Alors que les personnes âgées de 80 ans et plus (oldest old dans la littérature anglophone) constituent un segment de la population de plus en plus important dans le monde et que l’âge est le principal facteur de risque de démence, peu d’études se sont intéressées à la cognition et à la démence dans cette population. Le premier objectif de cette thèse a été de synthétiser les données épidémiologiques et neuropsychologiques relatives aux oldest old dans le cadre du vieillissement normal et de la démence. Le manque de connaissances, d’outils et de normes adaptées pour les oldest old font de l’évaluation neuropsychologique un véritable challenge. Ainsi, dans un deuxième travail, nous avons développé des normes pour sept tests neuropsychologiques communément utilisés en clinique, administrés auprès d’une population de sujets très âgés. Néanmoins, les outils habituellement utilisés présentent des contraintes pour les très âgés qui peuvent remettre en cause leur fiabilité. Le Test des Neuf Images du 93 (TNI-93) - test évaluant la mémoire épisodique initialement développé pour les sujets de bas niveau d’étude - comporte de nombreux avantages eu égard aux spécificités cliniques des oldest old. Dans un troisième travail, nous avons cherché à étudier l’utilité du TNI-93 chez les oldest old en établissant des normes puis en étudiant ses propriétés de détection de la démence dans cette population. L’ensemble de ces travaux pourrait contribuer à améliorer la prise de décision diagnostique dans cette population, même s’il convient de souligner l’importance de promouvoir la recherche dans ce domaine pour comprendre les enjeux cliniques et neuropsychologiques du très grand âge. / While persons aged 80 years and over, the so-called “oldest old”, constitute the fastest growing segment of the population worldwide and age is the major risk factor for developing dementia, only few studies have addressed cognition and dementia in this population. The first objective of this thesis was to review the epidemiological and neuropsychological data relating to oldest old in the context of normal aging and dementia. The lack of knowledge, tools and normative data for oldest old make neuropsychological assessment a real challenge for clinicians. For this reason, the second step consisted in computing normative data for seven neuropsychological tests commonly used in clinical practice collected in an oldest old population. Likewise, the tools generally used in older adults testing involve constraints that question the reliability of the measurement. The “Test des Neuf Images of the 93” (TNI-93), (meaning Nine Images test of the district of Seine-Saint-Denis in the suburb of Paris) - test evaluating episodic memory initially developed for low-educational level subjects - could deal with the testing difficulties due to clinical specificities of oldest old. Thus, in a third work, we assessed the relevance of TNI-93 in oldest old by providing normative data, and also by studying its dementia detection properties in this specific population. Taken together, these works may contribute to improve decision-making diagnosis in oldest old population even though it is necessary to underline the importance of promoting research in this domain to deal with the clinical and neuropsychological challenges of the very old age.

The fast growth of the Chinese oldest old population indicates higher demand for long-term care. In China, families assume the primary responsibility of caring for older adults. Since the oldest elders are more likely to be widowed, their adult children usually become their caregivers. Focusing on the Chinese adult children who provide care for their oldest-old parents, this study documented and helped to explain Chinese adult children's caregiving strain. A conceptual framework was developed based on Pearlin's stress process theory, Higgins' framework of self-concept discrepancy, and previous studies on family caregivers of elders. Using an existing dataset from the 2005 Chinese Longitudinal Healthy Longevity Survey of 895 caregivers and their care recipients, the researcher tested whether and how caregiving context (caregiver's structured context and care recipients' needs for care), caregiving performance, and sibling support were related to five types of caregiving strain including sacrifice strain, exhaustion strain, capability strain, expectation strain, and dependency strain. The results indicate that caregiving context and caregiving performance are statistically related to different types of caregiver strain. Three independent variables in the set of caregiving context, self-evaluation of living standard, education, and cultural identity, were related to two types of caregiver strain in different directions. The caregivers who were the eldest sons, who were females caring for female elders, who had a close relationship with their care recipients, who lived with the care recipients, who provided care for the elders with more needs for care in ADL (Activities of Daily Living), or whose care recipients had health insurance reported higher levels of at least one type of caregiver strain. Care recipients' cognitive status and entitlement to pension were negatively related to at least one type of caregiver strain. Caregivers' rural residence, having a job outside the family, having a child under age 16, and care recipient's needs for care in IADL (Instrumental Activities of Daily Living) were not found to be related to any type of caregiver strain. Monetary assistance, which was indicated by the proportion of their annual household per capita income that the caregivers provided to care recipients, was found to be positively related to caregivers' capability strain. The amount of time spent in caregiving (time assistance) was positively related to three types of caregiver strain: exhaustion, expectation, and dependency strain. Time assistance was also found to mediate the relationship between care recipients' needs for care in ADL and caregivers' exhaustion strain and the relationship between dependency strain and three caregiving context variables: closeness between caregivers and care recipients, co-residence with care recipients, and care recipients' needs for care in ADL. The results revealed the importance of caregiving context and caregiving performance in explaining Chinese adult-child caregivers' experience and the necessity of investigating caregiver strain in different dimensions. This study contributes to understanding caregiver strain from a filial perspective. The results imply directions for future research, social work practice and education, and policy legislation in addressing Chinese adult children's strain in caring for their oldest-old parents.

