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The overall aim of this thesis was to provide better understanding of the underlying factors related to health maintenance in very old people, with a focus on medical conditions, functional outcome and nutritional status. Data were gathered from the ELSA 85 project (Elderly in Linköping Screening Assessment). The ELSA 85 project was started in 2007 with a population-based survey of 85-year-old individuals (n = 650) residing in Linköping municipality, Sweden. During the study period from 2007 to 2010, we conducted surveys by postal questionnaire, home visits, geriatric clinic visits, and reviews of electronic medical records as well as the database of health service consumption. A series of cross-sectional analyses were performed on multimorbidity, health service consumption, activities of daily living (ADLs), physical functioning and nutritional status. Of 650 eligible individuals, 496 (78% of those alive) completed the questionnaire (Paper I). Despite the prevalence of multimorbidity (68%) and frequent use of assistive technology for mobility (40%), the majority managed self-care (85%), usual activities (74%) and had high self-rated health (>60/100, visual analogue scale). Factors associated with in-patient care were an increased number of general practitioner visits, more use of assistive technology, community assistance, multimorbidity (≥2 chronic diseases) and/or heart failure and arrhythmia. Cluster analyses (n = 496, Paper II) revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic–mental (only for men), mental disease (only for women), and three other clusters related to ageing (one for men and two for women). Heart failure in men (odds ratio [OR], 2.4; 95% confidence interval [CI], 1–5.7) and women (OR, 3; 95% CI, 1.3–6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency room visits. Men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.7) and women’s cardiopulmonary cluster (OR, 1.7; 95% CI, 1.2–2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.4) and one of the women’s ageing clusters (OR, 0.5; 95% CI, 0.3–0.8) showed interaction effects on hospitalization. In Paper III, overweight (body mass index [BMI], 25–29.9 kg/m2) and obese (BMI, ≥30 kg/m2) individuals (n = 333) perceived more difficulty performing instrumental ADL (IADL) and had more comorbidities than their normal weight counterparts (BMI, 18.5–24.9 kg/m2). After controlling for socio-demographic factors, obese but not overweight individuals were more likely to perceive increased difficulty in performing outdoor activities (OR, 2.1; 95% CI, 1.1–4) and cleaning (OR, 2.2; 95% CI, 1.2–4.2) than their normal weight counterparts. Although obesity was also associated with multimorbidity (OR, 3; 95% CI, 1.2–8), the health service cost of each case of multimorbidity (n = 251) was highest in individuals of normal weight and nearly three times as much as in obese individuals (ratio, 2.9; 95% CI, 1.1–8.1). In Paper IV, 88-year-old obese women (n = 83) had greater absolute waist circumference, fat mass (FM) and fat-free mass (FFM), and lower handgrip strength (HS) corrected for FFM and HS-based ratios (HS/weight (Wt), HS/BMI, HS/FFM and HS/FM) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, the HS-based ratios explained more variance in physical functioning in Short Form-36 (R2, 0.52–0.54) than other single anthropometric or body composition parameters (R2, 0.45–0.51). Waist circumference, HS, and two HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty. In conclusion, the ELSA 85 population showed a fairly positive image of healthy