Scandinavia has among the highest incidence of fragility fractures in the world. The reasons for this are unknown, but might involve differences in genetic and/or environmental factors, such as sunlight exposure and levels of physical activity. Weight-bearing exercise is thought to have a beneficial effect on bone health in the young, but few studies have evaluated whether exercise in older subjects affects bone density and protects against fragility fractures. The initial objective of this thesis was to evaluate whether a combined weight-bearing training programme twice a week would be beneficial as regards bone mineral density (BMD) and neuromuscular function in older women. Forty-eight community living women with a mean age of 73 years were recruited for this 12-month prospective, randomised controlled trial, and were randomly assigned to an intervention group (n=24) or a control group (n=24). The intervention group displayed significant increments in BMD at the Ward’s triangle, maximum walking speed, and isometric grip strength compared to the control group. The second objective was to investigate if training effects were retained in older women five years after the cessation of training. The 40 women who completed the first study included in this thesis were invited to take part in a follow-up assessment five years later, and 34 women (~79 years) agreed to participate. During these five years both groups had sustained significant losses in hip BMD and in all neuromuscular function tests, and the previous exercise-induced intergroup differences were no longer seen. The third and fourth objective of this thesis was to investigate whether exercise and weight-bearing leisure activities in middle-aged women are associated with a decreased risk of sustaining hip or wrist fractures at a later stage. A cohort of women participating in the Umeå Fracture and Osteoporosis (UFO) study, a longitudinal, nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures, was used for the purpose of this investigation. Eighty-one hip fracture cases and 376 wrist fracture cases, which had reported lifestyle data before they sustained their fracture, were identified. These cases were compared with age-matched controls identified from the same cohort. Using conditional logistic regression analysis with adjustments for height, BMI, smoking, and menopausal status, results showed that moderate frequency of leisure physical activities such as gardening and berry/mushroom picking, were associated with reduced hip fracture risk (OR 0.28; 95% CI 0.12 – 0.67), whereas active commuting (especially walking) along with dancing and snow shoveling in leisure time, reduced the wrist fracture risk (OR 0.48; 95% CI 0.27 – 0.88, OR 0.42; 95% CI 0.22 – 0.80 and OR 0.50; 95% CI 0.32 – 0.79 respectively). In summary, this thesis suggests that weight-bearing physical activity is beneficial for BMD and neuromuscular functions such as muscle strength and gait in older women, and that a physically active lifestyle, with outdoor activities, in middle age is associated with reduced risk of both hip and wrist fractures. Possible mechanisms underlying this association include improved muscle strength, coordination, and balance, resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

Syftet med denna studie var att belysa om lagstiftningen efterföljs vid behovsmedicinering på SÄBO (Särskiltboende) samt beskriva vilka likheter och skillnader som finns i dokumentationen gällande när vid behovs medicinering ges. Designen var jämförande, deskriptiv, kvantitativ, retrospektiv journalstudie. Urvalet var 100 patientjournaler från tre SÄBO i mellan Sverige. Journalerna har granskats utifrån följande variabler: demens- eller somatisk-avdelning, läkemedelsnamn, styrka, dos, orsak till att medicinen givits, effekten av medicinen, yrkestillhörighet på dokumenteraren samt jämförande med gammalt/nytt journalsystem. Resultatet visade signifikanta skillnader i dokumentationen utifrån om det var ett demensboende eller ett somatikboende. Ingen skillnad i dokumentationen fanns att finna mellan gammalt och nytt datasystem. Läkemedelsnamnet var det som förekom mest i dokumentationen vid behovsmedicinering. Minst förekommande var anteckningar angående utvärderad effekt. Dokumentationen kring given vid behovsmedicinering var bristfällig och resultatet i denna studie visade bland annat att det inte var journalföringssystemet som var orsaken.

Bakgrund: När allt fler lever längre ökar sannolikheten att möta livets slut vid en hög ålder. Att dö i hemmet är ett önskemål hos många personer i livets slut och deras närstående. Allt fler personer i livets slut vårdas i dag i hemmet och det är troligt att denna trend kommer att öka i framtiden. När palliativ vård utförs i hemmet förutsätter det ofta att det finns en närstående som kan fungera som vårdare. Konfronterandet med döden innebär vanligtvis en svår livssituation, som kan vara den närståendes första riktiga möte med döden. I detta påfrestande läge har den närstående ett stort behov av stöd från och god kommunikation med den professionella vården, då en god vård av den sjuke förutsätter att den närstående får ett professionellt stöd. För att kunna ge de närstående stöd är det viktigt att sjuksköterskan har förståelse för deras upplevelser. Syfte: Syftet är att beskriva närståendes upplevelser av att vårda en äldre person palliativt i hemmet. Metod: En litteraturstudie där totalt åtta kvalitativa och kvantitativa vetenskapliga artiklar relevanta för syftet analyserats. Fribergs kvalitativa analysmodell (2006) har använts för att identifiera kategorier. Resultat: Sju kategorier framkom ur analysen: upplevelsen av att se den sjuke förändras, önskan att vara tillräcklig och bidra, upplevelsen av de professionellas svek, strävan efter hopp och mening, upplevelsen av ansträngning, upplevelsen av brist på kontroll och betydelsen av familj och vänner. Diskussion: I diskussionen relateras centrala delar av resultatet till Travelbees teori om mellanmänskliga aspekter. Upplevelsen av de professionellas svek, strävan efter hopp och mening samt upplevelsen av lidande diskuteras. Även viktiga aspekter som sjuksköterskan bör tänka på diskuteras.