Introduction Approximately 1-2% of the adult population in developed countries suffer from heart failure (HF), with the prevalence rising to more than 10% among patients 80 years of age or older. The HF syndrome is associated with elevated mortality and morbidity, and decreased quality of life. Cognitive dysfunction has been reported in patients suffering from a variety of cardiovascular disorders. However, few studies have systematically assessed cognitive performance in HF patients, its prevalence and other factors influencing cognition in HF patients. Further, it is of great interest to understand the relationship between self-care in HF and cognition. It may be important to screen for cognitive dysfunction as it may influence HF patients’ ability to perform self-care, e.g. make lifestyle changes, adhere to medical treatment and monitor, evaluate and treat symptoms of deterioration. Aim The overall aim of this thesis was to explore cognitive function in elderly patients with chronic heart failure with focus on prevalence, risk factors, sleep and self-care. Design and method This thesis is based on four quantitative studies. The data from study I and II were collected in a prospective longitudinal design, including Swedish same-sex twin pairs born in 1913 or earlier in Sweden. The study was conducted 1991-2002 and a total of 702 individuals aged 80 and older were included. Study III and IV had a cross- sectional design and included stable HF patients, median 72 years of age, living in the community in the south of Sweden. Data were collected between 2009 and 2012. Study III included a total of 137 patients and Study IV included 142 patients. Results Study I found that  octogenarians with HF had significantly poorer spatial performance and episodic memory, and that the episodic memory declined more over time compared to a non-HF population of the same ages. Study II showed that octogenarians with HF had a significantly higher prevalence of vascular dementia, 16% vs. 6%, and all types of dementia, 40% vs. 30%, than those not diagnosed with HF. Factors related to dementia in individuals with HF were depression, hypertension and increased levels of homocysteine. Diabetes was associated with an increased risk for vascular dementia. In study III we found that  HF patients with sleep disordered breathing (SDB) (apnoea-hypopnoea index >15) had significantly higher saturation time < 90%, more difficulties maintaining sleep and lower levels of daytime sleepiness compared to those in the non-SDB group. Cognitive function did not differ between the SDB and the non-SDB-group. Only insomnia was associated with a decreased global cognititive function measured with the Mini Mental State Examination instrument. Finally, in study IV, the relationship between self-care and different dimensions of cognitive function was explored. Psycho- and visuomotor function (speed and attention) was the only dimension of cognitive function associated with self-care. Conclusion Octogenarians suffering from HF have a decreased performance in spatial and episodic memory and they also have a higher risk for developing dementia. Cognitive dysfunction as well as higher prevalence of dementia can contribute to decreased adherence to prescribed therapy and self-care management, and lead to other socio-behavioural problems.   Self-care was found to be associated with psychomotor speed. This may influence sustained attention negatively and the ability to carry out more than one task at the same time. This may lead to decreased attention for receiving and understanding information on self-care. / Thesis

No description available.

