Introduction:  If a person uses many different drugs at the same time it can be termed “polypharmacy”. Polypharmacy is mostly seen in the elderly and often associated with negative aspects of drug treatment. Some negative consequences of using many drugs are a higher risk of drug-drug interactions and side effects and a lower patient compliance. The number of drugs defining polypharmacy can vary. But what does the number really tell? Aim:  The aim of this work is to get a better picture of the medication of the elderly in Sweden and Germany. Which are the most common drugs used by the elderly with excessive polypharmacy (use of 10 or more drugs) in Sweden and Germany? Materials and Methods: A cross-sectional observational study was done using individual based drug dispensing data on elderly 65 years and older from the Swedish Prescribed Drug Register (1,4 million elderly) and Germany’s (AOK) drug register (5,3 million elderly). Period prevalence for the time interval October to December 2010 was calculated. Results:  Many interesting differences were found comparing the drug treatment of the elderly with excessive polypharmacy in Sweden and Germany. In Sweden the most common drugs for this population were paracetamol (56%), acetylsalicylic acid (52%) and furosemide (42%), in Germany the use of torasemide (35%), simvastatin (35%) and pantoprazole (33%) dominated. Differences between the countries can partly depend on how common a disease is in a country, but also which drugs are available as OTC-drugs, the availability of guidelines/formularies and how physicians in a country follow them and differences in the availability of drugs in the market. Conclusions:  When assessing drug use in terms of polypharmacy, the focus should not lie on the amount of drugs; the importance is which drugs are administered. Through international comparisons strengths and weaknesses of different countries’ drug treatment of the elderly can be found. The countries should support each other and make interventions. Hopefully a better drug treatment will be reached.

The mortality rate for elderly pedestrians struck by vehicles is the highest of any age group, approaching 30% in several large series. Currently, there is a lack of epidemiological studies of the risk factors associated with elderly pedestrian injury; in particular, few prospective studies of elderly pedestrian injuries have been performed. The primary purpose of this project was to identify risk factors that will lead to the development and implementation of effective prevention strategies to reduce the risk of pedestrian injury in this vulnerable population. The project had three phases. In phase 1, pilot studies were performed and identified potential risk factors for elderly pedestrians and confirmed their ability to recall accident details. Risk factors identified included certain walking and street crossing behaviors, as well as the lack of use of assistive devices. In Phase 2, the relatively new case-crossover design was utilized to investigate the association of transient (proximate) triggers or exposures with elderly pedestrian injuries. The relative risk of injury if not obeying the traffic signal is five-fold (odds ratio = 5.2; 95% confidence interval = 1.8 – 15.1). Risk factors such as use of sedating or mood altering medications, or the use of alcohol did not have sufficient discordance for analysis. The behavioral findings suggested that educational programs and behavioral modification might play an important role in designing future interventions. Therefore, in Phase 3, an elderly pedestrian safety program called Safe Crossings was created and evaluated. Over 700 subjects participated in the programs, with 99% reporting they felt it was an important topic and 93% acknowledging they learned something from the program. Focus groups were also utilized to help refine the content and delivery of the program. Posters and brochures were created and distributed in English, Spanish and Creole. The program is now set for wider dissemination and validation.

With aging there is a decrease in a person’s ability to perform activities of daily living (ADL) which may be most effectively addressed using training patterns that are biomechanically similar to ADL. Since aquatic exercise offers the opportunity to provide resistance with a high level of safety, the pool may afford the ideal environment for ADL-specific training in an aging population. Purpose: The purpose of this investigation was to compare a traditional aquatic exercise program (TRAD) to an aquatic program tailored to target ADL (ADLspec). Methods: Eighteen independently living individuals (68.7 + 7.5 years) were randomly assigned to a TRAD or ADLspec aquatic exercise group. The exercise groups attended 1 hr exercise sessions, 2 times per week for 8 weeks. ADL ability was assessed using the short version of the Continuous-Scale Physical Functional Performance Test (PFP-10); while strength and power were assessed using the 30s arm curl and 30 sec. chair stand tests. Results: Mixed design ANOVAs revealed a significant group x time interaction for floor sweep time with the ADLspec group outperforming the TRAD and control (CON) groups (p = .043). Additionally, the ADLspec group improved the pan weight and scarf time components of the PFP-10 (p < .020), while the TRAD group improved pan time and laundry time (p < .046). Both training groups showed similar improvements for jacket time, grocery weight, and 6-min walk, (p < .046). The ADLspec and TRAD groups also made similar improvements in upper and lower body strength, as well as lower body power across time, (p < .043). A student’s t-test revealed the TRAD group spent more time exercising during the hour session than the ADLspec group (p < .05). Conclusion: The results indicate that performing an ADLspec aquatic exercise program can increase performance of ADL that require more complex sequential movements; however, ADL more dependent on fitness may be better addressed using a TRAD intervention. These results can be helpful when designing a periodized aquatic training program to increase independence in older persons.