perception, good functional ability as well as low use of health care among the majority of participants. Patterns of cardiac and pulmonary conditions were better associated than any single morbidity with hospitalization. Heart failure as a single morbidity was better associated than multimorbidity patterns with emergency room visits. For 85-year-olds, being obese, as opposed to overweight, was associated with self-reported activity limitations and comorbidities. Overweight elderly living in their own homes in this population had similar well-being to those of normal weight. In the cohort of 88-year-olds, obese women had high waist circumference, but their HS was relatively low in relation to their Wt and FFM. These parameters were better than BMI for predicting physical function and independent daily living. / Att åldras innebär inte bara en utveckling över tid utan också en förändring av människans fysiologi och funktion. Vi har många olika bilder av åldrandet. Ofta överväger de negativa bilderna som betonar sjuklighet och höga samhällskostnader för vård och omsorg. ELSA 85, en förkortning av the Elderly in Linköping Screening Assessment, påbörjades 2007 med avsikt att kartlägga 85-åringars hälsotillstånd och funktion. Syftet med denna avhandling var att fördjupa kunskapen om faktorer med betydelse för bevarande av hälsa hos dessa 85-åringar. Populationsstudien genomfördes via enkätutskick (bl.a. livssituation, livskvalitet), hembesök (bl.a. aktiviteter i dagliga livet (ADL), kognitiva funktioner) och mottagningsbesök (bl.a. nutritionsstatus, rörelseförmåga, kroppslig undersökning, blodprover, läkemedel) under perioden mars 2007 till mars 2008. Vi kartlade även deltagarnas sjukvårdsbesök samt sjukvårdskostnader. Tre år senare, när individerna var 88 år, analyserades även kroppssammansättningen hos delar av populationen. Totalt 496 Linköpingsbor födda 1922, deltog i studien. Andelen som svarade på enkäten var 78 % av alla då levande 85-åringar. Resultaten visar att majoriteten av 85-åringarna klarade att sköta sin hygien (85%) samt huvudsakliga aktiviteter (74%). Sextio procent skattade sin hälsorelaterade livskvalitet som hög trots förekomst av flera kroniska sjukdomar och frekvent användning av hjälpmedel för att förbättra rörligheten. Oberoende riskfaktorer för slutenvård var multipla besök hos distriktsläkare, användande av flera hjälpmedel, förekomst av minst två sjukdomar eller förekomst av hjärtsvikt och arytmi. Multimorbiditet (förekomst av minst två kroniska sjukdomar) var vanligt hos 85-åringarna (68%). Olika kombinationer av sjukdomar hade varierande betydelse för behovet av sjukvård. I clusteranalys, där man försöker gruppera diagnoser med hög sannolikhet att förekomma hos en enskild individ, fann vi några cluster som var starkare relaterade till inläggning i slutenvård än andra. Clustren såg dessutom olika ut mellan män och kvinnor. För män var t.ex. kardiella och för kvinnor t.ex. hjärt-lung-cluster starkare relaterade till slutenvård än enskilda diagnoser. Personer med fetma (body mass index (BMI) ≥30 kg/m2) hade mer problem med rörlighet och instrumentell ADL (IADL) jämfört med de med normal- eller övervikt. Trots ett klart samband mellan fetma och multimorbiditet hade de normalviktiga individerna nästan tre gånger så höga hälso-sjukvårds kostnader som personer med fetma. Bland 88-åriga kvinnor, hade personer med fetma högre bukomfång, mer fettmassa (FM) och mer fettfri massa (FFM) men lägre handstyrka (HS) än de normal- eller överviktiga. Relativ HS, handstyrka i form av kvoter (HS/Vikt, HS/BMI, HS/FFM and HS/FM) hade starkare samband med fysisk