yes / Links between social relationships and emotional well-being in old age are well documented, but little is known about daily life fluctuations in momentary affective experiences of the oldest-old while interacting with specific social partners. We examined associations between the presence of different types of social partners and moment-to-moment fluctuations in affect in the oldest-old, taking into account individual differences in gender, neuroticism, depressive symptoms, chronic health conditions, and loneliness. Participants (N = 74, M age = 88.7 years, range = 84–102 years, 68% women) provided self-reports concurrently on the presence of social partners and subjective affective states 6 times a day for each of 7 consecutive days (3,071 occasions, in total). Relative to being with other people, time spent alone was associated with lower positive affect in the oldest-old. Being with other family members and friends was associated with more positive affective experiences. Compared with men, women reported more negative affective experiences when they were with their spouses than when their spouses were not present. Individuals with more chronic health problems reported more negative affective experiences when they were with their spouses than not. Participants higher in neuroticism reported more positive affective experiences when they were with their friends, compared with times when their friends were not present. Finally, lonelier individuals reported more positive affective experiences when they were with their spouses than when they were not. These findings suggest that affective experience is a function of individual differences and the type of social partners oldest-old adults interact with in everyday life. We discuss how our findings can be generalized to oldest-olds of different marital statuses, taking into account the proportion of widows in our sample as well as measurement specifics.

This thesis investigates gender differences in health and how they have changed between 1992 and 2002 among very old people. It explores gender differences in the association between disability and health, and gender differences in care utilization among our oldest old people. The studies are based on nationally representative data of the population in Sweden aged 77 and older (SWEOLD).  Results from Study I showed that women generally had more health problems than men. Analyses of change between 1992 and 2002 showed increased prevalence rates for both sexes, especially women. However, women’s reporting of poor global self-rated health did not increase. There were no gender differences and there was no change over time in activities of daily living (ADL). Several health indicators seem to be developing differently for women and men.  Study II showed that associations between ADL disability and other health indicators changed between 1992 and 2002, with several health problems and functional limitations becoming less disabling over time. This trend was especially true for women, while for men, the findings were mixed.  Study III found no gender differences in physician visits and dental visits, despite women’s worse health and dental status. Marriage was associated with more physician visits for men and dentist visits for women. Results imply that women and unmarried older adults may have unmet health-care needs.  Study IV examined whether the increase in life expectancy at age 65 observed between 1992 and 2002 consisted of years with or without musculoskeletal pain. Results showed that total years without pain decreased for both women and men, but more so for women. Women also had more years with pain added to life.  The results of this thesis suggest an increase of health problems, but not disability, in the oldest Swedish population. However, gender variations in the findings highlight the importance of analyzing health trends separately for women and men. / At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: In press. Paper 3: Manuscript. Paper 4: Submitted.

With the onset of the coronavirus pandemic in 2020 in Germany, the population faced a mentally challenging time. Governmental measures like social distancing measures, lockdowns and quarantines were implemented to reduce the spread of the coronavirus and save as many lives as possible. People of old age were soon identified as high risk group for a lethal course of disease and as in particular need of protection. Mental health professionals feared an aggravation of mental distress and mental pathology. Against this background, this dissertation aimed to investigate mental coping and the progression of mental health outcomes in old and oldest-old risk groups over the course of the COVID-19 pandemic, as well as associated sociodemographic and psychosocial factors associated with it. In our first study, we investigated the perceived stress coping competence (self-efficient coping vs. helplessness-associated coping) as well as perceived worries about and perceived threat by the COVID-10 pandemic and associated sociodemographic and psychosocial factors in the oldest-old population in Germany in the early phase of the pandemic. Linear multivariate regression models revealed that in our sample of n=197 people aged 78 to 100 years old higher levels of resilience were linked to higher perceived self-efficient