<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.

Abstract The aim of this present study was to investigate whether there is a relationship between birth order and the personality trait narcissism using 181 individuals from Finnveden High School in Värnamo (115 females, 60 males, mean age 17, sd=0,94), in the context of the proposal of Sulloway (1996) that personality is influenced by the specialized nich-es siblings adopt in the quest for access to parental resources. A questionnaire which in-cludes Narcissistic Personality Inventory test, Birth order test and also Rosenberg’s self-esteem test in order to investigate if it might has an impact on narcissistic personality trait, was used. Results showed that there was no significant relationship between birth order and narcissism, however, a significant relationship between narcissism and self-esteem was found. Furthermore, there was a significant relationship between narcissism and the individual’s relationship with the mother. In conclusion, there was no direct rela-tionship between birth order and narcissism. Our hypothesis was falsified and no support for Sulloways theory was found.

<p>Abstract</p><p>The aim of this present study was to investigate whether there is a relationship between birth order and the personality trait narcissism using 181 individuals from Finnveden High School in Värnamo (115 females, 60 males, mean age 17, sd=0,94), in the context of the proposal of Sulloway (1996) that personality is influenced by the specialized nich-es siblings adopt in the quest for access to parental resources. A questionnaire which in-cludes Narcissistic Personality Inventory test, Birth order test and also Rosenberg’s self-esteem test in order to investigate if it might has an impact on narcissistic personality trait, was used. Results showed that there was no significant relationship between birth order and narcissism, however, a significant relationship between narcissism and self-esteem was found. Furthermore, there was a significant relationship between narcissism and the individual’s relationship with the mother. In conclusion, there was no direct rela-tionship between birth order and narcissism. Our hypothesis was falsified and no support for Sulloways theory was found.</p>

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-05-13T13:32:27Z No. of bitstreams: 2 Dissertação - Samantha Pereira Araújo - 2015.pdf: 934382 bytes, checksum: b1d661d060a3b76400d652fe9380c056 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-05-13T15:33:44Z (GMT) No. of bitstreams: 2 Dissertação - Samantha Pereira Araújo - 2015.pdf: 934382 bytes, checksum: b1d661d060a3b76400d652fe9380c056 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-05-13T15:33:44Z (GMT). No. of bitstreams: 2 Dissertação - Samantha Pereira Araújo - 2015.pdf: 934382 bytes, checksum: b1d661d060a3b76400d652fe9380c056 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-02-23 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The aim of this study was to analise the influence of blood pressure control, nutritional status and level of physical activity in the quality of life of very elderly hypertensive patients. Cross-sectional study with forty-one oldest old patients (over 80 years), both males and females, followed at a reference center for hypertension treatment in a midwest brazilian City. A survey questionnaire about sociodemographic and lifestyle variables was applied. The International Physical Activity Questionnaire (IPAQ) and the Medical Outcomes Study SF-36 item Short Form Health Survey (SF 36) were also used to evaluate the Quality of Life. Blood pressure and anthropometric variables were measured. Fisher test, t test, chi-square and Mann-Whitney-U test were performed. The significance level was 5% and confidence interval was 95% for all tests. The study was approved by the Ethics Committee of the institution. Low educational levels and low income were found in the sample. Only 7.3% of the patients referred alcohol consumption and no one was a smoker. Smoking and alcohol intake showed differences between gender and was higher among men (p=0.002, p<0.001). Almost half of participants (46.3%) were overweight according to body mass index and 80,5% had increased waist circumference. Controled blood pressure were verified in 73.2% of the sample. Moderate and intense physical activity levels were observed on 46.3% of the participants. Nutritional status and physical activity level did not influence blood pressure control. The quality of life associated with the physical aspects was better in men (p=0,044). Physically active oldest old had better score for functional capacity in the SF 36 (p=0.007). Social, emotional and mental health domains obtained the highest scores for quality of life. Blood pressure control and nutritional status did not affect quality of life. These findings may contribute to health planning, with promotion of public policies for seniors. More studies should be conducted in the future in order to clarify the main factors for promoting longevity with quality of life. / Os objetivos deste trabalho foram avaliar a influência dos níveis pressóricos, do estado nutricional e do nível de atividade física sobre a qualidade de vida de pacientes muito idosos sob tratamento regular em um serviço público de referência no tratamento de hipertensão em uma capital brasileira. Foram incluídos 41 hipertensos de ambos os sexos, com idade igual ou maior que 80 anos. A coleta de dados ocorreu de julho a setembro de 2014. Os participantes foram entrevistados por nutricionista e foram aplicados o questionário para investigação das variáveis sociodemográficas e hábitos de vida, o Questionário Internacional de Atividade Física (IPAQ) e o Medical Outcomes Study 36-item Short-Form Health Survey (SF 36). Além disso, foram aferidas pressão arterial e medidas antropométricas. Foram realizados os testes exato de Fisher, Teste t e Mann-Whitney-U. O intervalo de confiança adotado foi de 95% e o nível de significância foi de 5% para todas as análises. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital das Clínicas da UFG. A amostra apresentou baixo nível de escolaridade e baixa renda per capita. Apenas 7,3% dos idosos referiram ingestão de bebidas alcoólicas e nenhum se declarou fumante. Quanto ao estado nutricional, 46,3% da amostra apresentou sobrepeso conforme o índice de massa corporal. Circunferência da cintura de 80,5% da amostra estava aumentada ou muito aumentada. Os níveis de pressão arterial de 73,2% dos participantes estavam controlados. A qualidade de vida dos idosos não foi influenciada pelo estado nutricional e controle da pressão arterial. O nível de atividade física moderado e intenso foi verificado em 46,3% dos muito idosos. Mulheres e homens apresentaram pontuações mais baixas no domínio capacidade funcional. A qualidade de vida associada aos aspectos físicos foi melhor em homens (p=0,044). A prática de atividade física refletiu em melhor qualidade de vida associada à capacidade funcional avaliada pelo SF 36 em ambos os sexos (p=0,007). Melhor qualidade de vida foi atribuída aos domínios aspectos emocionais, sociais e de saúde mental. Tais achados podem contribuir para o planejamento em saúde, com implementação de políticas públicas direcionadas aos idosos.

