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  • 1.
    Anderberg, Peter
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Abrahamsson, Linda
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Sanmartin Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    An Instrument for Measuring Social Participation to Examine Older Adults' Use of the Internet as a Social Platform: Development and Validation Study2021In: JMIR Aging, E-ISSN 2561-7605, Vol. 4, no 2, article id e23591Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Older people's use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people's internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time.

    OBJECTIVE: The aim of this study was to create an instrument to measure an older person's perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness.

    METHODS: A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193).

    RESULTS: A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach α coefficient was .92. The 1-factor solution explained 55% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model (χ26=13.985; χ2/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025).

    CONCLUSIONS: The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected.

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  • 2.
    Anderberg, Peter
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Skär, Lisa
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Abrahamsson, Linda
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Berglund, Johan Sanmartin
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Older people’s use and nonuse of the internet in Sweden2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 23, p. 1-11, article id 9050Article in journal (Refereed)
    Abstract [en]

    The use of the internet has considerably increased over recent years, and the importance of internet use has also grown as services have gone online. Sweden is largely an information society like other countries with high reported use amongst European countries. In line with digitalization development, society is also changing, and many activities and services today take place on the internet. This development could potentially lead to those older persons who do not use the internet or do not follow the development of services on the internet finding it difficult to take part in information and activities that no longer occur in the physical world. This has led to a digital divide between groups, where the older generations (60+), in particular, have been affected. In a large study of Sweden’s adult population in 2019, 95 percent of the overall population was said to be internet users, and the corresponding number for users over 66 years of age was 84%. This study shows that the numbers reported about older peoples’ internet use, most likely, are vastly overestimated and that real use is significantly lower, especially among the oldest age groups. We report that 62.4% of the study subjects are internet users and that this number most likely also is an overestimation. When looking at nonresponders to the questionnaire, we find that they display characteristics generally attributed to non-use, such as lower education, lower household economy, and lower cognitive functioning.

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  • 3.
    Beam, Christopher R.
    et al.
    Department of Psychology, University of Southern California, Los Angeles, CA, United States.
    Luczak, Susan E.
    Department of Psychology, University of Southern California, Los Angeles, CA, United States.
    Panizzon, Matthew S.
    Department of Psychiatry and Center for Behavior Genetics of Aging, University of California San Diego, CA, United States.
    Reynolds, Chandra A.
    Department of Psychology, University of California Riverside, CA, United States.
    Christensen, Kaare
    Danish Twin Registry, University of Southern Denmark, Odense, Denmark.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Elman, Jeremy A.
    Department of Psychiatry and Center for Behavior Genetics of Aging, University of California San Diego, CA, United States.
    Franz, Carol E.
    Department of Psychiatry and Center for Behavior Genetics of Aging, University of California San Diego, CA, United States.
    Kremen, William S.
    Department of Psychiatry and Center for Behavior Genetics of Aging, University of California San Diego, CA, United States.
    Lee, Teresa
    Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia.
    Nygaard, Marianne
    Danish Twin Registry, University of Southern Denmark, Odense, Denmark.
    Sachdev, Perminder S.
    Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia.
    Whitfield, Keith E.
    Department of Psychology, University of Nevada Las Vegas, NV, United States.
    Pedersen, Nancy L.
    Department of Psychology, University of Southern California, Los Angeles, CA, United States ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ; Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States.
    Estimating Likelihood of Dementia in the Absence of Diagnostic Data: A Latent Dementia Index in 10 Genetically Informed Studies2022In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 90, no 3, p. 1187-1201Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Epidemiological research on dementia is hampered by differences across studies in how dementia is classified, especially where clinical diagnoses of dementia may not be available. OBJECTIVE: We apply structural equation modeling to estimate dementia likelihood across heterogeneous samples within a multi-study consortium and use the twin design of the sample to validate the results. METHODS: Using 10 twin studies, we implement a latent variable approach that aligns different tests available in each study to assess cognitive, memory, and functional ability. The model separates general cognitive ability from components indicative of dementia. We examine the validity of this continuous latent dementia index (LDI). We then identify cut-off points along the LDI distributions in each study and align them across studies to distinguish individuals with and without probable dementia. Finally, we validate the LDI by determining its heritability and estimating genetic and environmental correlations between the LDI and clinically diagnosed dementia where available. RESULTS: Results indicate that coordinated estimation of LDI across 10 studies has validity against clinically diagnosed dementia. The LDI can be fit to heterogeneous sets of memory, other cognitive, and functional ability variables to extract a score reflective of likelihood of dementia that can be interpreted similarly across studies despite diverse study designs and sampling characteristics. Finally, the same genetic sources of variance strongly contribute to both the LDI and clinical diagnosis. CONCLUSION: This latent dementia indicator approach may serve as a model for other research consortia confronted with similar data integration challenges.

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  • 4.
    Berner, Jessica
    et al.
    Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands ; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
    Comijs, Hannie
    Amsterdam Public Health Research Institute, Amsterdam, the Netherlands ; Department of Psychiatry, VU University Medical Centre, Amsterdam, the Netherlands.
    Elmståhl, Sölve
    Lund University Sweden, Skåne University Hospital, Lund, Sweden.
    Welmer, Anna-Karin
    Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
    Sanmartin Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Anderberg, Peter
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Deeg, Dorly
    Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands ; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
    Maintaining cognitive function with internet use: a two-country, six-year longitudinal study2019In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 31, no 7, p. 929-936Article in journal (Refereed)
    Abstract [en]

    Objectives: Maintaining good cognitive function with aging may be aided by technology such as computers, tablets, and their applications. Little research so far has investigated whether internet use helps to maintain cognitive function over time.Design: Two population-based studies with a longitudinal design from 2001/2003 (T1) to 2007/2010 (T2).Setting: Sweden and the Netherlands.Participants: Older adults aged 66 years and above from the Swedish National Study on Ageing and Care (N = 2,564) and from the Longitudinal Aging Study Amsterdam (N = 683).Measurements: Internet use was self-reported. Using the scores from the Mini-Mental State Examination (MMSE) from T1 and T2, both a difference score and a significant change index was calculated. Linear and logistic regression analysis were performed with difference score and significant change index, respectively, as the dependent variable and internet use as the independent variable, and adjusted for sex, education, age, living situation, and functional limitations. Using a meta-analytic approach, summary coefficients were calculated across both studies.Results: Internet use at baseline was 26.4% in Sweden and 13.3% in the Netherlands. Significant cognitive decline over six years amounted to 9.2% in Sweden and 17.0% in the Netherlands. Considering the difference score, the summary linear regression coefficient for internet use was-0.32 (95% CI:-0.62,-0.02). Considering the significant change index, the summary odds ratio for internet use was 0.54 (95% CI: 0.37, 0.78).Conclusions: The results suggest that internet use might play a role in maintaining cognitive functioning. Further research into the specific activities that older adults are doing on the internet may shine light on this issue.

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  • 5.
    Berner, Jessica
    et al.
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Dallora, Ana Luiza
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Berglund, Johan Sanmartin
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Anderberg, Peter
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Blekinge Institute of Technology, Department of Health, Karlskrona, Sweden.
    Technology anxiety and technology enthusiasm versus digital ageism2022In: Gerontechnology, ISSN 1569-1101, E-ISSN 1569-111X, Vol. 21, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Europe has called attention to the importance of the e-inclusion of older adults. Society is indicating that the developers, websites, and devices are causing age bias in technology. This affects living independently, the values of ethical principles associated with an older person, and digital ageism: which is an age-related bias in artificial intelligence systems. Objective: This research attempts to investigate the instrument technology anxiety and enthusiasm, and assistive technology devices during the period 2019-2021. This instrument may be a way to redress misconceptions about digital ageism. The assistive technology device that we will investigate in this study is the adoption of a service that is designed for online health consultations. Method: The participants are part of the longitudinal Swedish National Study on Aging and Care. Technology anxiety and technology enthusiasm are two factors, which aim to measure technophilia (vs technophobia) in older adults. The age range is 63 -99 years of age in 2019 T1 and 66 -101 in 2021 T2. Wilcoxon rank test was conducted to investigate technology enthusiasm, technology anxiety, and how they changed with time. An Edwards Nunnally index was then calculated for both variables to observe a significant change in score from T1 to T2. Mann Whitney U test was used to investigate the variables sex and health status with technology anxiety & technology enthusiasm in T1 & T2. Age, Cognitive function MMSE, and digital social participation were investigated through a Kruskall-Wallis test. A logistic regression was conducted with the significant variable. Results: Between 2019-2021, change in technology enthusiasm was based on less digital social participation (OR: 0.608; CI 95%: 0.476-0.792). Technology anxiety was significantly higher due to age (OR: 1.086, CI 95%: 1.035-1.139) and less digital social participation (OR: 0.684; CI 95%: 0.522-0.895). The want for online healthcare consultations was popular but usage was low. Conclusion: Staying active online and participating digitally may be a way to reduce digital ageism. However, digital ageism is a complex phenomenon, which requires different solutions in order to include older people and reduce an inaccurate categorisation of this group in the digital society © 2022,Gerontechnology. All Rights Reserved.