coping. Male gender compared to the female gender, and a medium educational level in reference to a low educational level, was associated with less helplessness-associated coping. Loneliness showed associations with both, self-efficient and helplessness-associated coping. Higher levels of anxiety and depressive symptoms were linked to higher scores of helplessness-associated coping. Regarding perceived worries about the pandemic, binary logistic regression models showed that male gender and higher perceived social support were linked to more worries about the pandemic. Despite the higher risk for a severe course of disease for people of old age, older age was associated with less perceived personal threat by the coronavirus. Furthermore, more reported depressive symptoms were linked to less perceived threat, and higher reported somatization symptoms were associated with higher personal threat by the virus. Therefore, mental health factors seem to shape the way oldest-old individuals perceive the COVID-19 pandemic in partly unexpected ways, and resilience may illustrate an important factor when targeting more functional ways of coping with stress. Moreover, people of oldest-old age experiencing greater loneliness, high depressive and anxiety symptoms could be supported by adapting their coping skill repertoire to foster the feeling of self-efficiency when coping with stress. In our second and third study, we analyzed the development and progression of mental health factors like depressive, anxiety and somatization symptoms. First, in study 2 with n=156 people of oldest-old age (range= 78 to 97 years) Wilcoxon t-tests showed an increase of anxiety, depressive and somatization symptoms from 2021 to 2021 with generalized regression models revealing that higher levels of symptomatology in 2020 were associated with higher symptom burden in 2021. Higher perceived social support in 2020 was linked to less depressive symptoms in 2021. Building on this findings, we then conducted multilevel mixed-effects generalized linear models to analyzed data over three points of measurement from 2020, 2021 and end of 2021/beginning of 2022 with n=135 participants (age range= 78 to 97 years). Results showed that after a first increase of depressive and anxiety symptoms from 2020 to 2021, symptomatology levels stayed relatively stable from 2021 to 2021/2022. Moreover, older age and higher reported worries were associated with higher levels of anxiety symptoms. Greater perceived social support was linked to less anxiety and depressive symptoms over time. Resilience was associated with less depressive symptoms. Since pre-existing heart conditions illustrated an additional risk factor, next to an older age (60+ years), for a serious and lethal course of coronavirus disease, the fourth study additionally focused on an old age sample with cardiovascular risk profiles. The aim was a comparison of this cardiovascular risk group with the general old age population in terms of symptomatology levels and psychosocial factors associated with it. We analyzed data of n=1236 participants with n=618 showing a cardiovascular risk profile, drawn from the AgeWell.de study, and n=618 from a representative survey of the old age general population with an age range of 64 to 81 years in the beginning of the COVID-19 pandemic. Results showed that the cardiovascular risk group showed higher depressive symptom levels compared to the general population. Multivariate regression models revealed that in the cardiovascular risk group higher perceived social support was linked to less depressive and anxiety symptoms. In the general old age population perceived social support was associated with depressive symptoms, social support and anxiety symptoms showed no such association. Higher perceived worries were associated with higher reported anxiety symptoms in the general population only. Perceived resilience was linked to less depressive and anxiety symptoms in both groups. In conclusion, the oldest-old individuals showed an overall good mental health in the long term despite a first increase in anxiety and depressive symptomatology within the first year. Fostering perceived social support and perceived resilience may play an important role in preventing and reducing depressive symptomatology in times of crises like the pandemic.:Table of Contents I 1. Introduction 1.1. The Severe Acute Respiratory Syndrome Coronavirus 2: the Disease and the Pandemic 1.2. Mental Health during the Pandemic in the General Adult Population 1.3. Mental Health in Old Age – with a Focus on Depression and Anxiety 1.3.1. Epidemiology 1.3.2. Etiology 1.4. Social Support as a Protective Factor? The Role of Social Goals over the Lifespan 1.5. Aims of the Dissertation 2. Empirical Investigations in the Old Age Population during the COVID-19 Pandemic 2.1. The Perception of Coping with Stress in the Oldest-old Population 2.2. The Development of Mental Health Factors and the Role of Social Support in the Oldest-old Population 2.3. The Development of Depressive and Anxiety Symptoms during the COVID-19 Pandemic and the Role of Psychosocial Factors in the Oldest-old Population 2.4. Depressive and Anxiety Symptoms in an Old Age Cardiovascular Risk Group Compared to the Old Age General Population 3. General Discussion 3.1. Implications for Prospective Research and Impulses for Public Mental Health Strategies 4. Conclusion Summary References Appendix List of Tables and Figures II