funktion (Short Form-36, SF-36PF) än andra enskilda parametrar. Två enskilda parametrar (bukomfång och HS) samt HS/Vikt och HS/FFM var associerade med antal aktiviteter utan svårighet i IADL. Sammanfattningsvis är 85-åringarna inte så skröpliga som de ofta beskrivs. Studien ELSA 85 visar en övervägande positiv bild med bevarad hälsa och funktion för en övervägande del av populationen. De flesta 85-åringarna klarar sig ganska bra trots förekomst av flera sjukdomar. Vissa mönster av multimorbiditet med hjärt- och lungsjukdomar är mer relaterade till slutenvård medan hjärtsvikt hade hög risk för akutmottagningsbesök. Därför är det viktigt att beakta en komplexitet av sjukdomar, inte bara enskilda diagnoser eller antalet diagnoser, i planeringen av den framtida vården. Personer med normal- eller övervikt klarar sin funktion bättre och lever mer självständigt än de som lider av fetma. Den betydande andelen feta med begränsad rörlighet och funktion bland äldre kan komma att påverka behovet av tyngre omsorgsinsatser för den gruppen och är således en varningssignal inför framtiden. / 【目的】      通过研究高龄老人的医疗情况，躯体功能和营养状态，提高对高龄老人健康维护相关因素的理解。 【方法】      ELSA 85 项目（林雪平老年人普查，Elderly in Linköping Screening Assessment）是一个以瑞典林雪平城市中85岁高龄老人（1922年出生， n = 650）为研究对象的人群研究。(1) 2007/03–2008/03：通过邮寄问卷，家庭访问及门诊检查的三个步骤， 我们搜集的数据包括：个人和家庭的背景信息（居住情况，既往的学历和工作程度，健康相关的生活质量EQ-5D等），身体机能（日常生活活动能力ADL评定，移动性测试等）和营养状态（人体测量等）。我们同时还阅览了所有注册的电子病历和每位老年人的年卫生费用。（2） 2010/06–2010/10: 在3年后的随访中，我们对所有88岁的女性老年人增加了人体组成测定和SF-36健康调查量表之生理功能子量表（SF-36PF）的评估。 ELSA 85 项目还包括了其他医学检查项目以及为期一年的随访（2008–2009）, 但这些数据统计并未列入本论文中。 【结果】      论文1：共496人（参与率78％）回寄并参与了问卷调查。总体而言，虽然慢性多病以及日常生活中频繁使用辅助身体移动的器具在85岁高龄老人中非常普遍，多数老年人仍然能够完成个人卫生自理和常规日常活动。他们在健康相关评价问卷中的评估自身健康状态多为良好 (EQ-5D评估）。与住院相关的风险因素包括：全科医生的年就诊次数，有共患疾病（存在两种或两种以上的慢性病征），或者是心力衰竭和心律失常两个单病种。 论文 2：运用聚类分析和性别分层对共患疾病归类，生成男女组各五个集群：血管性类疾病集群，心肺疾病集群，心源性疾病集群（只存于男性组内），躯体-精神心理疾病集群（只存于男性组内），精神心理性疾病集群（只存于女性组内），以及三个和老化过程有关的集群（男性组内1组，女性组内2组）。心力衰竭 （男性组内的比值比 OR = 2.4，95% 的可信区间CI = 1–5.7；女性组内 OR = 3，95% CI = 1.3–6.9) 作为单一病种在预测急诊就诊的模型中比任一共患疾病集群都能解释更多的变量值。男性组内的心源性疾病集群 （OR = 1.6，95% CI = 1–2.7） 和女性组内的心肺疾病集群（OR = 1.7，95% CI = 1.2–2.4）与预测是否住院显著有关。在住院模型中， 心肺疾病集群与男性的心源性疾病集群（OR = 1.6，95% CI = 1–2.4）， 或与女性组内的老化相关集群（OR = 0.5，95% CI = 0.3–0.8）具有显著的交互作用。 论文3：超重（体重指数 BMI：25–29.9 kg/m2）和肥胖（BMI ≥30 kg/m2）者在工具性日常生活活动评定（IADL）比正常体重者（BMI: 18.5–24.9 kg/m2）有更多的困难，再者也比正常体重者有更高伴发疾病的风险。但是在控制了混杂变量（社会人口因素）后，对照正常体重组，只有肥胖者而不是超重者的IADL（户外活动：OR= 2.1，95% CI=1.1–4；居室清洁：OR= 2.2，95% CI= 1.2–4.2）存在更大的困难。虽然肥胖与共患疾病相关（OR= 3，95% CI=1.2–8），有共患疾病的正常体重者的卫生服务消费却是共患疾病的肥胖者的近三倍（ratio= 2.9，95% CI= 1.1–8.1）。 论文 4：88岁女性肥胖组相比正常体重和超重组而言，其腰围值、脂肪群值和祛脂肪群值较大。肥胖者的绝对握力值在校正祛脂肪群后以及握力比值（握力/体重，握力/BMI，握力/祛脂肪群，等等）都较其他两组低。在控制个体的体力活动程度和慢性疾病数量后，握力比值对生理功能（SF-36PF）的解释度（R2：0.52–0.54）高于任何单一人体测量指标或人体组成成分的测定值（R2：0.45–0.51）。腰围值、绝对握力值及握力比值（握力/体重和握力/祛脂肪群）与IADL中无困难的活动项目数显著相关。 【结论】      ELSA 85 人群研究显示了一个相对健康的，个体功能良好的，且使用卫生服务较低的高龄老年群体。心源性和肺部疾病的共患与住院风险相关，而心力衰竭作为单一病种与急诊就诊有显著相关。对85岁高龄老人而言，肥胖（但不是超重）与个体的活动限制和伴发疾病有关。居住于自己住所内的超重高龄老人，其健康水平与正常体重者相近。在88岁女性高龄老人中，肥胖者有较大的腰围值和较低的握力比值（握力/体重和握力值/祛脂肪群）。这些指标比体重指数更好地反映了生理功能及高龄老人的日常独立生活能力。 / Elderly in Linköping Screening Assessment, ELSA 85

