Högskolan i Skövde

Background: Obesity and aging share biological processes, but their relationship remains unclear, especially in late life. Understanding how body mass index (BMI) and biological aging influence each other can guide strategies to reduce age- and obesity-related health risks. We examined the bidirectional, longitudinal association between changes in BMI and biological aging, measured by frailty index (FI) and functional aging index (FAI), across late life.

Methods: This longitudinal cohort study used data from the Swedish Twin Registry substudies, GENDER, OCTO-Twin and SATSA, collected via in-person assessments from 1986 to 2014 at 2- to 4-year intervals. We analysed 6216–6512 evaluations from 1902 to 1976 Swedish twins. Dual change score models were applied to assess the bidirectional, longitudinal association between BMI and FI or FAI from ages 60.0–91.9. FI measured physiological aging, while FAI assessed functional aging through a composite score of functional abilities.

Results: At first measurement, mean age was 74 ± 8, and 41% were males. BMI–FI relationship was bidirectional (p value ≤ 0.001): Higher BMI predicted a greater increase in FI over time (coupling effect [γ] = 0.86, 95% confidence interval [CI] = 0.65–1.06, p value ≤ 0.001), and higher FI predicted steeper decline in BMI (γ = −0.04, 95% CI = −0.05 to −0.03, p value ≤ 0.001). When including coupling from FI, BMI showed a nonlinear trajectory with a mean intercept of 26.32 kg/m2 (95% CI = 25.76–26.88), declining more rapidly after age 75. When including BMI coupling, FI increased from a mean intercept of 7.91% (95% CI = 6.41–9.42), with steeper growth from ages 60–75. BMI–FAI relationship was unidirectional (p value ≤ 0.001): Higher FAI predicted a steeper BMI decline (γ = −0.02, 95% CI = −0.02 to −0.01, p value ≤ 0.001). By including FAI coupling, BMI had a mean intercept of 26.10 kg/m2 (95% CI = 25.47–26.74), declining rapidly after age 75. FAI increased exponentially from a mean intercept of 36.49 (95% CI = 34.54–38.43).

Conclusions: Higher BMI predicted a steeper increase in FI, substantiating the hypothesis that obesity accelerates biological aging. Higher biological aging, measured as FI and FAI, drove a steeper BMI decline in late life, signalling that late-life weight loss may result from accelerated aging. Higher BMI may accelerate aspects of the aging process, and the aging process, in turn, accelerates late-life BMI decline, necessitating an integrated approach to manage both obesity and unintentional weight loss among older adults.

Aims: About 10%–30% of individuals with obesity are metabolically healthy, but the specific characteristics of the metabolically healthy obesity (MHO) phenotype remain unclear. We aimed to examine how physical activity, education, depressive symptoms and genetic predisposition to obesity differ between individuals with MHO and those with metabolically unhealthy obesity (MUO), and whether these factors predict stability in MHO or conversion to a metabolically unhealthy state.

Materials and Methods: We retrieved data on 9809 individuals with obesity from the Health and Retirement Study collected between 2006 and 2016. We compared how physical activity, education, depressive symptoms and a polygenic score for higher body mass index (BMI) (PGSBMI) differed cross-sectionally between MHO and MUO using logistic regression. We then examined if the same factors predict conversion to a metabolically unhealthy state over 4 years in individuals with MHO.

Results: Individuals with MHO had higher physical activity (odds ratio [OR] = 0.81), higher education (OR = 0.83) and lower depressive symptoms (OR = 1.14) compared to those with MUO but did not differ in the PGSBMI. The associations were slightly attenuated in mutually adjusted models. None of the factors were associated with conversion from MHO to a metabolically unhealthy state. However, a higher PGSBMI indicated 24% lower risk of conversion to a metabolically unhealthy state (p = 0.07).

Conclusions: Physical activity, education and depressive symptoms differed between MHO and MUO, even when mutually adjusted for, but did not predict conversion from a metabolically healthy to unhealthy state. Although not statistically significant, the results indicated that those with genetically predicted high BMI are more likely to maintain MHO and not convert to a metabolically unhealthy state.

Background

Older persons (those 65 years of age and older) have the lowest digital competence and are thus at an increased risk of exclusion from a digitalizing society. To bridge this digital divide, several Swedish municipalities have introduced a service called Digital Coach (DC), where older persons can request in-home support for their digital needs. Little is known about older persons’ experiences of this unique service.