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  • 6.
    Berner, Jessica
    et al.
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Dallora, Ana Luiza
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Palm, Bruna
    Department of Mathematics, Blekinge Institute of Technology, Karlskrona, Sweden.
    Sanmartin Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Anderberg, Peter
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Five-factor model, technology enthusiasm and technology anxiety2023In: Digital Health, E-ISSN 2055-2076, Vol. 9Article in journal (Refereed)
    Abstract [en]

    Older adults need to participate in the digital society, as societal and personal changes and what they do with the remaining time that they have in their older years has an undeniable effect on motivation, cognition and emotion. Changes in personality traits were investigated in older adults over the period 2019–2021. Technology enthusiasm and technology anxiety are attitudes that affect the relationship to the technology used. The changes in the score of technology enthusiasm and technology anxiety were the dependent variables. They were investigated with personality traits, age, gender, education, whether someone lives alone, cognitive function, digital social participation (DSP) and health literacy as predictors of the outcome. The Edwards-Nunnally index and logistic regression were used. The results indicated that DSP, lower age, lower neuroticism and higher education were indicative of less technology anxiety. High DSP and high extraversion are indicative of technology enthusiasm. DSP and attitude towards technology seem to be key in getting older adults to stay active online. 

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  • 7.
    Bogl, Leonie H.
    et al.
    Institute for Molecular Medicine FIMM, University of Helsinki, Finland ; Department of Public Health, University of Helsinki, Finland.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network–Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Kaprio, Jaakko
    Institute for Molecular Medicine FIMM, University of Helsinki, Finland ; Department of Public Health, University of Helsinki, Finland.
    Does the sex of one’s co-twin affect height and BMI in adulthood?: A study of dizygotic adult twins from 31 cohorts2017In: Biology of Sex Differences, ISSN 2042-6410, Vol. 8, no 1, article id 14Article in journal (Refereed)
    Abstract [en]

    Background: The comparison of traits in twins from opposite-sex (OS) and same-sex (SS) dizygotic twin pairs is considered a proxy measure of prenatal hormone exposure. To examine possible prenatal hormonal influences on anthropometric traits, we compared mean height, body mass index (BMI) and the prevalence of being overweight or obese between men and women from OS and SS dizygotic twin pairs.

    Methods: The data were derived from COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) database, and included 68,494 SS and 53,808 OS dizygotic twin individuals above the age of 20 years from 31 twin cohorts representing 19 countries. Zygosity was determined by questionnaires or DNA genotyping depending on the study. Multiple regression and logistic regression models adjusted for cohort, age and birth year with the twin type as a predictor were carried out to compare height and BMI in twins from OS pairs with those from SS pairs and to calculate the adjusted odds ratios and 95% confidence intervals for being overweight or obese.

    Results: OS females were, on average, 0.31 cm (95% confidence interval (CI): 0.20, 0.41) taller than SS females. OS males were also, on average, taller than SS males, but this difference was only 0.14 cm (95% CI: 0.02, 0.27). Mean BMI and the prevalence of overweight or obesity did not differ between males and females from SS and OS twin pairs. The statistically significant differences between OS and SS twins for height were small and appeared to reflect our large sample size rather than meaningful differences of public health relevance.

    Conclusions: We found no evidence to support the hypothesis that prenatal hormonal exposure or postnatal socialization (i.e., having grown up with a twin of the opposite sex) has a major impact on height and BMI in adulthood.

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  • 8.
    Bokenberger, Kathleen
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ström, Peter
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Johansson, Anna L. V.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Åkerstedt, Torbjörn
    Stress Research Institute, Stockholm University, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Association between sleep characteristics and incident dementia accounting for baseline cognitive status: A prospective population-based study2017In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 72, no 1, p. 134-139Article in journal (Refereed)
    Abstract [en]

    Background: While research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

    Methods: Screening Across the Lifespan Twin Study (SALT) participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios (HR) for dementia.

    Results: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤ 6 hours) and extended (> 9 hours) time-in-bed (TIB) compared to the middle reference group (HR=1.40, 95% CI=1.06-1.85, HR=1.11, 95% CI=1.00-1.24, respectively) and rising at 8:00AM or later compared to earlier rising (HR=1.12, 95% CI=1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

    Conclusions: Short and extended TIB as well as delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

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  • 9.
    Bokenberger, Kathleen
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ström, Peter
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Åkerstedt, Torbjörn
    Stress Research Institute, Stockholm University, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Shift work and cognitive aging: A longitudinal study2017In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 43, no 5, p. 485-493Article in journal (Refereed)
    Abstract [en]

    Objectives The few studies of shift work and late life cognitive functioning have yielded mixed findings. The aim of the present study is to estimate the association between shift-work experience and change in cognitive performance before and after retirement age among older adults who were gainfully employed.

    Methods Five hundred and ninety five participants with no dementia were followed up for a mean of 17.6 standard deviation (SD) 8.8 years from a Swedish population-based sample. Participants had self-reported information on any type of shift-work experience (ever/never) in 1984 and measures of cognitive performance (verbal, spatial, memory, processing speed, and general cognitive ability) from up to 9 waves of cognitive assessments during 1986–2012. Night work history (ever/never) from 1998–2002 was available from a subsample (N=320). Early adult cognitive test scores were available for 77 men.

    Results In latent growth curve modeling, there were no main effects of "any-type" or night shift work on the mean scores or rate of change in any of the cognitive domains. An interaction effect between any-type shift work and education on cognitive performance at retirement was noted. Lower-educated shift workers performed better on cognitive tests than lower-educated day workers at retirement. Sensitivity analyses, however, indicated that the interactions appeared to be driven by selection effects. Lower-educated day workers demonstrated poorer cognitive ability in early adulthood than lower-educated shift workers, who may have selected jobs entailing higher cognitive demand.

    Conclusion There was no difference in late-life cognitive aging between individuals with a history of working shifts compared to those who had typical day work schedules during midlife.

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  • 10.
    Bouwmeester Stjernetun, Björn
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA.
    Odzakovic, Elzana
    School of Health and Welfare, Jönköping University, Sweden.
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    ”It´s like walking in a bubble”, nursing students´ perspectives on age suit simulation in a home environment – group interviews from reflection seminars2024In: BMC Nursing, E-ISSN 1472-6955, Vol. 23, no 1, article id 124Article in journal (Refereed)
    Abstract [en]

    Background

    Older persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults.

    Methods

    A qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis.

    Results

    The analysis generated three main themes; “It’s like walking in a bubble”, “An eye opener” and “Concerns about ageing and the current structure of geriatric care”. The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability.

    Conclusions

    Age suit simulation was described as an embodied and eye-opening experience, raising nursing students´ awareness of older persons´ functional limitations and the consequences for dignity and independence. Coping with cognitive loss was especially difficult. Students were motivated to apply their new knowledge to clinical practice. Age suit simulation can complement geriatric education, preparing students for the complex care needs of older persons.

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  • 11.
    Bouwmeester Stjernetun, Björn
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Education, University of Skövde, Skövde, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA.
    Effects of an age suit simulation on nursing students’ perspectives on providing care to older persons - an education intervention study2023In: Educational gerontology, ISSN 0360-1277, E-ISSN 1521-0472Article in journal (Refereed)
    Abstract [en]

    Nursing students are important future health care providers to the growing number of older persons in society. However, two barriers are their common ageist attitudes and lack of interest in geriatrics. This is a concern in light of the global demand for nurses and a challenge that need to be addressed in nurse education. Age suit simulation has been shown to affect the attitudes of students toward older persons, but the important context of home is often missing from studies. Accordingly, the present study employed a quantitative approach with the goal of investigating the effects of aging simulation with an age suit in a home context as a part of experiential learning among second-year nursing students. The age simulation allowed the students to experience both specific and common health problems from the patient’s point of view in a controlled environment and a relevant context: the home. Data were collected using a questionnaire in a quasi-experimental pretest – posttest design with a control group. Results showed that the intervention had a positive effect on various aspects of the nursing students’ perspectives on caring for older persons. Work experience was associated with more positive attitudes. The control group was more negative toward geriatrics as a career choice than the intervention group. In conclusion, age suit simulation can be an innovative part of nurse education because it raises awareness and understanding of the health challenges of older persons, which are important in combating ageism among future nurses.

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  • 12.
    Bravell, Marie Ernsth
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Finkel, Deborah
    Department of Psychology, Indiana University Southeast, USA.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, USA.
    Hallgren, Jenny
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, USA.
    Motor functioning differentially predicts mortality in men and women2017In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 72, p. 6-11Article in journal (Refereed)
    Abstract [en]

    Introduction

    Research indicates gender differences in functional performance at advanced ages, but little is known about their impact on longevity for men and women.

    Objective

    To derive a set of motor function factors from a battery of functional performance measures and examine their associations with mortality, incorporating possible gender interactions.

    Method

    Analyses were performed on the longitudinal Swedish Adoption/Twin Study of Aging (SATSA) including twenty-four assessments of motor function up to six times over a 19-year period. Three motor factors were derived from several factor analyses; fine motor, balance/upper strength, and flexibility. A latent growth curve model was used to capture longitudinal age changes in the motor factors and generated estimates of intercept at age 70 (I), rates of change before (S1) and after age 70 (S2) for each factor. Cox regression models were used to determine how gender in interaction with the motor factors was related to mortality.

    Results

    Females demonstrated lower functional performance in all motor functions relative to men. Cox regression survival analyses demonstrated that both balance/upper strength, and fine motor function were significantly related to mortality. Gender specific analyses revealed that this was true for women only. For men, none of the motor factors were related to mortality.

    Conclusion

    Women demonstrated more difficulties in all functioning facets, and only among women were motor functioning (balance/upper strength and fine motor function) associated with mortality. These results provide evidence for the importance of considering motor functioning, and foremost observed gender differences when planning for individualized treatment and rehabilitation.