Sammanfattning   Bakgrund: Demenssjukdomar är vanligt förekommande hos äldre, vid 90 års ålder är cirka 50 procent drabbade av demenssjukdomar. Demenssjukdomar leder till beteende- och kommunikations svårigheter, vilket kan försvåra omvårdnadsarbetet och interaktionen mellan vårdpersonal och personer med demens. Syfte: Belysa faktorer som främjar respektive hindrar en god interaktion mellan vårdpersonal och personer med demens. Metod: En systematisk litteraturstudie baserad på tio vetenskapliga artiklar. Resultat: Omvårdnaden av personer med demens påverkas av interaktionen mellan dem och vårdpersonalen. Interaktionen i sin tur påverkas av olika främjande respektive hindrande faktorer. En central faktor var kommunikationens betydelse hos både vårdpersonal och personer med demens. Det framkom att både vårdpersonal och personer med demens kan påverka interaktionen, men det är vårdpersonalen som har det största ansvaret. Slutsats: Med en ökad kunskap om hur främjande respektive hindrande faktorer hos vårdpersonal och hos personer med demens påverkar interaktionen ökar möjligheten att tillgodose patienternas behov och samtidigt få dem att känna sig unika och värdefulla.

No description available.

Abstract          Background: End of life is difficult to establish in patients with dementia and many patients die due to complications related to the disease. To document that care are palliative in this group of patients is not common among nurses and physicians. This may depend on that the palliative course is extended and not similar to the palliative course common among patients with cancer. Aim: To describe how the registered staff in nursing homes document the care of persons with dementia in a late palliative phase. Method: A retrospective record study with a deductive approach. Nursing (n = 50) and medical records (n = 50) for departed patients were reviewed using a review guide based on the Liverpool Care Pathway (LCP). Data were analyzed with a manifest content analysis.  The occurrence of documentation in the records was also counted. Results: Three categories were formulated from the analysis: Initial assessment, Coherent assessment and Follow-up. According to medical records the nurses and physicians knew that patients with dementia were dying, but the position on palliative care was not always decided. Nurses and physicians knew that patients with dementia were dying but they did not take a stand that the patient needed palliative care.  Mainly physical symptoms were documented and to a lesser degree psychological, social or existential/spirituality needs. Discussion: It was difficult to form a true picture of patients’ situation from out the documentation. Partly because all caring actions were not documented and the review guide was limited as all parts provided to give a holistic care was not represented. That relative had been provided information that the patient was palliative was accurately documented. Conclusion: The holistic care that patients with dementia need in a palliative phase is not elucidated in the documentation in nursing homes in spite of nurses and physicians knowledge of that the patient are dying.