With the number of people living longer and with more chronic problems, it is important that health educators examine who they are educating as well as the methods and circumstances of the education. The purpose of this study was to identify the relationship between self-directedness and health promotion in the elderly. A convenience sample of 108 elders who use Senior Centers in rural East Tennessee comprised the study group. The sample was asked to complete the Self-Directed Learning Readiness Scale, the Health Promoting Lifestyle Profile II, and a demographic information survey at a regular meeting of a Senior Center. A positive relationship (r=.394; p<.005) was found between self-directedness as a measure of intrinsic motivation with participation in health promoting behaviors. Demographic information was used to describe the sample and was also used to determine if there was a relationship between any of the demographic items and health promotion practices or self-directed learning readiness. Participation in religious/spiritual activities was significant for both self-directed learning readiness and health promotion practices. Pender’s Revised Health Promotion Model and the Personal Responsibility Orientation Model provided an excellent basis for this study. The study confirmed the need for personal motivation in the elderly to accomplish increased participation in health promotion practices. Both self-directed learning readiness and health promoting behaviors were reviewed for consideration of previous research in the area, and theoretical perspectives. The key implication for practice is that health educators need to understand the motivation of their client prior to educating them regarding an aspect of health promotion. Recommendations for research include more qualitative studies. Almost all the studies available at present are quantitative and the reason for participation needs further investigation. Qualitative studies would enhance the information regarding the reasons for participation in health promotion.

Bilingualism and its effect on individuals have been studied within different disciplines. Although the first psychological study of bilingualism was couducted by Cattell as early as 1887, only a few studies have exclusively investigated the effect of bilingualism on memory systems’ functioning. In the field of cognitive psychology of bilingualism, there is some evidence for the positive influence of bilingualism on children’s cognitive ability across various domains but there is little knowledge about the relationship between bilingualism and memory in a lifespan perspective. This thesis’s main aim was to investigate memory systems’ functioning and development in bilingual individuals. To this end, two studies were performed: a cross-sectional study of bilingual children (Study I) and a longitudinal study of young and older adults (Study II). The purpose of Studies I and II was to determine whether there are differences between monolinguals and bilinguals regarding various memory systems’ functioning. Study I compared monolingual and bilingual children’s performance on episodic and semantic memory, and Study II investigated performance on episodic and semantic memory in bilingual younger and older adults. Specifically, these studies aimed to examine a) which memory systems will be affected more as a function of language, and b) to what extent the differences would manifest themselves during a subject’s lifespan. The purpose of Study III was to explain the relation among word representations, lexical access and lexical selection in a bilingual word production paradigm. In this study, a model of bilingual production was developed to explain the results and clarify the role of automatic and controlled processes in using two languages. The results of Studies I and II showed a superiority of bilinguals over monolinguals as well as a variation of association between memory performance and bilingualism across different periods of adulthood. It appears that the lifelong experience of managing two languages enhances control processes, which in turn play an important role in enhancing memory performance. Using a “dual mechanism model”, Study III explains the efficiency of inhibitory processing when having two languages activated.

Syftet med litteraturstudien var att beskriva hur djur respektive musik kan användas som fysisk-, psykisk- och social stimulans i vården av äldre över 65 år. Litteratur har sökts i tre stora databaser och inkluderad litteratur har analyserats och kvalitetsbedömts. Djur och musik har visat sig ha positiva effekter för de äldre i ordinart boende eller på äldreboende. De positiva effekterna visade sig genom förbättring av depression, ensamhet, sömn, fysiska och kognitiva funktioner. Förbattringarna visade sig genom musikterapi eller djurterapi där människan kan interagera med djur. Att lyssna på musik gav någon slags emotionell respons. Slutsatsen av litteraturstudien ar att djur och musik ger effekt på äldres fysiska, psykiska och sociala funktioner. Djur och musik bidrar till en ökad aktivitet och kan ge äldre den stimulans de efterfragar. / The aim of this study was to describe how animals and music can be used as a physical-, psychological-, and social stimulation in the care of elderly aged 65 and older. The literature was found in three large databases. Included literature has been analyzed and quality judged. Music and animals have shown to have positive effects on the elderly, living at home or in nursing homes. Positive effects were shown through improvements of depression, loneliness, sleeping quality, physical and cognitive functions. These effects were a result of music therapy or pet-therapy when elderly was allowed to interact with an animal. Listening to music gave some kind of emotional response. The conclusion of the study is that animals and music give an effect on physical, psychological and social functions among the elderly. Animals and music can contribute to an increased activity and can provide the stimulus the elderly demands.