  • 13.
    Christiansen, Line
    et al.
    Blekinge Institute of Technology, Karlskrona, Sweden.
    Berglund, Johan Sanmartin
    Blekinge Institute of Technology, Karlskrona, Sweden.
    Anderberg, Peter
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Blekinge Institute of Technology, Karlskrona, Sweden.
    Cellek, Selim
    Anglia Ruskin University, Chelmsford, United Kingdom.
    Zhang, Jufen
    Anglia Ruskin University, Chelmsford, United Kingdom.
    Lemmens, Evi
    University Colleges Leuven-Limburg, Genk, Belgium.
    Garolera, Maite
    Brain, Cognition and Behavior—Clinical Research, Consorci Sanitari de Terrassa, Barcelona, Spain.
    Mayoral-Cleries, Fermin
    Regional University Hospital of Málaga, Spain.
    Skär, Lisa
    Blekinge Institute of Technology, Karlskrona, Sweden.
    Associations Between Mobile Health Technology use and Self-rated Quality of Life: A Cross-sectional Study on Older Adults with Cognitive Impairment2021In: Gerontology and geriatric medicine, E-ISSN 2333-7214, Vol. 7, p. 1-8, article id 23337214211018924Article in journal (Refereed)
    Abstract [en]

    Background: Quality of life (QoL) is affected even at early stages in older adults with cognitive impairment. The use of mobile health (mHealth) technology can offer support in daily life and improve the physical and mental health of older adults. However, a clarification of how mHealth technology can be used to support the QoL of older adults with cognitive impairment is needed. Objective: To investigate factors affecting mHealth technology use in relation to self-rated QoL among older adults with cognitive impairment. Methods: A cross-sectional research design was used to analyse mHealth technology use and QoL in 1,082 older participants. Baseline data were used from a multi-centered randomized controlled trial including QoL, measured by the Quality of Life in Alzheimer’s Disease (QoL-AD) Scale, as the outcome variable. Data were analyzed using logistic regression models. Results: Having moderately or high technical skills in using mHealth technology and using the internet via mHealth technology on a daily or weekly basis was associated with good to excellent QoL in older adults with cognitive impairment. Conclusions: The variation in technical skills and internet use among the participants can be interpreted as an obstacle for mHealth technology to support QoL. © The Author(s) 2021.

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  • 14.
    Dahl, Anna
    Institute of Gerontology, School of Health Sciences, Jönköping University.
    Body mass index, cognitive ability, and dementia: prospective associations and methodological issues in late life2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of the present study were to investigate the association between overweight and cognitive ability and dementia, and to evaluate the usefulness of self-reported body mass index (BMI) in late life and various data sources commonly used in epidemiological studies to identify persons with dementia. Data were drawn from three population-based studies: the Swedish Adoption/Twin Study of Aging (SATSA), Aging in Women and Men: A Longitudinal Study of Gender Differences in Health Behaviour and Health among Elderly (the Gender Study), and the Finnish Lieto Study. In Study I, the agreement between self-reported and measured BMI over time was evaluated among 774 men and women, ages 40 to 88 years at baseline (mean age 63.9) participating in both the questionnaire phase and in-person testing of SATSA. Latent growth curve (LGC) modeling showed a small but significant increase between self-reported and measured BMI (0.02 kg/m2/y) over time, which would probably not affect the results if self-reported BMI were used as a continuous variable in longitudinal research. In Study II, the agreement between dementia diagnoses from various sources and dementia diagnoses set at a consensus conference was evaluated. Among the 498 elderly people ages 70 to 81 at baseline (mean age 74.5) enrolled in the Gender Study, 87 were diagnosed with dementia during an eight-year period. Review of medical records and nurse evaluations yielded the highest sensitivity (0.83 and 0.80, respectively) and a high specificity (0.98 and 0.96), indicating that these sources might be good proxies of dementia, while data extraction from the Swedish Inpatient Discharge Registry underestimated the prevalence of dementia (sensitivity 0.26). In Study III, the association between being overweight in midlife and cognitive ability in late life was examined in SATSA. The 781 participants ages 25 to 63 at baseline (mean age 41.6) in 1963 or 1973 self-reported their height and weight. From 1986 until 2002, they were assessed five times using a cognitive test battery. LGC models showed that people with higher midlife BMI scores had significantly lower cognitive ability and a significantly steeper decline than their thinner counterparts, an association that persisted when those who developed dementia during the study period were excluded from the analysis. This finding indicates that being overweight might affect cognitive ability independently of dementia. In Study IV, the association between BMI and dementia risk in older persons was described among 605 persons without dementia and ages 65 to 92 at baseline (mean age 70.8) in the Lieto Study. Among these, 86 persons were diagnosed with dementia during eight years of follow-up. Cox regression analyses indicated that for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio = 0.92, 95% confidence interval = 0.87–0.97) and the association remained significant when individuals who developed dementia during the first four years of follow-up were excluded from the analyses. This result suggests that low BMI scores are present almost a decade before clinical dementia onset.

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  • 15.
    Dahl, Anna
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Berg, Stig
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Nilsson, Sven E.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Identification of dementia in epidemiological research: A study on the usefulness of various data sources2007In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 19, no 5, p. 381-389Article in journal (Refereed)
    Abstract [en]

    Background and aims: Prevalence and incidence ratios of dementia in epidemiological studies vary according to the data source used. Medical records, cognitive tests, and registry information are sources frequently used to differentiate dementia from normal aging. The aim of the present study was to compare the identification of dementia from these different sources with that from consensus diagnosis. 

    Methods: 498 elderly people (age range 70–81 at baseline) enrolled in a Swedish population-based longitudinal twin study (Gender) were evaluated on physical and mental health and interviewed for their socio-demographic background three times during an eight-year period. Reviews of medical records and the Swedish Discharge Registry (DR) were conducted. The 10th percentile was used to differentiate between dementia and non-dementia in all cognitive tests. Scores of 24 or below on the Mini-Mental State Examination (MMSE) (range 1–30) indicated dementia. A consensus conference diagnosed dementia on the basis of total information. The consensus diagnosis was used as the gold standard. 

    Results: MMSE scores (sensitivity 64%, specificity 96%, kappa 0.65) and the review of medical records (sensitivity 57%, specificity 99%, kappa 0.65) were good sources for dementia identification. The precision of medical records increased when recordings of cognitive impairment were included (sensitivity 83%, specificity 98%, kappa 0.84). The discharge registry had low sensitivity (26%) and kappa coefficient (0.31). 

    Conclusions: The present study shows that both review of medical records and MMSE scores are good although not perfect identifiers of dementia. The discharge registry is an uncertain source of dementia identification.

  • 16.
    Dahl, Anna
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Hassing, Linda B.
    Department of Psychology, University of Gothenburg, Sweden.
    Fransson, Eleonor
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Berg, Stig
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Gatz, Margrete
    Department of Psychology, University of Southern California, Los Angeles, USA ; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, USA.
    Pedersen, Nancy L.
    Department of Psychology, University of Southern California, Los Angeles, USA ; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life2010In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 65A, no 1, p. 57-62Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time. METHODS: Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25-63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion. RESULTS: Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis. CONCLUSIONS: Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia

  • 17.
    Dahl, Anna K.
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Hassing, Linda B.
    Department of Psychology, University of Gothenburg, Sweden.
    Fransson, Eleonor I.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Agreement between self-reported and measured height, weight and body mass index in old age: a longitudinal study with 20 years of follow-up2010In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 39, no 4, p. 445-451Article in journal (Refereed)
    Abstract [en]

    Background: self-reported body mass index (BMI) based on self-reported height and weight is a widely used measure of adiposity in epidemiological research. Knowledge about the accuracy of these measures in late life is scarce.

    Objective: the study aimed to evaluate the accuracy and changes in accuracy of self-reported height, weight and BMI calculated from self-reported height and weight in late life.

    Design: a longitudinal population-based study with five times of follow-up was conducted.

    Participants: seven hundred seventy-four community-living men and women, aged 40–88 at baseline (mean age 63.9), included in The Swedish Adoption/Twin Study of Aging.

    Methods: participants self-reported their height and weight in a questionnaire, and height and weight were measured by experienced research nurses at an in-person testing five times during a 20-year period. BMI was calculated as weight (kilogramme)/height (metre)2.

    Results: latent growth curve modelling showed an increase in the mean difference between self-reported and measured values over time for height (0.038 cm/year) and BMI (0.016 kg/m2/year), but not for weight.

    Conclusions: there is a very small increase in the mean difference between self-reported and measured BMI with ageing, which probably would not affect the results when self-reported BMI is used as a continuous variable in longitudinal studies.

  • 18.
    Dahl, Anna K.
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Löppönen, Minna
    Department of Family Medicine, University of Turku, Finland ; Härkätie Health Centre, Finland.
    Isoaho, Raimo
    Department of Family Medicine, University of Turku, Finland ; Nordic School of Public Health, Gothenburg, Sweden.
    Berg, Stig
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Kivelä, Sirkka-Liisa
    Department of Family Medicine, University of Turku, Finland ; Satakunta Central Hospital, Satakunta, Finland ; Unit of Family Medicine, Turku University Hospital, Finland.
    Overweight and obesity in old age are not associated with greater dementia risk2008In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 56, no 12, p. 2261-2266Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons.

    DESIGN: Prospective population‐based study, with 8 years of follow‐up.

    SETTING: The municipality of Lieto, Finland, 1990/91 and 1998/99.

    PARTICIPANTS: Six hundred five men and women without dementia aged 65 to 92 at baseline (mean age 70.8).

    MEASUREMENTS: Weight and height were measured at baseline and at the 8‐year follow‐up. Dementia was clinically assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.

    RESULTS: Eighty‐six persons were diagnosed with dementia. Cox regression analyses, adjusted for age, sex, education, cardiovascular diseases, smoking, and alcohol use, indicated that, for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio (HR)=0.92, 95% confidence interval (CI)=0.87–0.97). This association remained significant when individuals who developed dementia early during the first 4 years of follow‐up were excluded from the analyses (HR=0.93, 95% CI=0.86–0.99). Women with high BMI scores had a lower dementia risk (HR=0.90, 95% CI=0.84–0.96). Men with high BMI scores also tended to have a lower dementia risk, although the association did not reach significance (HR=0.95, 95% CI=0.84–1.07).