Urinary tract infection (UTI) is a common bacterial infection in women of all ages but the incidence and prevalence increase with age. Despite the high incidence of UTI, little is known about its impact on morale or subjective wellbeing and daily life in old women. UTI in older people can be a complex problem in terms of approach to diagnosis, treatment and prevention because in these patients it frequently presents with a range of atypical symptoms such as delirium, gastrointestinal signs and falls. Even if UTI has been shown to be associated with delirium it has frequently been questioned whether UTI can cause delirium or if it is only accidentally detected when people with delirium are assessed. The main purpose of this thesis was to describe the prevalence of UTI, to identify factors associated with UTI among very old women and to illuminate the impact of a UTI on old women’s health and wellbeing.  This thesis is based on two main studies, the GErontological Regional DAtabase (GERDA) a cross-sectional, population-based study carried out in the northern parts of Sweden and Finland during 2005-2007 and a qualitative interview study in western Sweden 2008-2009. Data were collected from structured interviews and assessments made during home visits, from medical records, care givers and relatives. UTI was diagnosed if the person had a documented symptomatic UTI, with either short- or long-term ongoing treatment with antibiotics, or symptoms and laboratory tests judged to indicate the presence of UTI by the responsible physician or the assessor. One hundred and seventeen out of 395 women (29.6%) were diagnosed as having suffered from at least one UTI during the preceding year and 233 of these 395 (60%) had had at least one diagnosed UTI during the preceding 5 years. These old women with UTI were more dependent in their activities of daily living, and had poorer cognition and nutrition. In these women, UTI during the preceding year was associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia. Eighty-seven of 504 women (17.3%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half (44.8%) were diagnosed as delirious or having had episodes of delirium during the past month. In all, 137 of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed as having a UTI. Delirium was associated with Alzheimer’s disease, multi-infarct dementia, depression, heart failure and UTI. Forty-six out of 319 women (14.4%) were diagnosed as having had a UTI with or without ongoing treatment and these had a significantly lower score on the Philadelphia Geriatric Center Morale Scale (PGCMS), (10.4 vs 11.9, p=0.003) than those without UTI, indicating a significant impact on morale or subjective wellbeing among very old women. The medical diagnoses significantly and independently associated with low morale were depression, UTI and constipation. The experience of suffering from repeated UTI was described in interviews conducted with 20 old women. The interviews were analysed using qualitative content analysis. The participants described living with repeated UTI as being in a state of manageable suffering and being dependent on alleviation. Being in a state of manageable suffering was described in terms of experiencing physical and psychological inconveniences, struggling to deal with the illness and being restricted regarding daily life. Being dependent on alleviation was illustrated in terms of having access to relief but also experiencing receiving inadequate care. In conclusion, UTI is very common among old and very old women and is a serious health problem. UTI seems to be associated with delirium and to have a significant impact on the morale or subjective wellbeing of old women and those affected suffer both physically and psychologically and their social life is limited. UTI was also associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia which might raise the suspicion that UTI can have serious medical effects on health in old women. / Embargo t o m 2011-11-11

No description available.

Patients with Alzheimer's disease (AD) often have a family history of the disease, implicating genetics as a major risk factor. Three genes are currently known to cause familial early-onset AD (<65 years): the amyloid precursor protein (APP) and the presenilins (PSEN1 and PSEN2). For the much more common late-onset disease (>65 years), only the APOE gene has repeatedly been associated to AD, where the ε4 allele increases disease risk and decreases age at onset. As APOE ε4 only explains part of the total estimated disease risk, more genes are expected to contribute to AD. This thesis has focused on the study of genetic risk factors involved in AD. In the first study, we conducted a linkage analysis of six chromosomes previously implicated in AD in a collection of affected relative pairs from Sweden, the UK and the USA. An earlier described linkage peak on chromosome 10q21 could not be replicated in the current sample, while significant linkage was demonstrated to chromosome 19q13 where the APOE gene is located. The linkage to 19q13 was further analyzed in the second study, demonstrating no significant evidence of genes other than APOE contributing to this peak. In the third study, the prevalence of APP duplications, a recently reported cause of early-onset AD, was investigated. No APP duplications were identified in 141 Swedish and Finnish early-onset AD patients, implying that this is not a common disease mechanism in the Scandinavian population. In the fourth study, genes with altered mRNA levels in the brain of a transgenic AD mouse model (tgAPP-ArcSwe) were identified using microarray analysis. Differentially expressed genes were further analyzed in AD brain. Two genes from the Wnt signaling pathway, TCF7L2 and MYC, had significantly increased mRNA levels in both transgenic mice and in AD brains, implicating cell differentiation and possibly neurogenesis in AD.

It is suggested that Alzheimer’s disease (AD) is caused by an imbalance between production, degradation and clearance of the amyloid-β (Aβ) protein. This imbalance leads to aggregation of Aβ and tau proteins and neurodegeneration in the brain. Today there is increasing evidence that the balance between the protease cathepsin B and the protease inhibitor cystatin C affects the tendency for Aβ to aggregate. The primary aim of this thesis was to investigate Aβ, cystatin C and cathepsin B levels in blood and cerebro-spinal fluid (CSF) in relation to the risk of AD. Studies I & II were based on the re-examinations of participants, at ages 70 and 77, in the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based prospective study initiated in 1970 (participants then being 50 years of age). In ULSAM, low plasma Aβ1-40 (Study I) and low serum cystatin C levels (Study II) were associated with a higher risk of AD. Studies III & IV were based on a cross-sectional sample of people with AD, mild cognitive impairment and healthy controls, recruited at three Swedish Memory Disorder units: Uppsala University Hospital, Uppsala, Skåne University Hospital, Malmö, and Karolinska University Hospital, Huddinge, Stockholm. In Study III, CSF cystatin C levels were positively correlated with both Aβ1-42 and tau levels. In Study IV, individuals with AD had higher mean plasma cathepsin B levels than healthy controls. In conclusion, low plasma Aβ1-40 and low serum cystatin C levels may precede clinically manifest AD in elderly men, cystatin C levels are positively correlated with Aβ1-42 and tau levels in CSF, and mean plasma cathepsin B levels are higher in people with AD compared to healthy controls. In addition to Aβ1-42 and tau levels in CSF, Aβ1-40, cystatin C and cathepsin B levels in blood may reflect the risk of AD.