Background The prevalence and incidence of stroke are known to increase with age, which, combined with demographic change, means that very old patients with stroke are a growing patient group. Risk factors for incident stroke among very old people have not been widely investigated. The impact of depression on mortality in very old people who have had a stroke also remains unclear.  The aim of this thesis was to investigate the risk factors for incident stroke, the epidemiology of stroke and depression, and the consequences of having had a stroke regarding the risk of depression and mortality among very old people. Methods A randomly selected half of 85-, all 90-, and all ≥95-year-olds in certain municipalities in Västerbotten County, Sweden, and Pohjanmaa County, Finland were targeted in a population-based cohort study from 2000-2012. The 65-, 70-, 75-, and 80-year-olds in all the rural and random samples from the urban municipalities in the same counties were furthermore targeted in a survey in 2010. In the cohort study patients were assessed in their homes, by means of the 15-item Geriatric Depression Scale (GDS-15) and other assessment scales, as well as blood pressure measurements, several physical tests, and a review of medical diagnoses appearing in the medical charts. Incident stroke data were collected from medical charts guided by hospital registry records, cause of death records, and reassessments after 5 years. Depression was defined as a GDS-15 score ≥5. A clinical definition of all depressive disorders, based on assessment scale scores and review of medical charts was also used. A specialist in geriatric medicine evaluated the diagnoses. The survey included yes/no questions about stroke and depression status, and the 4-item Geriatric Depression Scale. Associations with mortality and incident stroke were tested using Cox proportional-hazard models.  Results In the ≥85-year-olds examined in 2005-2007 (n=601), the stroke prevalence was 21.5%, the prevalence of all depressive disorders was 37.8% and stroke was independently associated with depressive disorders (odds ratio 1.644, p=0.038). The prevalence of depression according to GDS-15 scores was 43.2% in people with stroke compared with 25.0% in people without stroke (p=0.001). However, in ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, depression was not independently associated with incident stroke.  In ≥65-year-olds who responded to a survey in 2010 (n=6098), the stroke prevalence rose with age from 4.7% among the 65- to 11.6% among the 80-year-olds (p<0.001). The prevalence of depression rose from 11.0% among the 65- to 18.1% among the 80-year-olds (p<0.001). In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year, while in the non-stroke group, depression was independently associated with several additional demographic, social and health factors. In ≥85-year-olds examined in 2005-2007 with valid GDS-15 tests (n=452), having had a stroke was associated with increased 5-year mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.15-2.03]. Having had a stroke and depression was associated with increased 5-year mortality compared with having only stroke (HR 1.90, 95% CI 1.15-3.13), having only depression (HR 1.59, 95% CI 1.03-2.45), and compared with having neither stroke nor depression (HR 2.50, 95% CI 1.69-3.69). Having only stroke without a depression did not increase mortality compared with having neither stroke nor depression. In ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, the stroke incidence was 33.8/1000 person-years during a mean follow-up period of about three years. In a comprehensive multivariate model, atrial fibrillation (HR 1.85, 95% CI 1.07–3.19) and higher systolic blood pressure (SBP; HR 1.19, 95% CI 1.08–1.30 per 10-mmHg increase) were associated with incident stroke overall. In additional multivariate models, diastolic blood pressure (DBP) ≥90 mmHg (HR 2.45, 95% CI 1.47–4.08) and SBP ≥160 mmHg (v. <140 mmHg; HR 2.80, 95% CI 1.53–5.14) were associated with incident stroke. Conclusion The prevalence of both stroke and depression increased with age, and rates were especially high among very old people. Having had a stroke was independently associated with a higher prevalence of depression among very old people, however, depression was not independently associated with a higher incidence of stroke. Having had a stroke was associated with increased all-cause mortality among very old people, but only among those who were also depressed. High SBP (≥160 mmHg), DBP (≥90 mmHg) and atrial fibrillation were the only consistent independent risk factors for incident stroke among very old people. / I västvärlden inklusive Sverige så ökar gruppen av människor som uppnår åldern 80 år eller äldre. Människorna som uppnår denna mycket höga ålder har en hög förekomst av kardiovaskulära riskfaktorer, har ofta flera samtidiga sjukdomar och ofta funktionsnedsättningar. Medicinska behandlingsåtgärder är ofta mindre effektiva och förknippade med biverkningar i åldersgruppen. Stroke är en sjukdom som beror på skada av hjärnvävnad till följd av minskad blodtillhörsel till delar av hjärnan. Det är känt att såväl förekomsten av och insjuknandet i stroke ökar med stigande