While most people with schizophrenia face the functional consequences of a lifelong disorder, very few studies have investigated the specific domain of daily living activities performance. The purpose of this thesis was to examine the relationships between daily activity performance, cognitive deficits, and community functioning in people with schizophrenia. More specifically, the objectives were: 1) to describe functional limitations during daily task performance, 2) to explore the existence of subgroups of participants with similar functional limitations profiles, 3) to explore the relationships between daily task performance and cognitive functions as well as 4) with community functioning. This thesis tested the hypothesis that limitations in task performance negatively influence community functioning. / A sample of 82 individuals with schizophrenia and 28 healthy controls participated in this study and were assessed during a meal preparation task with the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis and on cognitive tests of visuospatial memory, spatial working memory, visuomotor coordination, planning and selective attention. Community functioning was assessed with the Independent living Skills Survey and the Multnomah Community Ability Scale. Limitations in the Perceive, Recall and Plan quadrants of the PRPP System, were found in participants with schizophrenia when compared to a control group (n = 28), as well as in the complete sample (n = 82). Participants in the high-efficiency subgroup ( n =36) were more independent in daily living and performed better on the visuospatial associative learning task than the low-efficiency subgroup (n = 46). At the specific level of individual profiles, participants were distributed along a continuum of low- to high-functioning on the PRPP System factors and on functional, cognitive, and clinical characteristics. / The associative learning task was most associated with task performance, along with working memory and planning. Finally, less efficient planning skills were associated with a lower level of community functioning, confirming the hypothesis. These results emphasize the relationship of associative visual memory to daily task performance, as well as that of efficiency in daily activities for residential status. Integrating these findings into the rehabilitation process will contribute to better meeting the needs of people with schizophrenia.

Tyrimo tikslas - ištirti pacientų, patyrusių nudegimo traumas, slaugos problemas ir jų kaitą. Tyrimo uždaviniai: 1. Ištirti pacientų, patyrusių lengvas, vidutinio sunkumo ir sunkias nudegimo traumas, slaugos problemas ir jų kaitą. 2. Ištirti pacientų, patyrusių nudegimo traumas, slaugos problemų priklausomybę nuo traumos sunkumo. 3. Parengti praktines rekomendacijas. Tyrimo metodika. Tyrimas vyko 2006 birželio - 2007 vasario mėn. KMUK Plastinės rekonstrukcijos ir chirurgijos klinikoje. Buvo tiriamos trys respondentų grupės: lengvas, vidutines bei sunkias nudegimo traumas patyrę pacientai (n=107). Atsako dažnis - 85,7 proc. Tyrimui taikyta dviejų etapų anoniminė anketinė apklausa: respondentai buvo apklausiami po patirtos traumos praėjus 10 dienų ir 17 dienų. Išvados. Lengvas nudegimo traumas patyrę pacientai I ir II vertinimo metu pacientai labiausiai skundėsi skausmu ir nerimu prieš miegą, mitybos trūkumu ir skausmingu vaikščiojimu. Vertinant problemų kaitą nustatyta, kad I vertinimo metu šios grupės respondentai dažniau skund��si padažnėjusiu šlapinimusi, o II vertinimo - vidurių užkietėjimu. Pacientai, patyrę vidutinio sunkumo nudegimo traumas, I ir II vertinimo metu dažniausiai skundėsi skausmu bei nerimu prieš miegą, karščiavimu bei papildomo maisto trūkumu. I vertinimo metu šios grupės respondentai dažniau skundėsi karščiavimu, ribotomis galimybėmis pasikeisti baltinius ir judėti. Niežuliu didesnė respondentų dalis skundėsi antrojo vertinimo metu. Pacientai, patyrę... [toliau žr. visą tekstą] / Object of the research - to investigate the nursing problems and their alternation in patients with burns. Goals of the research: 1. To investigate the nursing problems and their alternation of patients with minor, moderate and major burns. 