The primary aim of this study has been to examine and describe self-reported fatigue among the oldest old in Sweden and to look at changes both over a ten year period, between and within different social groups. Additional aims were to examine if fatigue is related to mortality. Fatigue is defined as an outcome in self-rated ill-health which includes several dimensions of fatigue – physical, psychological and/or medical. Data were constructed out of two levels of living study – SWEOLD – comprising aged 77 and above. Two dependent variables are being uses as outcomes – fatigue and tiredness. Background variables being used – defined as different social groups – are (interview year), age, gender, social class, civil status and type of housing. Cross tabulation, gamma, multivariate logistic regression and Cox regression were used in the analysis. The result shows that fatigue is a commonly experienced phenomenon, especially among those who are institutionalize. Differences were also found among age, social class and civil status. Fatigue has increased between 1992 and 2002 but no changes over time could be identified for a particular social group. The results also showed that fatigue is related to mortality. Conclusion drawn from the results is that the increasing among the elderly persons in reporting fatigue and/or tiredness over time has fall upon all examined social groups in the Swedish society and still, fatigue as a phenomenon is poorly understood.

Abstract Elderly people are going to be a growing number in Europe. Between one third are going to be 60 years or older at 2025. For Sweden the situation is going to be similar. A reduced muscle function could lead to complications for the individual to perform daily tasks and will lead to a higher rate for falling and getting bone fractures. The positive sides are that for men and women there are a possibility for maintaining physical function and strength even in older years. The purpose of this study was to investigate the possibility of gaining strength in M. Quadriceps femoris among five elderly people. The training schedule followed over 6 weeks of time with training sessions twice a week, training the Quadriceps muscle with one set of each training session. The result shows that for the three people that completed the study, all of them managed to gain strength. Further the study examines resistance training comparing single and multiple sets. Is there any difference in gaining strength between training programs with single set training versus multiple sets training?

Bakgrund: Genom tusentals år har människor och sällskapsdjur levt sida vid sida. Tidigare studier har fokuserat på de fysiska, psykiska och sociala effekterna djur har på människor. Syfte: Syftet med denna litteratur studie är att undersöka vilken betydelse sällskapsdjur har i omvårdnaden av den äldre människan. Metod: Till denna litteraturstudie samlades data in från databaserna Cinahl och Swemed. I studien användes metodprocessens åtta steg enligt Polit och Beck (2004). Tre kategorier framkom ur analysen. Dessa tre kategorier var: sällskapsdjurs betydelse för den äldre människan, sällskapsdjur som terapi och problem som kan uppstå för den äldre människan som vill umgås med djur. Resultat: Resultaten visar att sällskapsdjur har en viktig roll för många äldre människor. För äldre människor kan djur vara den viktigaste relationen och ibland den enda nära relationen de har. Djurterapi visar sig vara ett gott komplement till andra behandlingsmetoder för den äldre människan. Konklusion: Äldre människor mår bra när de umgås med djur. Djur ger en trevlig atmosfär i sin omgivning. / Background: Through thousands of year people and domestic animal have been living side by side. Earlier studies have focused on the physiological, psychological and sociological effects pets have on humans. Aim: The aim of this literature review was to examine which meaning pets have in the caring of the elderly people. Method: For this literature review, data was collected from the databases Cinahl and Swemed. In the studie a method processing in eight steps according to Polit and Beck (2004) was used. During analyse three main categories appeared. These three categories were, pets meaning of the elderly people, pets as therapy and problems which can appear when elderly people want to socialize with pets. Result: The result showed that pets have an important role in the daily life of many elderly people. For the elderly people, pets can be the most important relation and sometimes the only close relation they have. Pet therapy indicates that it is a good complement to other treatment therapies for the elderly people. Conclusion: Elderly people feel good when they socialize with pets. Pets bring a nice atmosphere in their environment.

Mer än 25 % av äldre patienter lider av undernäring under sin sjukhusvistelse. Detta problem har varit känt i ett flertal år. Syftet med studien var att beskriva sjuksköterskors bedömning och hantering av undernutrition hos äldre patienter som vårdas på sjukhus. Metoden som valdes till studien var en kvalitativ enkätstudie och dess svar bearbetades genom en kvalitativ innehållsanalys. Resultaten presenterades i sju olika teman: Den kliniska blicken, Samlad bedömning, Bedömningshjälpmedel, Registrering av kostintag, Psykisk hälsa, Undersköterskans roll och Tidsbrist. Konklusionen är att sjuksköterskor har tillräcklig kunskap och hjälpmedel för att kunna bedöma ett adekvat nutritionsstatus på sina patienter. Det som dock hindrar dem är den ständiga tidsbristen som gör att nutritionsfrågor prioriteras lägre. Undersköterskorna tar ofta på sig ansvaret för nutritionsbedömningen. / In spite of the fact the situation has been well known for several years, more than 25 percent of elderly patients suffer from malnutrition during hospital care. The aim of this study was to describe the nurse's assessment of nutrition status among elderly patients treated in hospital. The chosen method was a qualitative questionnaire and by using a qualitative content analysis, the answers were processed. The results were presented in seven themes; The clinical eye, Resources, Raised assessment, Registration of food intake, Mental health, Assistant nurse´s role and Lack of time. Our conclusion is that nurses have enough knowledge and aid to appraise an adequate nutrition status on their patients, but is prevented by constant lack of time resulting in nutrition questions being lower prioritized. Instead, the assistant nurse takes more responsibility for the nutrition assessment.