide suggest a better prognosis for community samples than for in- and out-patient samples.

Housing matters in very old age - yet differently due to ADL dependence level differences.

In order to support the development of optimal housing options for older people, we need to increase our understanding of relations between aspects of housing and aspects of health in old and very old age. The objective of this cross-sectional study was to explore whether and how aspects of housing are related to life satisfaction and perceived health among very old, single-living Swedish people. Based on survey study data from the ENABLE-AGE Project (n = 397), correlation and regression analyses were performed with sub-groups of participants defined according to different levels of ADL dependence. The results showed that the aspects of housing related to life satisfaction and perceived health were different in the three ADL sub-groups. Among objective aspects of housing, accessibility problems influenced life satisfaction as well as perceived health, yet differently among the sub-groups. As concerns perceived aspects of housing, aspects of meaning of home (MOH) were influential on perceived health in several sub-groups, while only among persons dependent in I-ADL were social aspects of MOH related to life satisfaction. Among persons dependent in I-ADL, external housing-related control beliefs also played a role. In conclusion, the results indicate that housing matters in very old age, yet differently due to ADL dependence-level differences. Most importantly, different aspects of housing seem to play a role in different phases of the trajectory of disability in very old age, while longitudinal studies are needed to verify these indicative results.

Mortality in alcohol use disorder in the Lundby Community Cohort--a 50 year follow-up.

AIMS To describe the mortality and causes of death among subjects with alcohol use disorder in comparison with those without alcohol disorder and to study whether mental disorders increase mortality in alcoholics. DESIGN AND SETTING Data were analysed from the database of the Lundby Study, comprising 3563 subjects followed from 1947 to 1997. METHOD A community-based sample was investigated in 1947 with follow-ups in 1957, 1972 and 1997. Best-estimate consensus diagnoses of mental disorders, including alcohol use disorder, were assessed. In the total cohort, 427 cases of alcohol use disorders were identified. Differences in mortality between subjects with alcohol use disorders and non-alcoholics were studied using Cox regression models and causes of death were compared between alcoholic subjects and other participants. Risk factors for mortality among the 348 individuals with alcohol use disorders and known age-of-onset were analysed by means of Cox regression analyses. RESULTS The hazard ratio for mortality was higher for alcoholics compared to other subjects in the cohort. A substantial proportion of the causes of death among the alcoholics was suicide N=27 (6.3%) (26 males, 1 female). In the multivariate models of risk factors in alcohol use disorders, anxiety disorders, psychotic disorders, alcohol induced psychotic disorders and dementia were risk factors for premature death. CONCLUSION The mortality risk for subjects with alcohol use disorder was increased, females were especially vulnerable. The risk for suicide was high among males with alcohol problems. Anxiety disorders and severity of alcohol use disorder turned out as risk factors for premature death.

Risk factors for depressive disorders in the Lundby cohort : A 50 year prospective clinical follow-up

BACKGROUND Depressive disorders are common and disabling. The Lundby Study is a prospective study of a community sample that started in 1947 (N=2550). In 1957, 1013 newcomers were added. The latest field investigation was carried out in 1997. AIM To identify risk factors for depressive disorders. METHOD The Lundby database contains clinical assessments of the subjects made by psychiatrists. It also includes information about socio-demographic factors and episodes of somatic and mental disorders. Two different but partly overlapping cohorts from the same geographical area in 1947 (N=2470) and in 1957 (N=3310) were investigated. During follow-up 418 individuals experienced their first depressive disorder. For each cohort, possible risk factors were analysed by means of Cox regression analyses for the whole sample and for each sex separately. CONCLUSION The personality trait nervous/tense and anxiety disorders were statistically significant risk factors for depression for both genders. For males, the diagnoses alcohol disorders and tiredness disorder were risk factors. The personality trait subvalidity (low grade of energy) and nervous symptoms as a child were also risk factors for males. For females personality traits such as being easily hurt, abnormal/antisocial and tired/distracted were associated with depressive disorders. CLINICAL RELEVANCE Knowledge of risk factors may help to reduce incidence of depression.

Alterations of prolyl endopeptidase activity in the plasma of children with autistic spectrum disorders.

BackgroundProlyl Endopeptidase (PEP, EC 3.4.21.26), a cytosolic endopeptidase, hydrolyses peptide bonds on the carboxyl side of proline residue in proteins with a relatively small molecular weight. It has been shown that altered PEP activity is associated with various psychological diseases such as schizophrenia, mania and depression. Autistic Spectrum Disorders (ASD) are neuropsychiatric and behavioural syndromes affecting social behaviours and communication development. They are classified as developmental disorders. The aim of this study was to examine the hypothesis that PEP activity is also associated with ASDs.MethodsFluorometric assay was used to measure PEP activity in EDTA plasma in children with ASD (n = 18) aged 4–12 years (mean ± SD: 7.9 ± 2.5). These results were then compared to PEP activity in a control group of non-ASD children (n = 15) aged 2–10 years (mean ± SD: 6.4 ± 2.2).ResultsAn alteration in PEP activity was found in the children with ASD compared to the control group. There was much greater variation of PEP activity in the group of ASD children when compared to the controls (SD= 39.9 and SD 9.6, respectively). This variation was significant (p < 0.0005), although the mean level of PEP activity in the group of ASD children was slightly higher than in the control group (124.4 and 134.1, respectively).ConclusionOur preliminary finding suggests a role for PEP enzyme in the pathophysiology of autism but further research should be conducted to establish its role in the aetiology of psychiatric and neurological disorders, including autism and related spectrum disorders.