Studiens syfte är att ur ett livsloppsperspektiv belysa vilka bemästringsstrategier finlandssvenskar i åldern 100-103 år har använt från barndomen till ålderdomen. Fokus läggs främst på bemästring av svårigheter, men studien tar även fasta på hur man som 100-åring ser på livet idag och på framtiden. För studien intervjuades tre kvinnor och två män i Finland. En kvalitativ innehållsanalys användes för att tolka intervjumaterialet. Studiens resultat visar att de intervjuade som barn i Finland i början av 1900-talet fick bemästra genom att acceptera och vara i ödets händer. I vuxenlivet tog de däremot kontroll över sina liv och vägde ofta fördelar mot nackdelar. Idag som 100-åringar vill de behålla kontrollen trots behov av hjälp, men ser också tillbaka på och accepterar livet som helhet. Vissa strategier syns även över längre perioder i livet. Behovet av socialt stöd är en viktig aspekt, men även individens inställning till livet har stor roll. Resultatet visar hur viktigt det är att låta till och med 100-åringar behålla sin självbestämmanderätt för att själva kunna bemästra svårigheter. / The aim of this study is to show which coping strategies fennoswedish centenarians aged 100-103 have used throughout life. The study is conducted from a life course perspective, with focus on coping strategies in times of difficulties, but the study also sheds light on how centenarians experience life today and what they think of the future. Three women and two men were interviewed for the study in Finland. A qualitative content analysis was done to interpret the data. The result shows that the interviewed centenarians, as childen in the early 20th century Finland, had to cope by accepting and by leaving one’s fate in someone else’s hands. In adult life, however, the interviewees took control of their lives and often weighed the pros and cons to cope with difficulties. Today the centenarians want to maintain control even though they are in need of help, but also look back on and accept life as a whole. Some coping strategies are also present over longer periods in life, for example the need for social support, as well as the individual attitude. The result shows the importantance of allowing centenarians to maintain their autonomy in order to cope with difficulties.