Objective

To study older persons’ experiences of one-to-one in-home support, with their digital needs, through the DC service.

Methods

A qualitative study was conducted through interviews, and the data were analysed using qualitative content analysis following the approach of Graneheim and Lundman.

Results

The older persons (n = 14) expressed awareness of the importance of digital competence to keep up with the times to avoid exclusion and vulnerability. They requested support to become part of a digital society. The DC service was experienced as providing respectful support at home, which is considered a calm, safe environment. They expressed that the support made them feel valued and increased opportunities for independence and social participation.

Conclusions

Older persons found one-to-one in-home support to be the optimal form of support for their digital needs. The support gave them the best conditions to achieve digital competence, and without the support, would have felt stranded. Efforts to support older persons’ digital competence should be based on the older persons’ own digital needs and be provided in their home.

Background: The role of biological ageing in the association between body mass index (BMI) and survival remains unclear. We examined whether epigenetic age acceleration (EAA), a biomarker of biological ageing, mediates the BMI-survival association. Methods: We analysed data from 3840 participants (aged 51–100) in the 2016 US Health and Retirement Study, with survival information through 2020. Mediation analyses were performed using linear regression and Gompertz proportional hazards models with restricted cubic splines, adjusting for age, sex, ethnicity/race, smoking, education, and metabolic health. Average direct effects (ADE) of BMI and average causal mediation effects of EAA (HannumAgeAcc, PhenoAgeAcc, GrimAgeAcc, and DunedinPace) on survival time were estimated with 95% confidence intervals (CI). Findings: Associations between BMI, EAA, and survival were nonlinear: high and low BMIs were associated with higher EAA and reduced survival time. ADEs of high BMI (35 kg/m2 versus 27 kg/m2) were not statistically significant (reduced survival time: 1.21–1.58 years) but significant for low BMI (19 kg/m2 versus 27 kg/m2, reduced survival time: 5.60–6.38 years). For high BMI, mediation was significant through all EAAs, with reduced survival time ranging from 0.28 to 0.71 years, accounting for 15–37% of total effects. For low BMI, mediation was statistically significant through HannumAgeAcc (reduced survival time: 0.44, CI: 0.08–0.86) and GrimAgeAcc (reduced survival time: 0.73, CI: 0.15–1.38), accounting for 7–11% of total effects. Interpretation: EAA partially mediated the high BMI-survival association, supporting the mediating role of accelerated ageing in the obesity-survival relationship. Mediation through EAA in the low BMI-survival association was weaker, indicating that alternative mechanisms, other than accelerated ageing, may dominate. Funding: Forte, Vetenskaprådet, SFOepi, Karolinska Institutet's Research Foundation, Loo and Hans Osterman Foundation, the Foundation for Geriatric Diseases at Karolinska Institutet. 

Background: Digitalization is seen as a necessity to manage the increasing burden on the health care system and is accordingly considered an important tool in the transformation to integrated care (Swedish Nära vård). However, when health care is digitalized older persons are at increased risk of being marginalized and dependent on others due to their generally lower digital competence. To address this, several Swedish municipalities offer individual support to older persons in their own home, a service called Digital Coach (DC). As this service is new, the aim is to describe older persons’ experiences of getting individual support with digital needs in the context of home. Method: Semi-structured interviews (n=14) were conducted with older persons who have had DC support in their home. The focus was on older persons’ experiences of the support. Data was analyzed with qualitative content analysis. Results, preliminary: The overall theme, to be a valued person in the digital society, represents a feeling of being taken seriously and worth investing resources in to gain access to society. Three categories emerged: (1) The need to keep up with the times which means to understand and navigate the new digital landscape with the opportunity for independence and participation, (2) Support and respect in the learning situation, is crucial for feeling comfortable to expose insufficient knowledge, and (3) Increased digital competence empowers autonomy and is manifested as the ability to handle the digital tools and services by your own creates a feeling of joy and satisfaction and increases the opportunity to participate in both social and community activities. Conclusion: The result shows that individual support with digital needs in the context of home increase digital competence in older persons and create feelings of being valued and included in the digital society, which can extend to integrated person-centered care.

