Forskningsartikler

Abstarct:

Introduction: Goal-setting interviews in randomised controlled trials (RCTs), such as the Bangor Goal-Setting Interview (BGSI), provide personalised, measurable outcomes that are meaningful to participants because they reflect their unique needs. The PRACTIC (PReventing and Approaching Crises for frail community-dwelling patients Through Innovative Care) RCT (2023– 2024) evaluates a biopsychosocial intervention to approach and prevent crises for frail community-dwelling patients. The PRACTIC Goal Setting Interview (PGSI), adapted from the BGSI, focuses on individual goal attainment and readiness to change and was chosen as the primary outcome in the PRACTIC RCT. This study aimed to translate and develop the PGSI, exploring its feasibility, content validity and interrater reliability.

Design and Methods: This study used a convergent mixed-method design; quantitative and qualitative data were collected with equal priority, analysed separately, and compiled for the results and discussion. Two substudies are included: 1) translation and development of the BGSI towards the PGSI and 2) feasibility, content validity and interrater reliability of the PGSI. Substudy 1 comprised field notes from meetings with municipal staff (n=7) across two municipalities. Substudy 2 included data from 28 municipalities participating in the PRACTIC RCT; patient (n=126), next of kin (n=72), and data from focus groups with staff members (n=13) and data collectors (n=5), as well as individual interviews; patients (n=8) and next of kin (n=4).

Results: The PGSI was well received in the home care services and helped strengthen patient involvement. However, there were challenges in using the PGSI, such as time pressure and workload for the staff. After 12 weeks, participants with high motivation showed a significant increase in PGSI compared with those with low motivation (p = 0.010). Analyses also revealed strong positive correlations between participants and staff members assessments of goal attainment at 12 weeks (Spearman’s ρ = 0.87– 0.92, p < 0.001). The results indicate that the PGSI is a valid and reliable tool for improving patient care through structured goal setting and the active involvement of patients and their next of kin.

Conclusion: The PGSI appears to be a useful and feasible tool for goal setting in home care services. The tool strengthens patient engagement and goal attainment with high content validity and interrater reliability.

Væringstad A , Kirkevold Ø , Dalbak ETG , Myhre J, Feiring IH , Bergh S , Lichtwarck B

Abstract

Background: Malnutrition and frailty frequently affect older adults receiving domiciliary care services, increasing their vulnerability to adverse events such as delirium. Despite this, the role of malnutrition as a risk factor for delirium in this population remains under-researched. The aim of this study was to examine the relationship between nutritional status and the development of delirium over a 2-year period among older adults who received domiciliary care services.

Method: In this 2-year prospective cohort study, we included 210 participants aged 65 years or older who received domiciliary care services at least once per week. Nutritional status was assessed using the Mini Nutritional Assessment at the time of inclusion, while delirium was assessed weekly, upon admission to hospital, and upon clinical indication according to DSM-5 criteria. Logistic regression analysis was used to examine the relationship between malnutrition and delirium.

Results: Of the sample, 116 (55.2%) were malnourished/at risk of malnutrition at the time of inclusion. Over a 2-year period, 42.4% developed delirium. The odds ratio for developing delirium was 2.00 (95% CI 1.08-3.72, P = 0.028), for the group with malnutrition/risk of malnutrition, adjusted for covariates.

Conclusion: Malnutrition is an independent risk factor for delirium in older adults receiving domiciliary care services. These findings highlight the importance of regular nutritional assessments and interventions to potentially reduce the risk of delirium in this vulnerable population.

Benedicte Huseby Bøhn, Maria Krogseth, Nina Jøranson, Torgeir Bruun Wyller, Geir Selbæk & Gro Gujord Tangen

Abstract: 

Background: Immersive technologies such as virtual reality (VR) that has been developed the recent years, are now increasingly accessible and offers new opportunities for VR environments combined with games that may enhance physical activity. However, these games may require adaptation and further customization for use among older users. In this pilot study, we investigate the experiences of older adults using a head-mounted VR exercise game that was developed in close collaboration with end users.

Methods: We included ten community-dwelling older adults aged 65 years and older who undertook six VR exercise sessions across a two-week period, each session lasting 15 min. Descriptive information included age, gender, mobility (Timed Up and Go test, TUG), and gait speed (10 m walk test), and daily steps from ankle-worn accelerometers. Semi-structured individual interviews were conducted, transcribed verbatim and analyzed by use of reflexive thematic analysis.

Results: We included four men and six women, age range from 66 to 77 years, with an average gait speed of 1.4 m/sec and an average TUG-time of 7.6 s. Their average activity levels were close to 4200 steps per day. After the trial period, participants’ experiences were that VR is a new and exciting development. They found VR to be more of a game than exercise, and they suggested integrating more challenging activities, physical movement and social engagement to enhance the exercise part of the game. They did not feel that the game facilitated any more physical activity in their daily lives.