Depressionen bei hochaltrigen Menschen sind weit verbreitet und folgenschwer, dennoch bleiben diese häufig unentdeckt und unbehandelt. Daher ist die Identifizierung von Risikofaktoren besonders wichtig, um Depressionen im Alter zu erkennen oder präventiv zu begegnen. Die Bedeutung von psychosozialen Faktoren, wie Verlusterfahrungen und das soziale Netzwerk, werden dabei häufig vernachlässigt. Dabei wird der Tod von nahestehenden Personen mit zunehmendem Alter häufiger und erfordert ein hohes Maß an psychologischer Anpassungsleistung der Hinterbliebenen. Die damit einhergehende Veränderung des sozialen Netzwerks birgt ein Risiko für soziale Isolation und damit auch für Depressionen. Das Ziel der Dissertation war es, Depressionen bei hochaltrigen Menschen in Deutschland in Abhängigkeit von sozialer Isolation und Verlusterfahrungen zu analysieren und dabei auf mögliche Geschlechtsunterschiede einzugehen. Datengrundlage der ersten Untersuchung war die „Leipziger Langzeitstudie in der Altenbevölkerung“ (LEILA 75+), eine prospektive, epidemiologische und bevölkerungs-repräsentative Kohortenstudie. Mit einer Stichprobe von 783 Personen (durchschnittliches Alter 80,78 (SD 4,52) Jahre) wurde zunächst mittels einer deskriptiven Analyse die Veränderung des sozialen Netzwerks (PANT) im Alter unter Berücksichtigung von Verlusterfahrungen analysiert. 57% der älteren Menschen lebte kontinuierlich in einem restriktiven sozialen Netzwerk. Bei 30,9% der Hochaltrigen konnte eine Änderung im sozialen Netzwerk während des Untersuchungszeitraums festgestellt werden, diese konnten allerdings in keinen Zusammenhang mit Verlusterfahrungen gebracht werden. Verlusterfahrungen (OR 7,56 (1,60–35,72)) und ein restriktives soziales Netzwerk (OR 4,08 (1,52–10,95)) stellten sich in den Hybridregressionen als signifikante Prädiktoren zur Entwicklung einer Depression (ADS-L) heraus. Protektive wirkte hingegen ein integriertes soziales Netzwerk. In der zweiten Studie wurden die AgeDifferent.de Daten, die aus drei gepoolten Alterskohortenstudien (LEILA 75+, AgeCoDe / AgeQualiDe und AgeMooDe) bestehen, ausgewertet. Das durchschnittliche Alter der 2.470 Befragten lag bei 79,2 (SD 3,64) Jahren. Bei Frauen konnte ein signifikant höherer Schweregrad der Depression festgestellt werden als bei Männern (β=0.16; 95%-CI=0.09; 0.23). Analysen zum Vergleich der Depressivität vor und nach der Verwitwung verdeutlichten, dass der Schweregrad der Depression nach der Verwitwung signifikant höher ist. In dieser Studie konnte zudem gezeigt werden, dass verwitwete Männer signifikant mehr depressive Symptome haben als nicht verwitwete Männer. Bei der Betrachtung von Frauen konnten jedoch keine Unterschiede festgestellt werden. Bei intraindividueller Betrachtung zeigte sich, dass sowohl verwitwete Männer als auch verwitwete Frauen signifikant mehr depressive Symptome haben als vor ihrer Verwitwung. In der letzten Untersuchung wurde mit Daten der AgeCoDe / AgeQualiDe Studie analysiert ob Unterschiede zwischen Verwitweten und Verheirateten in Alter, Geschlecht und Bildung auch eine mögliche Erklärung für die Unterschiede in der Depressivität zwischen diesen Gruppen sein könnten. Mit Daten von 679 Personen (456 verwitwet, 223 verheiratet), mit einem durchschnittlichem Alter von 86,5 (SD 2,9) Jahren konnte gezeigt werden, dass Verwitwete häufig älter, häufiger weiblich und eher niedriger gebildet sind. Mittels „Entropy Balancing“ wurden diese Eigenschaften von Verwitweten und Verheirateten vereinheitlicht. Das Ausmaß der depressiven Symptome bei verwitweten hochaltrigen Frauen und Männern war in dieser Untersuchung ähnlich. Bei der Berücksichtigung der sozialen Isolation stellte sich in dieser Untersuchung heraus, dass soziale Isolation vor allem in der Gruppe der Verwitweten zu mehr depressiven Symptomen führt. Verwitwete Männer und Frauen, die zudem sozial isoliert leben, weisen signifikant mehr depressive Symptome auf, als Verwitwete ohne soziale Isolation (β=0.83; 95%-CI=0.44; 1.23). Soziale Isolation hatte in der Gruppe der Verheirateten im Gegensatz zu den Verwitweten keinen Einfluss auf die Häufigkeit depressiver Symptome. Zusammenfassend zeigt sich, dass Verlusterfahrungen als ein Risikofaktor zur Entwicklung depressiver Symptome identifiziert werden konnte. Nicht eindeutig ist der Einfluss des Geschlechts. Mögliche Unterschiede zwischen Frauen und Männern im Zuge der Verwitwung könnte beispielsweise die Unterrepräsentation von verwitweten Männern sein. Wird dieser Faktor berücksichtigt, können Frauen und Männer als ähnlich vulnerabel zur Entwicklung einer Depression nach dem Verlust des Ehepartners gelten. Für Menschen die zusätzlich neben dem Verlust des Ehepartners ein sozial isoliertes soziales Netzwerk haben, ist das Risiko zur Entwicklung einer Depression noch größer. Ein gestärktes soziales Netzwerk kann hingegen bei beiden Geschlechtern als ein protektiver Faktor zum Erhalt der psychischen Gesundheit gesehen werden.:Abbildungsverzeichnis Tabellenverzeichnis Abkürzungsverzeichnis 1 Einleitung 1.1 Depressionen im Alter 1.2 Trauer- und Verlusterfahrungen im Alter 1.3 Bedeutung des sozialen Netzwerks im Alter 1.4 Geschlechtsunterschiede im Alter 2 Datengrundlage und Publikationen der vorliegenden Dissertation 2.1 Datengrundlage 2.1.1 LEILA 75+ 2.1.2 AgeCoDe / AgeQualiDe 2.1.3 AgeMooDe 2.1.4 AgeDifferent.de 2.2 Überblick über die Publikationen der vorliegenden Dissertation 3 Loss experiences in old age and their impact on the social network and depression– results of the Leipzig Longitudinal Study of the Aged (LEILA 75+) 4 Are older men more vulnerable to depression than women after losing their spouse? Evidence from three German old-age cohorts (AgeDifferent.de platform) 5 The role of social isolation and the development of depression. A comparison of the widowed and married oldest old in Germany 6 Diskussion 6.1 Allgemeine Diskussion 6.2 Implikationen für die Praxis und die Versorgungsforschung 6.3 Fazit Zusammenfassung der Arbeit Literaturverzeichnis Anhang A: Darstellung des eigenen Beitrags Anhang B: Erklärung über die eigenständige Abfassung der Arbeit Anhang C: Lebenslauf Anhang D: Wissenschaftliche Beiträge Anhang E: Danksagung