    CONCLUSION: Older persons with higher BMI scores have less dementia risk than their counterparts with lower BMI scores. High BMI scores in late life should not necessarily be considered to be a risk factor for dementia.

  • 19.
    Dahl Aslan, Anna
    Hälsohögskolan i Jönköping.
    Psykologiskt åldrande2020In: Äldre och åldrande: grundbok i gerontologi / [ed] Marie Ernsth Bravell; Lena Östlund, Malmö: Gleerups Utbildning AB, 2020, 3, p. 209-236Chapter in book (Other academic)
  • 20.
    Dahl Aslan, Anna K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health Sciences, Jönköping, Sweden.
    Starr, John M.
    Geriatric Medicine, University of Edinburgh, Royal Victoria Hospital, Edinburgh, UK ; Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK.
    Pattie, Alison
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK.
    Deary, Ian
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK.
    Cognitive consequences of overweight and obesity in the ninth decade of life?2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 1, p. 59-65Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: the association between late-life obesity and late-life cognitive abilities is poorly understood. We studied the association between body mass index (BMI) and cognitive change in longitudinal population-based study spanning over the ninth decade of life.

    SUBJECTS/METHODS: in total, 475 participants free of dementia at baseline from the Lothian Birth Cohort 1921 (mean age: 79.1 years, SD: 0.6) were included. Height and weight were assessed at baseline. BMI was calculated as kg/m(2). Cognitive abilities were assessed at age ∼11 years and at age ∼79, ∼83, ∼87 and ∼90 years.

    RESULTS: latent growth models showed that men being overweight and obese had a 0.65 (SD: 0.3) and 1.10 (SD: 0.5) points less steep decline in general cognitive ability (as measured by the Moray House Test) for each year than people of normal weight. These associations were to some extent confounded by childhood intelligence. No other association between BMI and cognition was significant, either for men or women. People who were obese in old age had significantly lower childhood intelligence (m = 43.6, SD: 1.3) than people who were normal in weight (m = 47.0, SD: 0.8) and persons being overweight (m = 47.5, SD: 0.8), F (472, 3) = 3.2, P = 0.043.

    CONCLUSIONS: the current study shows weak or no evidence for an association between BMI in old age and cognitive function, especially not when childhood intelligence is controlled for. Lower intelligence at the age of 11 years predicted obesity at the age of 79 years.

  • 21.
    Emery, Charles F.
    et al.
    Departments of Psychology and Internal Medicine, Institute for Behavioral Medicine Research, Ohio State University, Columbus, OH, United States.
    Finkel, Deborah
    Department of Psychology, Indiana University Southeast, New Albany, IN, United States ; Institute for Gerontology Jönköping University, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Karolinska Institutet, Stockholm, Sweden.
    Bidirectional associations between body mass and bodily pain among middle-aged and older adults2022In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 163, no 10, p. 2061-2067Article in journal (Refereed)
    Abstract [en]

    Higher body mass and obesity are associated with bodily pain, and rates of chronic pain increase among older adults. Most past studies are cross-sectional, precluding determination of the temporal relationship between body mass and pain. A longitudinal study of body mass and pain among middle-aged adults found that higher body mass index (BMI) led to greater lower back pain. No longitudinal study of BMI and pain has been conducted among adults older than 70 years. This study used dual change score models to determine the directional relationship between BMI and bodily pain in a sample of middle-aged and older adults. Participants (n = 1889) from the Swedish Twin Registry (baseline age range 40-93 years) completed at least 1 nurse assessment of BMI and self-report ratings of pain interference and joint pain. Pain interference was not associated with BMI, but joint pain was analyzed in univariate and bivariate models, with dual change score models modeling the relationship of BMI and joint pain across age, both independently and as part of bivariate relationships. The results indicated a reciprocal relationship between BMI and joint pain, but joint pain generally led to changes in BMI. In addition, the relationship changed with age, until approximately age 80 years, increasing joint pain contributed to higher BMI, but after that time increasing joint pain contributed to lower BMI. In addition, sex differences in the relationship between BMI and pain appeared after age 70 years. Thus, joint pain contributes to changes in BMI among middle-aged and older adults, but the relationship may change by age and sex.

  • 22.
    Emery, Charles F.
    et al.
    Department of Psychology, Ohio State University, Columbus, USA.
    Finkel, Deborah
    Department of Psychology, Indiana University Southeast, New Albany, USA ; Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles, USA ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Evidence of bi-directional associations between depressive symptoms and body mass among older adults2020In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 75, no 8, p. 1689-1698Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Body fat, measured with body mass index (BMI), and obesity are associated with depressive symptoms. Among younger adults there is stronger evidence of obesity leading to depressive symptoms than of depressive symptoms leading to obesity, but the temporal relationship is unknown among older adults. This study utilized dual-change-score models (DCSMs) to determine the directional relationship between body mass and depressive symptoms among older adults.

    METHOD: Participants (n=1743) from the Swedish Twin Registry (baseline age range 50-96 years) completed at least one assessment of BMI (nurse measurement of height and weight) and the Center for Epidemiologic Studies-Depression scale (CESD). More than half the sample completed three or more assessments, scheduled at intervals of 2-4 years. DCSMs modeled the relationship of BMI and CESD across age, both independently and as part of bivariate relationships.

    RESULTS: Depressive symptoms contributed to subsequent changes in BMI after age 70, while BMI contributed to subsequent changes in depressive symptoms after age 82. Thus, there is a reciprocal relationship that may change with age. The effect was more pronounced for women.

    DISCUSSION: The association of BMI and depressive symptoms is bi-directional among older adults, and it appears to be affected by both age and sex.

  • 23.
    Emmesjö, Lina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Patients’ and next of kin’s expectations and experiences of a mobile integrated care model with a home health care physician – a qualitative thematic study2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 921Article in journal (Refereed)
    Abstract [en]

    Background

    The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients’ and next of kin’s experiences of integrated care is however lacking, motivating exploration.

    Method

    A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later.

    Results

    The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making.

    Conclusion

    Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.

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  • 24.
    Ericsson, Malin
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundholm, Cecilia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fors, Stefan
    Aging Research Center, Karolinska Institutet & Stockholm University, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute for Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Zavala, Catalina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, United States.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, United States.
    Childhood social class and cognitive aging in the Swedish Adoption/Twin Study of Aging2017In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 114, no 27, p. 7001-7006Article in journal (Refereed)
    Abstract [en]

    In this report we analyzed genetically informative data to investigate within-person change and between-person differences in late-life cognitive abilities as a function of childhood social class. We used data from nine testing occasions spanning 28 y in the Swedish Adoption/Twin Study of Aging and parental social class based on the Swedish socioeconomic index. Cognitive ability included a general factor and the four domains of verbal, fluid, memory, and perceptual speed. Latent growth curve models of the longitudinal data tested whether level and change in cognitive performance differed as a function of childhood social class. Between-within twin-pair analyses were performed on twins reared apart to assess familial confounding. Childhood social class was significantly associated with mean-level cognitive performance at age 65 y, but not with rate of cognitive change. The association decreased in magnitude but remained significant after adjustments for level of education and the degree to which the rearing family was supportive toward education. A between-pair effect of childhood social class was significant in all cognitive domains, whereas within-pair estimates were attenuated, indicating genetic confounding. Thus, childhood social class is important for cognitive performance in adulthood on a population level, but the association is largely attributable to genetic influences.

  • 25.
    Fabisiak, Beata
    et al.
    Department of Furniture Design, Faculty of Forestry and Wood Technology, Poznan University of Life Sciences, Poland.
    Jankowska, Anna
    Department of Economics and Economic Policy in Agribusiness, Faculty of Economics, Poznan University of Life Sciences, Poland.
    Kłos, Robert
    Department of Furniture Design, Faculty of Forestry and Wood Technology, Poznan University of Life Sciences, Poland.
    Knudsen, Joan
    Development Centre UMT, Secretariat for Lifestyle and Design Cluster, Herning, Denmark.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). University of Rhode Island, College of Nursing, Kingston, RI, United States.
    Kuprienko, Igor
    Project Development Division, ITMO University, Saint Petersburg, Russian Federation.
    Vidiasova, Lyudmila
    e-Governance Center, Institute of Design and Urban Studies, Saint Petersburg, Russian Federation.
    Poberznik, Anja
    Satakunta University of Applied Sciences, Faculty of Technology, Pori, Finland.
    Kreigere, Vineta
    Art Academy of Latvia, Rīga, Latvia.
    Preferences of seniors living in selected Baltic Sea region countries towards the use of indoor public space furniture2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 12 December 9, article id e0258676Article in journal (Refereed)
    Abstract [en]

    Demographic changes can be observed all over the world. The number of seniors located in the societies of well-developed countries continues to rise. Both enterprises and governments need to be prepared for such changes. Consequently, public spaces need to evolve to reduce problems related to ageism and be friendly to all. Much attention is currently being paid to finding solutions for redesigning public spaces and adjusting them to the needs and requirements of senior citizens. To identify the preferences of seniors in relation to the characteristics of furniture in indoor public spaces, a survey study with 1539 respondents aged 60+ was conducted in Denmark, Finland, Latvia, Poland, Russia and Sweden. The gathered data were coded and implemented to the unified database. The statistical grouping method was used to recognize the characteristics of the needs and attitudes of seniors related to the use of public space furniture. The main variables taken into consideration in the analysis were the age and gender of respondents and their country of living. Among the most important findings are those indicating the necessity to provide the increased number of furniture for sitting in the public spaces and making sure they are not located too far away from each other. As the main disadvantages of public space furniture respondents indicated the lack of armrests or other solutions to facilitate getting up and/or sitting down, as well as profiled backrests that constitute solid support for the spine. The implementation of these data in the process of rethinking and redesigning public spaces may support the adaptation of indoor public furniture according to the requirements of a very large group of customers, namely, seniors. 