The function of an activity-guide is an innovative municipal collaborative support effort that fits well into the strategies for healthy ageing and person-centred care. The activity-guide mission is to be a support, a personal contact, for elderly who experience involuntary loneliness in daring to recommence or find new social contexts, such as physical, cultural or creative activities. Today we know that experienced involuntary loneliness over longer period of time not only affects the psychological well-being but also the physical health. Put into perspective, involuntary loneliness is refereed to be as strongly associated with premature death as smoking fifteen cigarettes a day. Simultaneously, we know that involuntary loneliness can be difficult to break by yourself, as perceived loneliness is often surrounded by feelings of shame. Fortunately, today there are good initiatives of collaborative support efforts to break the involuntary loneliness of elderly. One of these good initiatives is this collaborative project between Skövde Municipality and the University of Skövde where the aim is to contribute in development of the activity-guide function and collect data to evaluate the users’ perception and usefulness of the activity-guide function. The project is collecting both qualitative and quantitate data from elderly who have contact with the activity-guide. Preliminary data collected from individual-in-depth interviews with the elderly, shows that the activity-guide have a significant role in resuming or finding new social contexts. Concurrently, the preliminary results show that the elderly want more understanding and knowledge from healthcare providers about how involuntary loneliness affects their health and well-being. In the project, it is planned for focus-group interviews with the persons who are activity-guides in the municipalities that offer their residents this function. This projects knowledge can be used for a deeper understanding of what enables and prevents elderly person from daring to recommence or find new social contexts.

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. 

Denna rapport innehåller en kartläggning av digitalisering, ensamhet och hälsa i Skövde kommun. Resultaten baseras på en enkät som skickats ut till 1000 invånare i Skövde kommun som är 55 år eller äldre. Enkäten har tagits fram i samverkan mellan Skövde kommun och Högskolan i Skövde. Rapporten vänder sig främst till politiker, beslutsfattare och handläggare som arbetar med frågor som berör digitalisering, ensamhet och hälsa. Andra målgrupper finns inom civilsamhälle, näringsliv och forskning.

Obesity and metabolic syndrome (MetS) share common pathophysiological characteristics with aging. To better understand their interplay, we examined how body mass index (BMI) and MetS jointly associate with physiological age, and if the associations changed from midlife to late-life. We used longitudinal data from 1,825 Swedish twins. Physiological age was measured as frailty index (FI) and functional aging index (FAI) and modeled independently in linear mixed-effects models adjusted for chronological age, sex, education, and smoking. We assessed curvilinear associations of BMI and chronological age with physiological age, and interactions between BMI, MetS, and chronological age. We found a significant three-way interaction between BMI, MetS, and chronological age on FI (p-interaction = 0·006), not FAI. Consequently, we stratified FI analyses by age: < 65, 65–85, and ≥ 85 years, and modeled FAI across ages. Except for FI at ages ≥ 85, BMI had U-shaped associations with FI and FAI, where BMI around 26-28 kg/m2 was associated with the lowest physiological age. MetS was associated with higher FI and FAI, except for FI at ages < 65, and modified the BMI-FI association at ages 65–85 (p-interaction = 0·02), whereby the association between higher BMI levels and FI was stronger in individuals with MetS. Age modified the MetS-FI association in ages ≥ 85, such that it was stronger at higher ages (p-interaction = 0·01). Low BMI, high BMI, and metabolic syndrome were associated with higher physiological age, contributing to overall health status among older individuals and potentially accelerating aging. 

BACKGROUND: In 2020 the Swedish Government started a gradual raising of the retirement age, but employers have been silent on the issue. Little is known about whether and how they reflect on what it will mean for their organization, or whether they already have, or are going to, make arrangements in order to facilitate and motivate older workers to stay longer.

OBJECTIVE: The aim of this study was to explore and describe managers' experiences of older workers and age management in connection with the increase of the retirement age in Sweden.

METHODS: Data was collected through semi-structured interviews with fourteen managers from a broad set of organizations in the public and private sectors, and from the Middle and East of Sweden. The transcribed material was analysed in line with qualitative content analysis.

RESULTS: The analysis ended up in seven main categories with associated sub-categories: Older Workers, Retirement Ages, Transition Initiatives, Competence Transfer, Competence Development, Increased Retirement Ages, Knowledge Gaps.

CONCLUSION: Our findings reveal that there is an ambivalence in addressing the issue of age among the interviewed managers, what we have interpreted and labelled as "silent age discrimination", and it was shown that they do not have elaborated strategies for age management.