2. To investigate the dependency upon the degree of burn trauma and the nursing problems. 3. To prepare practical recommendations. Methods of the research. The research was carried on from July, 2006 to February, 2007 in the Clinic of Plastic Reconstruction and Surgery in Kaunas Medical University Hospital. 3 groups of patients with minor, moderate and major traumas participated in the research. There were 107 respondents. The research was carried on in two stages: the questioning after 10 and 17 days of burn trauma. The interview was anonymous with the response rate of 85,7 per. Conclusions. During the first and the second interviews the patients with minor burn trauma complained about pain and uneasiness before bedtime, lack of feeding, painful walking. Evaluating the alternation in nursing problems it was found out that the patients more often complained about rapid urination in the first part of questioning and about constipation in the second part. During the first and the second interviews the patients with moderate burn traumas complained about pain and uneasiness before bedtime, fever and lack of extra feeding. Evaluating a change of problems, it was found out that in the first part of questioning the patients more often complained... [to full text]

Alzheimer’s disease (AD) progressively impairs cognitive and functional abilities. Research on pharmacological treatment of AD is shifting to earlier forms of the disease, including preclinical stages. However, assessment methods traditionally used in clinical research may be inappropriate for these populations. The Alzheimer Disease Assessment Scale-cognitive (ADAS-cog), a commonly used cognitive battery in AD research, is most sensitive in the moderate range of cognitive impairment. It focuses on immediate recall and recognition aspects of memory rather than retention and delayed recall. As clinical trials for dementia continue to focus on prodromal stages of AD, instruments need to be retooled to focus on cognitive abilities more prone to change in the earliest stages of the disease. One such domain is delayed recall, which is differentially sensitive to decline in the earliest stages of AD. A supplemental delayed recall subtest for the ADAS-cog is commonly implemented, but we do not know precisely where along the spectrum of cognitive dysfunction this subtest yields incremental information beyond what is gained from the standard ADAS-cog. An item response theory (IRT) approach can analyze this in a psychometrically rigorous way. This study’s aims are twofold: (1) to examine where along the AD spectrum the delayed recall subtest yields optimal information about cognitive dysfunction, and (2) to determine if adding delayed recall to the ADAS-cog can improve prediction of functional outcomes, specifically patients’ ability to complete basic and instrumental activities of daily living. Results revealed differential functioning of ADAS-cog subtests across the dimension of cognitive impairment. The delayed recall subtest provided optimal information and increased the ADAS-cog’s measurement precision in the relatively mild range of cognitive dysfunction. Moreover, the addition of delayed recall to the ADAS- cog, consistent with my hypothesis, increased covariation with instrumental but not basic activities of daily living. These findings provide evidence that the delayed recall subtest slightly improves the ADAS-cog’s ability to capture information about cognitive impairment in the mild range of severity and thereby improves prediction of instrumental functional deficits.