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  • 26.
    Flyborg, Johan
    et al.
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Renvert, Stefan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden ; Faculty of Health Sciences, Kristianstad University, Sweden.
    Anderberg, Peter
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Larsson, Tobias
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Sanmartin-Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Results of objective brushing data recorded from a powered toothbrush used by elderly individuals with mild cognitive impairment related to values for oral health2024In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 28, no 1, article id 8Article in journal (Refereed)
    Abstract [en]

    Objectives: The study aimed to investigate how the objective use of a powered toothbrush in frequency and duration affects plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm in elderly individuals with MCI. A second aim was to compare the objective results with the participants’ self-estimated brush use.

    Materials and methods: Objective brush usage data was extracted from the participants’ powered toothbrushes and related to the oral health variables plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm. Furthermore, the objective usage data was compared with the participants’ self-reported brush usage reported in a questionnaire at baseline and 6- and 12-month examination.

    Results: Out of a screened sample of 213 individuals, 170 fulfilled the 12-month visit. The principal findings are that despite the objective values registered for frequency and duration being lower than the recommended and less than the instructed, using powered toothbrushes after instruction and information led to improved values for PI, BOP, and PPD ≥ 4 mm in the group of elderly with MIC.

    Conclusions: Despite lower brush frequency and duration than the generally recommended, using a powered toothbrush improved oral health. The objective brush data recorded from the powered toothbrush correlates poorly with the self-estimated brush use.

    Clinical relevance: Using objective brush data can become one of the factors in the collaboration to preserve and improve oral health in older people with mild cognitive impairment. Trial registration: ClinicalTrials.gov Identifier: NCT05941611, retrospectively registered 11/07/2023. 

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  • 27.
    Gillsjö, Catharina
    University of Skövde, School of Life Sciences.
    Äldre personers erfarenheter av att leva med långvarig muskeloskeletal smärta i hemmet2013In: Smärta, ISSN 1402-1048, no 4, p. 11-14Article in journal (Other (popular science, discussion, etc.))
  • 28.
    Gillsjö, Catharina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Bouwmeester Stjernetun, Björn
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    En utbildnings-intervention med simulering i äldredräkt i Skaraborgs Hälsoteknikcentrum för ökad insikt och förståelse för att åldras och leva med åldersrelaterade hälsoproblem2021In: DAL-21 Det akademiska lärarskapet: Konferensbidrag / [ed] Jessica Lindblom; Christina Lönnheden; Peter Fogel, Skövde: Högskolan i Skövde , 2021, p. 30-31Conference paper (Refereed)
    Abstract [sv]

    Världshälsoorganisationen, [1] belyser utmaningen att ge en vård som stödjer ett hälsosamt åldrande. Ett centralt hinder är den höga förekomsten av negativa attityder gentemot åldrandet, äldre personer och vård av äldre, särskilt bland vårdpersonal [2-4]. Vidare påvisas att sjuksköterskestudenter kan bära på negativa attityder till att vårda äldre och därför inte ser arbete inom äldrevård som ett önskvärt och framtida arbetsfält [5, 6]. Otillräcklig forskning avseende ålderism tillsammans med bristande utbildning inom området äldre, det normala åldrandet samt åldrandets hälsoproblem beskrivs som en bidragande faktor till ålderism [4]. Trots att interventioner kontinuerligt genomförs för att ändra attityder och minska ålderism i vården kvarstår dessa i betydande omfattning [3]. Det finns således ett behov av att skapa innovativa lösningar som bidrar till en ökad och hållbar förståelse för åldrandet, äldre och åldersrelaterade hälsoproblem. Detta adresseras i en ny utbildningsintervention med simulering i äldredräkt som utformats och genomförs i Skaraborgs Hälsoteknikcentrum (SHC), Högskolan i Skövde. Forskning [7] lyfter fram att simulering i utbildning, särskilt genom användande av utrustning som äldredräkt, är en framgångsrik väg att ändra studenters attityder gentemot äldre. Simulering i SHC ger även möjlighet att testa hälso- och välfärdsteknik vilket ytterligare kan inverka positivt på uppfattningar om dess nytta vid implementering av teknik i vården [8].

    Pågående utbildningsmoment i utbildning till sjuksköterska och distriktssköterska

    Under läsåret 2019-2020 har grupper av studerande inom omvårdnad deltagit i simulering i SHC. Vid denna simulering har äldredräkt använts för att återspegla upplevelsen av normalt åldrande och vanligt förekommande hälsoproblem. De studerande tilldelas en personas och genomför olika scenarier i SHC. I samband med detta besvaras enkät [9], före simulering samt efter simulering för att ta del av synen på åldrandet och att vårda äldre samt eventuell förändring efter genomgången simulering. Efter simuleringen reflekterar studenterna i grupp över upplevelsen av simuleringen, åldrandet och den vård som ges. Reflektionerna relateras sedan till centrala begrepp i omvårdnad samt sjuksköterskans kärnkompetenser. Vidare reflekterar de studerande över hur simuleringen påverkat deras insikt och förståelse samt hur det kommer att visa sig i den vård som ges.

    Forskningsprojekt

    Utbildningsinterventionen beforskas som en del i ett longitudinellt projekt med övergripande syfte att studera hur en utbildningsintervention med simulering i äldredräkt inverkar på insikt och förståelse för åldrandet, att vara äldre och att leva med åldersrelaterade hälsoproblem i kontexten samt vård av äldre personer. Vidare är syftet att longitudinellt studera studenters syn på åldrandet, äldre och att vårda äldre personer. De hittills genomförda simuleringarna visar tecken på att studenters insikt och förståelse avseende åldrandet, att åldras och att leva med åldersrelaterade hälsoproblem förändras på ett positivt sätt. Det finns därför ett behov av att systematiskt utvärdera effekten och nyttan av den intervention som nu genomförs i SHC. Externa medel söktes hos Familjen Kamprads stiftelse och 3,5 miljoner erhölls för att genomföra projektet och att anställa en doktorand.

    Referenser

    1. WHO, Integrated care for older people (ICOPE) implementation framework: guidance for systems and services. 2019, Geneva: World Health Organization.

    2. Wyman, M.F., S. Shiovitz-Ezra, and J. Bengel, Ageism in the Health Care System: Providers, Patients, and Systems, in Contemporary Perspectives on Ageism, L. Ayalon and C. Tesch-Römer, Editors. 2018, Springer International Publishing: Cham. p. 193-212.

    3. Burnes, D., et al., Interventions to Reduce Ageism Against Older Adults: A Systematic Review and Meta-Analysis.American Journal of Public Health, 2019. 109(8): p. e1-e9.

    4. Wilson, D.M., et al., A critical review of published research literature reviews on nursing and healthcare ageism. Journal of Clinical Nursing, 2017. 26(23-24): p. 3881-3892.

    5. Szadowska-Szlachetka, Z., et al., Attitudes of students of nursing major towards people of geriatric age. Polish Journal of Public Health, 2019. 129(3): p. 95.

    6. Naughton, C., K.L. O’Shea, and N. Hayes, Incentivising a career in older adult nursing: The views of student nurses. International Journal of Older People Nursing, 2019. 14(4): p. e12256.

    7. Giner Perot, J., et al., Aging-simulation experience: impact on health professionals’ social representations. BMC Geriatrics, 2020. 20(1): p. 14.

    8. Frennert, S. and K. Baudin, The concept of welfare technology in Swedish municipal eldercare. Disability and Rehabilitation, 2019: p. 1-8.

    9. Burbank, P.M., G.J. Burkholder, and J. Dugas, Development of the Perspectives on Caring for Older Patients scale: Psychometric analyses. Applied Nursing Research, 2018. 43: p. 98-104

  • 29.
    Gillsjö, Catharina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, USA.
    Karlsson, Sandra
    Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Sweden.
    Ståhl, Fredrik
    Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
    Eriksson, Irene
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Lifestyle's influence on community-dwelling older adults' health: A mixed-methods study design2021In: Contemporary Clinical Trials Communications, E-ISSN 2451-8654, Vol. 21, article id 100687Article in journal (Refereed)
    Abstract [en]

    Background: Aging often involves health problems and difficulties, such as physical and psychological impairments, isolation, and loneliness, causing social and existential consequences. Studies have explored aging from different perspectives. However, few studies have examined healthy older adults’ genetic backgrounds, lifestyles, and meaning in life separately or in combination. This study aims to describe how healthy older adults experience aging, health, lifestyles, and meaning in life and explore potential genetic correlations.

    Methods and Design:The project will comprise three main parts: a quantitative section featuring the development and testing of a lifestyle questionnaire, a quantitative genetic analysis, and a qualitative interview study. Participants will be communitydwelling, healthy, older adults between 70 and 95 years of age. A sample size of 800 older adults will be invited to participate at a gathering in collaboration with the national Swedish association Active Seniors. Data will be collected through lifestyle questionnaires, DNA extracted from saliva samples, and interviews. Based on questionnaire responses, profile groups will be created and compared statistically with variations in genetic backgrounds, providing the basis for recruiting participants to the qualitative interviews.