Background. Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) may have different effects on cognitive health due to their anti- or pro-inflammatory properties. Methods. We aimed to prospectively examine the relationships between n-3 and n-6 PUFA contents in serum phospholipids with incident all-cause dementia and Alzheimer’s disease dementia (AD). We included 1264 non-demented participants aged 84 ± 3 years from the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) multicenter-cohort study. We investigated whether fatty acid concentrations in serum phospholipids, especially eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), linoleic acid (LA), dihomo-γ-linolenic acid (DGLA), and arachidonic acid (AA), were associated with risk of incident all-cause dementia and AD. Results. During the follow-up window of seven years, 233 participants developed dementia. Higher concentrations of EPA were associated with a lower incidence of AD (hazard ratio (HR) 0.76 (95% CI 0.63; 0.93)). We also observed that higher concentrations of EPA were associated with a decreased risk for all-cause dementia (HR 0.76 (95% CI 0.61; 0.94)) and AD (HR 0.66 (95% CI 0.51; 0.85)) among apolipoprotein E ε4 (APOE ε4) non-carriers but not among APOE ε4 carriers. No other fatty acids were significantly associated with AD or dementia. Conclusions. Higher concentrations of EPA were associated with a lower risk of incident AD. This further supports a beneficial role of n-3 PUFAs for cognitive health in old age.

There are only few dialect regions within Czech language territory, where a systematic dialect research can be made, since the traditional territorial dialect irreversibly disappears. In the northern part of the East-Moravian dialect region we would find Valachian region, where the dialect is still maintained alive, and where the lexicon collected in Dialect dictionary of southwest part of the Vsetin region (hereinafter as DDSV) originates. During the field survey I managed to collect a rich lexical material, on the basis of which the DDSV consisting of 2.027 basic and 427 referential lexical units was created. DDSV is a type of local, alphabetic and differential dictionary. The aim of this work is mainly to catch and elaborate the lexicon collected in DDSV, based on contemporary lexicographical methods. A differential approach was used at the selection of phraseology, it means, that achieved lexical material was thoroughly confronted with Czech explanatory dictionaries. The dialect research for DDSV was made among the members of the oldest generation (above 60 years). Among the youngest generation (under 30 years), a research for inter-generation comparison of the lexicon of substantive semantic register area of meals, drinks and smoking was led, focused at sub-groups poléfka, máčka, kaša, placka...