Despite pharmacological advances, exercise remains a cost effective preventative for cardiovascular disease (CVD) by acutely and chronically lowering systolic blood pressure (SBP). Although numerous studies have investigated aerobic and resistance training’s role in eliciting an acute SBP response termed post-exercise hypotension (PEH), few researchers have investigated how performing both cardiovascular and weight training in a single session (concurrent training) or how different prescriptions for order of exercise modality will elicit this PEH response; no known studies have attempted altering the order of exercise types within each session. This study seeks to determine if the order of exercise type will affect a PEH response following concurrent exercise. Participants (n=13), considered low risk for cardiovascular disease participated in a control session, graded exercise test (GXT) and two concurrent sessions, with concurrent sessions counterbalanced for order of exercise mode. Recovery SBP was analyzed in the laboratory for sixty minutes and for twenty-four hours thereafter using an ambulatory blood pressure monitor. All exercise conditions elicited a depression in SBP; however, only the cardiovascular-weight training (CVWT) concurrent session elicited PEH (p = 0.05). However, there were no differences in SBP attenuation between conditions. There was no main effect for PEH between conditions during twenty-four hour assessment. With no statistically significant differences in the magnitude of PEH twenty-four hours after exercise, it may be determined that the order of exercise does not vi affect the preventative attributes of aerobic and resistance exercise in regards to acute SBP response. Furthermore, only exercise involving resistance training (CVWT) provoked PEH during the first 60 minutes; therefore it may be argued that individuals should pair cardiovascular exercise with weight training in order to elicit the greatest cardiovascular benefits. Future studies should consider evaluating the effect of time of day and PEH following concurrent exercise to determine if pairing exercise modalities will at different times will affect the blood pressure response.

An aging population is one common challenge faced by many developed countries including Australia. The Australian government has realised that the existing healthcare system must be improved to provide better support longer-term for the healthcare needs of this population. This research examines one such opportunity by suggesting a reform on how the care needs of residents living in Australian residential aged care facilities (RACF) are assessed. A recent study has shown that the current assessment system, known as the Residential Classification Scale (RCS), is subjected to high administrative procedural overhead costs and significant deviations in assessment results. This thesis documents a technical feasibility study of a novel method aimed to solve issues related to the time demands and subjectivity of the RCS through the design and implementation of a Wireless Sensor Network (WSN). This WSN is engineered to unobtrusively collect data from wireless sensor nodes either embedded in the RACF environment or attached to the resident??s body. The collected data can be potentially used to provide automatic and accurate care level assessments for the resident. The methodology of preparing and conducting the experiments to prove the hypotheses is justified and described, including the experimental instruments and procedures involved. The results show that this WSN surpasses similar research systems in terms of its application scale, the number and types of sensor nodes involved and the complexity of its hardware and firmware architectures. The major contributions of this thesis are: ?? The WSN developed satisfies certain technical requirements to be declared fit for use in a mock Australian RACF. ?? The WSN provides high sensor detection accuracies (between 88% and 100%), superior location tracking capability (94.75%) and activities of daily living inference capability over similar studies. Opportunities for further improvements of this WSN include: ?? Fine tuning the detection accuracy of Passive Infra-red (PIR) motion sensors. ?? Minimising the down time of the sensor nodes due to firmware memory leak. ?? An extra location tracking mechanism to improve location accuracy determination.

An aging population is one common challenge faced by many developed countries including Australia. The Australian government has realised that the existing healthcare system must be improved to provide better support longer-term for the healthcare needs of this population. This research examines one such opportunity by suggesting a reform on how the care needs of residents living in Australian residential aged care facilities (RACF) are assessed. A recent study has shown that the current assessment system, known as the Residential Classification Scale (RCS), is subjected to high administrative procedural overhead costs and significant deviations in assessment results. This thesis documents a technical feasibility study of a novel method aimed to solve issues related to the time demands and subjectivity of the RCS through the design and implementation of a Wireless Sensor Network (WSN). This WSN is engineered to unobtrusively collect data from wireless sensor nodes either embedded in the RACF environment or attached to the resident??s body. The collected data can be potentially used to provide automatic and accurate care level assessments for the resident. The methodology of preparing and conducting the experiments to prove the hypotheses is justified and described, including the experimental instruments and procedures involved. The results show that this WSN surpasses similar research systems in terms of its application scale, the number and types of sensor nodes involved and the complexity of its hardware and firmware architectures. The major contributions of this thesis are: ?? The WSN developed satisfies certain technical requirements to be declared fit for use in a mock Australian RACF. ?? The WSN provides high sensor detection accuracies (between 88% and 100%), superior location tracking capability (94.75%) and activities of daily living inference capability over similar studies. Opportunities for further improvements of this WSN include: ?? Fine tuning the detection accuracy of Passive Infra-red (PIR) motion sensors. ?? Minimising the down time of the sensor nodes due to firmware memory leak. ?? An extra location tracking mechanism to improve location accuracy determination.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.