    Discussion: This study’s expected outcome will be to gain knowledge about variations in genetic backgrounds correlated with individual experiences regarding aging, health, and meaning in life. This knowledge can improve the understanding of motivations for healthy lifestyle changes. The results can reveal potential implications for individual prerequisites to healthy aging and how health-promoting aging and lifestyle counseling can be adjusted to meet individual needs.

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  • 30. Granstedt, Annika
    Biståndsmötet  –  kärnan  i  omsorgsarbetet2002In: Äldre i centrum: tidskrift för aktuell äldreforskning, ISSN 1653-3585, no 3, p. 36-37Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Mötet mellan handläggare och sökande, och hur biståndsbedömningen görs, är centralt. Ändå finns inga yrkesspecifika metoder för hur det ska gå till. Hur bedömningen görs har konsekvenser också för hur personalen kommer att utföra sitt arbete.

  • 31.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Ernsth Bravell, Marie
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Josephson, Iréne
    Region Jönköping County, Jönköping, Sweden ; The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Sweden.
    In Hospital We Trust: Experiences of older peoples' decision to seek hospital care2015In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 36, no 4, p. 306-311Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People's Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples' arguments for seeking hospital care may have implications for how home care staff address individuals' perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life.

  • 32.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Regional Development Council of Jönköping County, Sweden.
    Ernsth Bravell, Marie
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Mölstad, Sigvard
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Östgren, Carl Johan
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Midlöv, Patrik
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Factors associated with increased hospitalisation risk among nursing home residents in Sweden: a prospective study with a three-year follow-up2016In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 11, no 2, p. 130-139Article in journal (Refereed)
    Abstract [en]

    Background

    Hospitalisation of nursing home residents might lead to deteriorating health.

    Aim

    To evaluate physical and psychological factors associated with hospitalisation risk among nursing home residents.DesignProspective study with three years of follow-up.

    Methods

    Four hundred and twenty-nine Swedish nursing home residents, ages 65–101 years, from 11 nursing homes in three municipalities were followed during three years. The participants' physical and psychological status was assessed at baseline. A Cox proportional hazards model was used to evaluate factors associated with hospitalisation risk using STATA.

    Results

    Of the 429 participants, 196 (45.7%) were hospitalised at least once during the three-year follow-up period, and 109 (25.4%) during the first six months of the study. The most common causes of hospitalisation were cardiovascular diseases or complications due to falls. A Cox regression model showed that residents who have had previous falls (P < 0.001), are malnourished (P < 0.001), use a greater number of drugs (P < 0.001) and have more diseases (P < 0.001), are at an increased risk of hospitalisation.

    Conclusion

    Nursing home residents are frequently hospitalised, often due to falls or cardiovascular diseases. Study results underscore the relationships between malnutrition, previous falls, greater numbers of drugs and diseases and higher risk of hospitalisation.

    Implications for practice

    Preventive interventions aimed at malnutrition and falls at the nursing home could potentially reduce the number of hospitalisations. With improved education and support to nurses concerning risk assessment at the nursing homes, it may be possible to reduce the numbers of avoidable hospitalisation among nursing home residents and in the long run improve quality of life and reduce suffering.

  • 33.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Fransson, Eleonor I.
    Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of Southern California, Riverside, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Factors associated with hospitalization risk among community living middle aged and older persons: Results from the Swedish Adoption/Twin Study of Aging (SATSA)2016In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 66, p. 102-108Article in journal (Refereed)
    Abstract [en]

    The aims of the present study were to: (1) describe and compare individual characteristics of hospitalized and not hospitalized community living persons, and (2) to determine factors that are associated with hospitalization risk over time. We conducted a prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). A total of 772 Swedes (mean age at baseline 69.7 years, range 46–103, 59.8% females) answered a postal questionnaire about physical and psychological health, personality and socioeconomic factors. During nine years of follow-up, information on hospitalizations and associated diagnoses were obtained from national registers. Results show that 484 persons (63%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases (25%) and tumors (22%). Cox proportional hazard regression models controlling for age, sex and dependency within twin pairs, showed that higher age (HR = 1.02, p < 0.001) and more support from relatives (HR = 1.09, p = 0.028) were associated with increased risk of hospitalization, while marital status (unmarried (HR = 0.75, p = 0.033) and widow/widower (HR = 0.69, p < 0.001)) and support from friends (HR = 0.93, p = 0.029) were associated with lower risk of hospitalization. Social factors were important for hospitalization risk even when medical factors were controlled for in the analyses. Number of diseases was not a risk in the final regression model. Hospitalization risk was also different for women and men and within different age groups. We believe that these results might be used in future interventions targeting health care utilization.

  • 34.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Fransson, Eleonor I.
    Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, USA.
    Finkel, Deborah
    School of Social Sciences, Indiana University Southeast, New Albany, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cognitive trajectories in relation to hospitalization among older Swedish adults2018In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 74, p. 9-14Article in journal (Refereed)
    Abstract [en]

    Introduction

    Research indicate that cognitive impairment might be related to hospitalization, but little is known about these effects over time.

    Objective

    To assess cognitive change before and after hospitalization among older adults in a population-based longitudinal study with up to 25 years of follow-up.

    Method

    A longitudinal study on 828 community living men and women aged 50–86 from the Swedish Adoption/Twin Study of Ageing (SATSA) were linked to The Swedish National Inpatient Register. Up to 8 assessments of cognitive performance (general cognitive ability, verbal, spatial/fluid, memory, and processing speed) from 1986 to 2010 were available. Latent growth curve modelling was used to assess the association between cognitive performance and hospitalization including spline models to analyse cognitive trajectories pre- and post-hospitalization.

    Results

    A total of 735 persons (89%) had at least one hospital admission during the follow-up. Mean age at first hospitalization was 70.2 (±9.3) years. Persons who were hospitalized exhibited a lower mean level of cognitive performance in general ability, processing speed and spatial/fluid ability compared with those who were not hospitalized. The two-slope models revealed steeper cognitive decline before hospitalization than after among those with at least one hospitalization event, as compared to non-hospitalized persons who showed steeper cognitive decline after the centering age of 70 years.

    Conclusions

    Persons being hospitalized in late life have lower cognitive performance across all assessed domains. The results indicate that the main decline occurs before the hospitalization, and not after. This might indicate that when you get treatment you also benefit cognitively.

  • 35.
    Hansson, Carina
    et al.
    University of Skövde, School of Health Sciences.
    Rogö, Jenny
    University of Skövde, School of Health Sciences.
    Preventiva samhällsinterventioner för att undvika ofrivillig ensamhet hos äldre: En litteraturstudie2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: The elderly population is increasing and many feel lonely and isolated. It is a public health challenge to find solutions to this problem as involuntary loneliness can lead to mental illness. One of the global goals is to fight inequality in health, so by society working with preventive measures in the group of older people, it can contribute to increased equality in society. Aim: To describe the social efforts that can be made to counteract involuntary loneliness in the elderly. Method: A literature study based on 20 original scientific articles obtained from the databases PubMed, Medline Ebsco and CINAHL. The articles were analyzed with a thematic analysis. The most used keywords were elderly people, loneliness, prevention, intervention and effective. Results: Eight themes of counteracting involuntary loneliness were found and grouped into three categories, all themes were social support, digital technology, contact-creating societies, physical activity, primary care, social interactions, mental well-being and digital social interventions. Conclusion: The results of the study show that society's efforts contribute to reducing involuntary loneliness and isolation among the elderly. Society also needs to develop its work and be more responsive to the wishes of the elderly. More studies are needed, especially how digitization can be developed and used to the benefit of the elderly.

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  • 36.
    Hellberg, Ingela
    et al.
    Department of Senior Care, Municipality of Lidköping, Lidköping, Sweden.
    Augustsson, Veronica
    Department of Senior Care, Municipality of Götene, Sweden.
    Hellström Muhli, Ulla
    University of Skövde, School of Life Sciences.
    Seniors' experiences of living in special housing accommodation2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 1, article id 5894Article in journal (Refereed)
    Abstract [en]

    This article presents a hermeneutic phenomenological analysis of interview material in which 12 seniors living in Special Housing Accommodation (SHA) facilities reflect on the experience of living in such facilities. Of particular interest in the analysis is living in a SHA as a phenomenon. The finding shows that the phenomenon of lived experience in a SHA seems to be a state of ambiguity regarding one’s existence, which is made up of several constituents (elements of meaning).The analysis contributes to the understanding of how the phenomenon of SHA living is coming into existence as a need, due to an individual’s failing health; however, the SHA is not considered to be a true home. Accordingly, this has consequences to the subject position for the seniors in that they have to navigate between existing and not existing. The seniors learn to cope with living in the SHA by lowering their expectations of life and existence while the SHA provides the prerequisites for their existence. An implication for promoting care is to support the seniors to enable a full existence of life within SHA living.

  • 37.
    Hellström Muhli, Ulla
    University of Skövde, School of Life Sciences.
    Accounts of Pain Experience in a Swedish Elderly Care Context2010In: Communication & Medicine: An Interdisciplinary Journal of Healthcare, Ethics and Society, ISSN 1612-1783, E-ISSN 1613-3625, Vol. 7, no 1, p. 56-64Article in journal (Refereed)
  • 38.
    Hellström Muhli, Ulla
    University of Skövde, School of Life Sciences. Sociologiska institutionen, Uppsala universitet.
    Delaktighet i äldreomsorgens språkliga möten2012In: Delaktighetens praktik: det professionella samtalets villkor och möjligheter / [ed] Pia Bülow; Daniel Persson Thunqvist; Inger Sandén, Malmö: Gleerups Utbildning AB, 2012, p. 115-128Chapter in book (Other academic)
  • 39.
    Hellström Muhli, Ulla
    et al.
    University of Skövde, School of Life Sciences.
    Karlsson, Christina
    University of Skövde, School of Life Sciences.
    Registered nurses' shared knowledge construction of dementia careManuscript (preprint) (Other academic)
  • 40.
    Hovlin, Lina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Jönköping, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Mutual trust is a prerequisite for nurses’ sense of safety and work satisfaction – Mobile Integrated Care Model: A qualitative interview study2023In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 43, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizations. The aim of the study was to describe nurses’ experiences in working and providing health care in the Mobile Integrated Care Model in the home with home health care physicians. Semi-structured interviews were conducted with 18 nurses and analyzed through qualitative content analysis. The method was compliant with the COREQ checklist. A mutually trusting collaboration with physicians, which formed person-centered care, created work satisfaction for the nurses. Working within the Mobile Integrated Care Model was negatively impacted by being employed by different organizations, lack of time to provide health care, and physicians’ person-centered work abilities.