Psychometric evaluation of multidimensional pain inventory (Swedish version) in a sample of elderly people

Objectives The aim was to psychometrically evaluate the Swedish version of the Multidimensional Pain Inventory (MPI‐S) and the “brief screening version of MPI‐S” for use in an elderly sample.

Mortality of subjects with mood disorders in the Lundby community cohort: A follow-up over 50 years.

AIMS To compare causes of death and mortality among subjects with and without mood disorder in the Lundby Cohort and to analyse additional mental disorders as risk factors for mortality in subjects with mood disorders. BACKGROUND The Lundby study is a longitudinal study that investigated mental health in an unselected population. The study commenced in 1947; the population was further investigated in 1957, 1972, and 1997. METHODS Experienced psychiatrists performed semi-structured diagnostic interviews, and best estimate consensus diagnoses of mental disorders were assessed at each field investigation. Subjects with mood disorder (n=508, 195 males, 313 females) were identified until 1997. Causes and dates of death between 1947 and 2011 were obtained from the Swedish cause of death register and were compared between subjects diagnosed with mood disorder and other participants. Mortality was compared between those with mood disorders and the remaining cohort with Cox regression analyses. Other mental disorders were considered as risk factors for death for subjects with mood disorders. RESULTS The hazard ratio for mortality in mood disorders was HR=1.18. However, the mortality was elevated only for males, HR=1.5. Comorbid anxiety disorders, organic disorders, dementia and psychotic disorders were significant risk factors for death. A total of 6.3% of the participants with mood disorder and 1.2% of the remaining participants committed suicide. CONCLUSIONS As expected, the suicide rate was higher among participants with mood disorders. Only males with mood disorders had elevated mortality. The impact on mortality from other mental disorders seems to vary between the genders.

Lundby revisited: first incidence of mental disorders 1947–1997

Objective: To investigate how first incidence of various mental disorders changed between the periods of 1947–1972 to 1972–1997 in the Lundby cohort. Method: First-incidence rates of mental disorders were calculated for two 25 year periods and ten 5 year periods. Results: From 1947–1972 to 1972–1997 a decrease in almost all age- and sex-specific incidences of neurotic and organic brain disorders was observed, whereas incidence rates of psychotic disorders increased consistently in male subjects but decreased in most age intervals in female subjects. For both sexes the age-standardized 5 year period incidences of neurotic disorders decreased after 1972, fluctuated for psychotic disorders 1947–1997 and decreased steadily for organic disorders 1947–1997. Conclusions: The reduction in neurotic and organic brain disorder incidences may be linked to structural changes in society and medical advances.

Relationship of SOC with sociodemographic variables, mental disorders and mortality.

Background: SOC is associated with wellbeing and health. The Lundby Study is a cohort study of an unselected population (n=3563) in whom mental health and personality traits have been assessed since 1947, with follow ups in 1957, 1972, and 1997. Aim: To describe the relationship of Antonovsky’s 29-item sense of coherence scale (SOC) and its three subscales (comprehensibility, manageability, and meaningfulness) to mental health and mortality in an unselected middle-aged and elderly community cohort, controlling for gender, age, marital status, and socioeconomic status. Another aim was to analyse the three-factor structure of the SOC. Methods: Of the 1797 surviving subjects in 1997, 1559 participated in a semistructured diagnostic interview, and 1164 subjects completed the SOC questionnaire. Psychiatrists performed diagnostic evaluations. Collateral information was obtained from case notes and registers. Dates of death from 1997–2011 were obtained from the cause of death register. Results: SOC scores showed no sex differences, but were positively correlated with age. SOC scores were higher in married relative to unmarried participants and in blue-collar workers and self-employed individuals relative to white-collar workers. Total SOC and subscale scores were negatively correlated with depressive, anxiety, organic, and psychotic disorders. Male gender was positively correlated with comprehensibility and female gender was positively correlated with manageability and meaningfulness. Higher comprehensibility scores were correlated with lower mortality. Conclusions: SOC scores increased with age, were higher for blue-collar workers, and were lower for individuals with psychiatric disorders. Higher comprehensibility scores were associated with lower mortality. However, there was only weak evidence for a three-factor structure.