Discussion/conclusion: VR is a promising tool that older adults in this trial enjoyed, but the game was not physically demanding enough for the participants. Future adaptations should include more challenges. Game development should focus on tasks that keep players interested and engaged over longer times, without jeopardizing safety.

Bård Bogen, Martin Moum Hellevik, Gro Gujord Tangen, Lars Peder Bovim, Nina Øye, Kristin Taraldsen

Abstarct:

Background: Knowledge about how older adults walk is crucial for the effective prevention and treatment of various mobility issues as well as treatment evaluation, but it is currently largely limited to laboratory-based measurements. Although laboratory-based data provide relevant information about what older adults can do under standardized conditions, they do not provide insight into how they actually walk in their daily life, a gap that needs to be addressed urgently.

Objective: The objective of this study was to describe how older adults walk in daily life, in relation to age, sex, and level of physical function, using wearable sensor data from a large sample of older adults with a wide range of age and function from the HUNT4 Trondheim 70+ study.

Methods: The current study is based on 1-week accelerometer data (Axivity AX3) from 1289 older adults (mean age 77.41, SD 6.06 years; age range 70-105 years; n=705, 54.7% women). Physical function was assessed using the Short Physical Performance Battery (SPPB). To investigate the effect of age and SPPB score on gait metrics (daily number of steps, 95th percentile speed, mode speed, 95th percentile cadence, mode cadence, and maximum walking bout [WB] distance) for women and men, univariate gamma regression models with log link were used for each outcome measure, with age and SPPB score in separate models. Sex differences were investigated using Mann-Whitney U tests.

Results: Older adults showed a large variation in how and how much they walked in daily life across age, sex, and physical function, particularly younger participants and those with better physical function. Most gait metrics decreased at an increasing rate with higher age, with men maintaining their levels up to higher ages than women. Poorer physical function led to an exponential or close-to-linear decrease in all gait metrics apart from habitual cadence, which remained stable up to a high age. Women had a lower daily number of steps, gait speed, and maximum distance but higher cadence than men (P<.001 for all). On average, 63% of all WBs lasted <10 seconds, corresponding to a median accumulated time of 99 (IQR 66-128) minutes. For WBs lasting 10 to 30 seconds, 30 to 60 seconds, and >60 seconds, the median accumulated time was 105 (IQR 65-154) minutes, 31 (IQR 18-47) minutes, and 113 (IQR 37-219) minutes, respectively.

Conclusions: Daily-life walking performance was affected more by functional ability than by age itself, except for the highest ages, and differed significantly between sexes. Although most WBs were very short, the total accumulated walking time in WBs shorter than 30 seconds was longer than that in longer WBs. Future research can build upon our findings by considering both the impact of short WBs and relevant group and sex differences when implementing daily-life mobility assessment in both clinical studies and patient follow-up.

Karoline Blix Grønvik, Anisoara Paraschiv-Ionescu, Gro Gujord Tangen, Øyvind Salvesen, Jorunn Lægdheim Helbostad, Nina Skjæret-Maroni & Beatrix Vereijken

Abstract:

Purpose:
Suicide rates are high among older adults, yet research on risk factors associated with suicide in this age group remain largely unexplored. This study aims to examine the relationship between suicide and sociodemographic characteristics among individuals aged 60 and older.

Methods:
We utilized data from Norwegian national registries, identifying individuals aged 60 and older who died by suicide between 2005 and 2019 (n = 2060, 70.7% males), and used a case-control design. To examine the relationships between suicide and sociodemographic factors, we used descriptive analyses and conditional multivariate logistic regression analyses, stratified by sex and age categories.

Results:
Among individuals aged 60 to 69, risk factors for suicide included receiving a disability pension (odds ratio (OR) = 2.79 males, OR = 7.71 females), having mixed income sources (OR = 1.79 males, OR = 3.70 females), living alone (OR = 2.49 males, OR = 2.46 females), and living in urban areas, which was associated with an increased risk for females (OR = 1.85). Among males, living alone was also a significant risk factor for suicide in the 70 to 79 age group (OR = 1.85), and those aged 80 and above (OR = 2.16). Living in rural areas reduced risk for females aged 80 and above (OR = 0.05).

Conclusion:
This first register-based study of suicide in older adults in Norway highlights that living arrangements, urbanization level, and income source are significant risk factors for suicide among older adults. Interventions to improve social connectedness, with a focus on the urban-rural divide, could potentially reduce suicide risk. Sex and age categories should be considered in future research and when implementing preventive measures.

Anna Torp Johansen, Sissel Marguerite Bélanger, Anne Reneflot, Erlend Hem, Eivind Aakhus, Carine Øien-Ødegaard, Kim Stene-Larsen & Cecilie Bhandari Hartberg