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  • 41.
    Hovlin, Lina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA.
    The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study2022In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 22, no 1, article id 554Article in journal (Refereed)
    Abstract [en]

    Background: An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.

    Methods: A phenomenographic qualitative study design, with semi-structured interviews using an interview guide.

    Results: Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians’ role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients’ homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making.

    Conclusions: The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other’s medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model. 

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  • 42.
    Huvila, Isto
    et al.
    Department of ALM, Uppsala University, Sweden / Information Studies, Åbo Akademi University, Turku, Finland.
    Hirvonen, Noora
    Information Studies, Åbo Akademi University, Turku, Finland / Information Studies, University of Oulu, Finland.
    Enwald, Heidi
    Information Studies, Åbo Akademi University, Turku, Finland / Information Studies, University of Oulu, Finland.
    Åhlfeldt, Rose-Mharie
    University of Skövde, School of Informatics. University of Skövde, The Informatics Research Centre.
    Differences in Health Information Literacy Competencies Among Older Adults, Elderly and Younger Citizens2019In: Information Literacy in Everyday Life: 6th European Conference, ECIL 2018, Oulu, Finland, September 24–27, 2018, Revised Selected Papers / [ed] Serap Kurbanoğlu, Sonja Špiranec, Yurdagül Ünal, Joumana Boustany, Maija Leena Huotari, Esther Grassian, Diane Mizrachi, Loriene Roy, Springer, 2019, Vol. 989, p. 136-143Chapter in book (Refereed)
    Abstract [en]

    To address the research gap on age-based differences in health information literacy (HIL), we investigated how younger (born 1960–) and older adults (1946–1960), and elderly citizens (–1945) differed from each other by their HIL competencies. Data were collected with an online survey of patients using the Swedish national electronic health record system. Altogether, 2,587 users responded. One-way ANOVA with post hoc tests revealed several differences between the groups: younger adults were less likely to value health information than older adults; older adults and elderly were least likely to compare information from multiple sources and had trouble in determining health information needs; older adults were most likely to have trouble understanding health terminology and the elderly to have difficulties in understanding medicinal package labels. The study shows that HIL is not necessarily improving or declining but adapting to challenges of advanced age. © 2019, Springer Nature Switzerland AG.

  • 43.
    Javeed, Ashir
    et al.
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Anderberg, Peter
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Ghazi, Ahmad Nauman
    Department of Software Engineering, Blekinge Institute of Technology, Karlskrona, Sweden.
    Noor, Adeeb
    Department of Information Technology, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia.
    Elmståhl, Sölve
    EpiHealth: Epidemiology for Health, Lund University, SUS Malmö, Sweden.
    Sanmartin Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Breaking barriers: a statistical and machine learning-based hybrid system for predicting dementia2023In: Frontiers in Bioengineering and Biotechnology, E-ISSN 2296-4185, Vol. 11, article id 1336255Article in journal (Refereed)
    Abstract [en]

    Introduction: Dementia is a condition (a collection of related signs and symptoms) that causes a continuing deterioration in cognitive function, and millions of people are impacted by dementia every year as the world population continues to rise. Conventional approaches for determining dementia rely primarily on clinical examinations, analyzing medical records, and administering cognitive and neuropsychological testing. However, these methods are time-consuming and costly in terms of treatment. Therefore, this study aims to present a noninvasive method for the early prediction of dementia so that preventive steps should be taken to avoid dementia. Methods: We developed a hybrid diagnostic system based on statistical and machine learning (ML) methods that used patient electronic health records to predict dementia. The dataset used for this study was obtained from the Swedish National Study on Aging and Care (SNAC), with a sample size of 43040 and 75 features. The newly constructed diagnostic extracts a subset of useful features from the dataset through a statistical method (F-score). For the classification, we developed an ensemble voting classifier based on five different ML models: decision tree (DT), naive Bayes (NB), logistic regression (LR), support vector machines (SVM), and random forest (RF). To address the problem of ML model overfitting, we used a cross-validation approach to evaluate the performance of the proposed diagnostic system. Various assessment measures, such as accuracy, sensitivity, specificity, receiver operating characteristic (ROC) curve, and Matthew’s correlation coefficient (MCC), were used to thoroughly validate the devised diagnostic system’s efficiency. Results: According to the experimental results, the proposed diagnostic method achieved the best accuracy of 98.25%, as well as sensitivity of 97.44%, specificity of 95.744%, and MCC of 0.7535. Discussion: The effectiveness of the proposed diagnostic approach is compared to various cutting-edge feature selection techniques and baseline ML models. From experimental results, it is evident that the proposed diagnostic system outperformed the prior feature selection strategies and baseline ML models regarding accuracy. 

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  • 44.
    Johansson, Karin
    et al.
    Department of Health and Care Sciences, Faculty of Health and Life Science, Linnaeus University, Växjö, Sweden / Department of Administration, Kronoberg County Council, Växjö, Sweden / Primary Care, Region Kronoberg County Council, Växjö, Sweden.
    Almerud Österberg, Sofia
    Department of Health and Care Sciences, Faculty of Health and Life Science, Linnaeus University, Växjö, Sweden.
    Leksell, Janeth
    School of Health and Social Sciences, University Dalarna, Falun, Sweden / Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Berglund, Mia
    University of Skövde, Health and Education. University of Skövde, School of Health and Education.
    Patients' experiences of support for learning to live with diabetes to promote health and well-being: A lifeworld phenomenological study2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 31330Article in journal (Refereed)
    Abstract [en]

    Learning to live with diabetes in such a way that the new conditions will be a normal and natural part of life imposes requirements on the person living with diabetes. Previous studies have shown that there is no clear picture of what and how the learning that would allow persons to incorporate the illness into their everyday life will be supported. The aim of this study is to describe the phenomenon of support for learning to live with diabetes to promote health and well-being, from the patient’s perspective. Data were collected by interviews with patients living with type 1 or type 2 diabetes. The interviews were analysed using a reflective lifeworld approach. The results show that reflection plays a central role for patients with diabetes in achieving a new understanding of the health process, and awareness of their own responsibility was found to be the key factor for such a reflection. The constituents are responsibility creating curiosity and willpower, openness enabling support, technology verifying bodily feelings, a permissive climate providing for participation and exchanging experiences with others. The study concludes that the challenge for caregivers is to create interactions in an open learning climate that initiates and supports reflection to promote health and well-being.

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  • 45.
    Johansson, Yvonne A.
    et al.
    Skaraborg Hospital, Skövde, Sweden ; The Research School of Health and Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping University, Sweden.
    Tsevis, Theofanis
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden ; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Nasic, Salmir
    Skaraborg Hospital, Skövde, Sweden ; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, United States.
    Johansson, Linda
    Institute of Gerontology, Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Bogdanovic, Nenad
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden ; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Kenne Sarenmalm, Elisabeth
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Skaraborg Hospital, Skövde, Sweden ; Institute of Health and Care Science, Sahlgrenska Academy, Centre for Person-Centred Care Sahlgrenska Academy, University of Gothenburg, Sweden.
    Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting2021In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, no 1, article id 568Article in journal (Refereed)
    Abstract [en]

    Background: Delirium is common in older hospitalized patients. It has serious consequences e.g., poor health outcomes, mortality and increased costs. Despite that, many cases are undetected. Early detection of delirium is important in improving outcomes and use of assessment tools improves detection rates. The 4AT is a brief screening tool for delirium detection, which has not previously been translated into Swedish. The study aim was to evaluate diagnostic accuracy and clinical applicability of a Swedish version of the screening tool 4AT for delirium detection. Method: This diagnostic test accuracy study used a quantitative and a qualitative approach and evaluated the patients’ and the health care professionals’ experiences of the tool. Study included 200 patients ≥65 years from a university hospital and a county hospital in two Swedish regions. Medical specialties were geriatric stroke/neurology, geriatric multimorbidity, severe cognitive impairment, orthopaedic, and urology. The translated 4AT was tested against the reference standard DSM-IV-TR criteria, based on the Organic Brain Syndrome scale and patient records. The 4AT was assessed simultaneously and independently by two assessors. Additionally, data was collected through patient record reviews, and questions about applicability to the patients (n = 200) and the assessors (n = 37). Statistical analyses, and qualitative content analyses were conducted. Results: By reference standard 18% had delirium, and by 4AT 19%. The overall percent agreement was 88%, AUROC 0.808, sensitivity 0.70 (95% CI 0.51–0.84) and specificity 0.92 (95% CI 0.87–0.96). In the ward for severe cognitive impairment (n = 63) the 4AT was less sensitive and less specific. In the other wards (n = 132) sensitivity was 0.77 (95% CI 0.50–0.93), specificity 0.93 (95% CI 0.87–0.97), and AUROC 0.848. Interrater reliability (Kappa) was 0.918, p = < 0.001 (n = 144). The 4AT was well tolerated by patients, easy to use for health care professionals, and took a few minutes to conduct. Conclusion: The Swedish version of 4AT is an accurate and applicable tool to use in clinical practice for detecting delirium in hospitalized patients across different medical specialities, and to use by different professionals and levels of seniority. To improve patient outcomes, we recommend the 4AT to be incorporated in clinical practice in health care settings in Sweden. 