ålder. Den som drabbas av stroke löper risk att få en bestående funktionsnedsättning och att dö i förtid. En vanlig komplikation efter att ha drabbats av stroke är nedstämdhet eller depression. Vetenskapliga studier om stroke har tidigare negligerat mycket gamla människor, vilket i takt med den pågående demografiska utvecklingen framstått som allt mer orimligt. Det är ej helt klarlagt vilka riskfaktorer som leder till att insjukna med stroke i mycket hög ålder. Överdödligheten förknippad med att drabbas av depression efter stroke är också oklar i åldersgruppen. Det är också oklart vad som skiljer depression efter stroke från depression bland den övriga befolkningen av åldrade människor. Den populations-baserade kohortstudien GErontologisk Regional DAtabas (GERDA) inleddes år 2000 för att kartlägga faktorer förknippade med gott åldrande bland mycket gamla människor. Hälften av 85-åringarna, alla 90-åringar och alla ≥95-åringar i utvalda kommuner i Västerbotten erbjöds att delta i studien. Därefter har återbesök hos tidigare deltagare i sina nya åldersgrupper och rekrytering av nya deltagare genomförts vart femte år. Studien utvidgades med utvalda kommuner i Österbotten, Finland vid den första femårsuppföljningen. Datainsamlingen i studien bestod av demografiska frågor, skattningsskalor, blodtrycksmätning och kognitiva test genomförda vid ett hembesök i deltagarens hem, samt genomgång av journalhandlingar. År 2010 skickades även en enkät ut till 65-, 70-, 75- och 80-åringar i alla kommuner i Västerbotten och Österbotten. Enkäten innehöll frågor om demografi, hälsa, sjukdomar och intressen. Bland deltagarna i kohortstudien bestämdes förekomsten av tidigare stroke baserat på genomgång av journaluppgifter och uppgifter från hembesöken. Förekomsten av depression bestämdes baserat på poängsättning från en validerad skattningsskala för depression, samt baserat på en sammanvägning av journaluppgifter och skattningsskalor. En specialist i geriatrik fattade det slutliga beslutet om diagnoser. Insjuknande i stroke bestämdes baserat på journalgenomgång av individer med stroke-relaterade diagnoskoder i sjukhusregistret, i dödsorsaksregistret eller uppgift om stroke vid femårsuppföljningen i studien. Bland deltagarna i enkätstudien bestämdes förekomsten av tidigare stroke baserat på självrapportering, och förekomsten av depression bestämdes baserat på en sammanvägning av självrapportering och en skattningsskala för depression.  Förekomsten av stroke i enkätstudien steg med ålder, från 4.7% bland 65-åringar till 11.6% bland 80-åringar. Förekomsten av stroke var omkring 20% bland ≥85-åringar, med minimal variation mellan 85-, 90- och ≥95-åringar. Förekomsten av depression var högre bland dem med stroke jämfört med de övriga deltagarna, både gällande den sammavägda diagnosen och baserat endast på poängsättning. Stroke och sömnproblem var oberoende associerade med depression. Bland ≥65-åringar i enkätstudien var funktionsnedsättning och genomgången livskris associerade med depression hos dem med en tidigare stroke. Bland deltagare utan stroke var ett antal ytterligare externa faktorer, inklusive subjektiv upplevelse av dålig ekonomi och att inte ha någon att anförtro sig till, associerade med depression. Både stroke och depression var associerade med ökad dödlighet bland ≥85-åringar. De med stroke utan depression hade en dödlighet i linje med normalbefolkningen utan stroke eller depression. Förekomsten av samtidig stroke och depression var associerad med högre dödlighet än normalbefolkningen, jämfört med dem med enbart stroke eller enbart depression. Högt systoliskt blodtryck (≥160 mmHg), högt diastoliskt blodtryck (≥90 mmHg) och förmaksflimmer var oberoende riskfaktorer för att insjukna i stroke bland ≥85-åringarna. Sambandet mellan blodtryck och strokerisk försvagades ej hos människor med kognitiv eller funktionell nedsättning. Tidigare stroke, hjärtsvikt, kognitiv nedsättning, näringsbrist, depressiva symtom och låg gånghastighet var också associerade med att insjukna i stroke, men ej oberoende av varandra. Sammanfattningsvis så stiger förekomsten av stroke med åldern och är särskilt hög bland mycket gamla människor. Depression är betydligt vanligare hos mycket gamla människor med stroke, även justerat för störningsfaktorer. Depression är främst associerat med funktions-nedsättning hos människor med stroke, men med ett större antal externa faktorer hos människor utan stroke. Mycket gamla människor med stroke har särskilt hög dödlighet om de samtidigt är deprimerade, men en dödlighet i linje med normalbefolkningen om de inte är deprimerade. Högt systoliskt och diastoliskt blodtryck samt förmaksflimmer är viktiga och behandlingsbara orsaker till att drabbas av stroke i mycket hög ålder.

<p>This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).</p><p>Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.</p><p>Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.</p><p>Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.</p><p>The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.</p>

This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+). Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up. Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults. Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment. The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.