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  • 46.
    Karlsson, Ida K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Ericsson, Malin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Wang, Yunzhang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hägg, Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, United States.
    Epigenome-wide association study of level and change in cognitive abilities from midlife through late life2021In: Clinical Epigenetics, ISSN 1868-7075, Vol. 13, no 1, article id 85Article in journal (Refereed)
    Abstract [en]

    Background: Epigenetic mechanisms are important in aging and may be involved in late-life changes in cognitive abilities. We conducted an epigenome-wide association study of leukocyte DNA methylation in relation to level and change in cognitive abilities, from midlife through late life in 535 Swedish twins. Results: Methylation levels were measured with the Infinium Human Methylation 450 K or Infinium MethylationEPIC array, and all sites passing quality control on both arrays were selected for analysis (n = 250,816). Empirical Bayes estimates of individual intercept (age 65), linear, and quadratic change were obtained from latent growth curve models of cognitive traits and used as outcomes in linear regression models. Significant sites (p &lt; 2.4 × 10–7) were followed up in between-within twin pair models adjusting for familial confounding and full-growth modeling. We identified six significant associations between DNA methylation and level of cognitive abilities at age 65: cg18064256 (PPP1R13L) with processing speed and spatial ability; cg04549090 (NRXN3) with spatial ability; cg09988380 (POGZ), cg25651129 (-), and cg08011941 (ENTPD8) with working memory. The genes are involved in neuroinflammation, neuropsychiatric disorders, and ATP metabolism. Within-pair associations were approximately half that of between-pair associations across all sites. In full-growth curve models, associations between DNA methylation and cognitive level at age 65 were of small effect sizes, and associations between DNA methylation and longitudinal change in cognitive abilities of very small effect sizes. Conclusions: Leukocyte DNA methylation was associated with level, but not change in cognitive abilities. The associations were substantially attenuated in within-pair analyses, indicating they are influenced in part by genetic factors. 

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  • 47.
    Karlsson, Ida K.
    et al.
    Institute of Gerontology and Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.
    Arpawong, Thalida Em
    Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Institute of Gerontology and Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    The dynamic association between body mass index and cognition from midlife through late-life, and the effect of sex and genetic influences2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Body mass index (BMI) is associated with cognitive abilities, but the nature of the relationship remains largely unexplored. We aimed to investigate the bidirectional relationship from midlife through late-life, while considering sex differences and genetic predisposition to higher BMI. We used data from 23,892 individuals of European ancestry from the Health and Retirement Study, with longitudinal data on BMI and three established cognitive indices: mental status, episodic memory, and their sum, called total cognition. To investigate the dynamic relationship between BMI and cognitive abilities, we applied dual change score models of change from age 50 through 89, with a breakpoint at age 65 or 70. Models were further stratified by sex and genetic predisposition to higher BMI using tertiles of a polygenic score for BMI (PGSBMI). We demonstrated bidirectional effects between BMI and all three cognitive indices, with higher BMI contributing to steeper decline in cognitive abilities in both midlife and late-life, and higher cognitive abilities contributing to less decline in BMI in late-life. The effects of BMI on change in cognitive abilities were more evident in men compared to women, and among those in the lowest tertile of the PGSBMI compared to those in the highest tertile, while the effects of cognition on BMI were similar across groups. In conclusion, these findings highlight a reciprocal relationship between BMI and cognitive abilities, indicating that the negative effects of a higher BMI persist from midlife through late-life, and that weight-loss in late-life may be driven by cognitive decline.

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  • 48.
    Karlsson, Ida K.
    et al.
    Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lehto, Kelli
    National Institute for Health Development, Tallinn, Estonia ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles, CA, United States ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Dahl Aslan, Anna K.
    Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Age-dependent effects of body mass index across the adult life span on the risk of dementia: A cohort study with a genetic approach2020In: BMC Medicine, E-ISSN 1741-7015, Vol. 18, no 1, article id 131Article in journal (Refereed)
    Abstract [en]

    Background: While a high body mass index (BMI) in midlife is associated with higher risk of dementia, high BMI in late-life may be associated with lower risk. This study combined genetic designs with longitudinal data to achieve a better understanding of this paradox. Methods: We used longitudinal data from 22,156 individuals in the Swedish Twin Registry (STR) and 25,698 from the Health and Retirement Study (HRS). The STR sample had information about BMI from early adulthood through late-life, and the HRS sample from age 50 through late-life. Survival analysis was applied to investigate age-specific associations between BMI and dementia risk. To examine if the associations are influenced by genetic susceptibility to higher BMI, an interaction between BMI and a polygenic score for BMI (PGSBMI) was included in the models and results stratified into those with genetic predisposition to low, medium, and higher BMI. In the STR, co-twin control models were applied to adjust for familial factors beyond those captured by the PGSBMI. Results: At age 35-49, 5 units higher BMI was associated with 15% (95% CI 7-24%) higher risk of dementia in the STR. There was a significant interaction (p = 0.04) between BMI and the PGSBMI, and the association present only among those with genetic predisposition to low BMI (HR 1.38, 95% CI 1.08-1.78). Co-twin control analyses indicated genetic influences. After age 80, 5 units higher BMI was associated with 10-11% lower risk of dementia in both samples. There was a significant interaction between late-life BMI and the PGSBMI in the STR (p = 0.01), but not the HRS, with the inverse association present only among those with a high PGSBMI (HR 0.70, 95% CI 0.52-0.94). No genetic influences were evident from co-twin control models of late-life BMI. Conclusions: Not only does the association between BMI and dementia differ depending on age at BMI measurement, but also the effect of genetic influences. In STR, the associations were only present among those with a BMI in opposite direction of their genetic predisposition, indicating that the association between BMI and dementia across the life course might be driven by environmental factors and hence likely modifiable. © 2020 The Author(s).

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  • 49.
    Karlsson, Ida K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Zhan, Yiqiang
    School of Public Health, Sun Yat-Sen University, Shenzhen, China.
    Wang, Yunzhang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Li, Xia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hägg, Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Center for Economic and Social Research, University of Southern California, Los Angeles, United States.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, United States.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Adiposity and the risk of dementia: mediating effects from inflammation and lipid levels2022In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 37, no 12, p. 1261-1271Article in journal (Refereed)
    Abstract [en]

    While midlife adiposity is a risk factor for dementia, adiposity in late-life appears to be associated with lower risk. What drives the associations is poorly understood, especially the inverse association in late-life. Using results from genome-wide association studies, we identified inflammation and lipid metabolism as biological pathways involved in both adiposity and dementia. To test if these factors mediate the effect of midlife and/or late-life adiposity on dementia, we then used cohort data from the Swedish Twin Registry, with measures of adiposity and potential mediators taken in midlife (age 40–64, n = 5999) or late-life (age 65–90, n = 7257). Associations between body-mass index (BMI), waist-hip ratio (WHR), C-reactive protein (CRP), lipid levels, and dementia were tested in survival and mediation analyses. Age was used as the underlying time scale, and sex and education included as covariates in all models. Fasting status was included as a covariate in models of lipids. One standard deviation (SD) higher WHR in midlife was associated with 25% (95% CI 2–52%) higher dementia risk, with slight attenuation when adjusting for BMI. No evidence of mediation through CRP or lipid levels was present. After age 65, one SD higher BMI, but not WHR, was associated with 8% (95% CI 1–14%) lower dementia risk. The association was partly mediated by higher CRP, and suppressed when high-density lipoprotein levels were low. In conclusion, the negative effects of midlife adiposity on dementia risk were driven directly by factors associated with body fat distribution, with no evidence of mediation through inflammation or lipid levels. There was an inverse association between late-life adiposity and dementia risk, especially where the body’s inflammatory response and lipid homeostasis is intact. 

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  • 50.
    Ler, Peggy
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ojalehto, Elsa
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Zhan, Yiqiang
    School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China.
    Finkel, Deborah
    Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States ; School of Health and Welfare, Jönkoping University, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Karlsson, Ida K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Conversions between metabolically unhealthy and healthy obesity from midlife to late-life2023In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497Article in journal (Refereed)
    Abstract [en]

    Introduction: Metabolically healthy obesity may be a transient phenotype, but studies with long follow-up, especially covering late-life, are lacking. We describe conversions between cross-categories of body mass index (BMI) and metabolic health in 786 Swedish twins with up to 27 years of follow-up, from midlife to late-life. Methods: Metabolic health was defined as the absence of metabolic syndrome (MetS). We first visualized conversions between BMI-metabolic health phenotypes in 100 individuals with measurements available at ages 50–64, 65–79, and ≥80. Next, we modeled conversion in metabolic health status by BMI category in the full sample using Cox proportional hazards regression. Results: The proportion of individuals with MetS and with overweight or obesity increased with age. However, one-fifth maintained a metabolically healthy overweight or obesity across all three age categories. Among those metabolically healthy at baseline, 59% converted to MetS during follow-up. Conversions occurred 56% more often among individuals with metabolically healthy obesity, but not overweight, compared to normal weight. Among those with MetS at baseline, 60% regained metabolic health during follow-up, with no difference between BMI categories. Conclusions: Conversions between metabolically healthy and unhealthy status occurred in both directions in all BMI categories. While conversions to MetS were more common among individuals with obesity, many individuals maintained or regained metabolic health during follow-up. 

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