Forskningsartikler

Abstract

Background: Frailty in older people is a rising global health concern; therefore, monitoring prevalence estimates and presenting projections of future frailty are important for healthcare planning.

Aim: To present current prevalence estimates of frailty and pre-frailty and future projections according to both dominant frailty models in a large population-based observational study including adults ≥ 70 years in Norway.

Methods: In this population-based observational study, we included 9956 participants from the HUNT4 70 + study, conducting assessments at field stations, homes, and nursing homes. Frailty was assessed using Fried criteria and a 35-item frailty index (HUNT4-FI). Inverse probability weighting and calibration using post-stratification weights and aggregated register data for Norway according to age, sex, and education ensured representativeness, and population projection models were used to estimate future prevalence.

Results: According to Fried criteria, the current prevalence rates of frailty and pre-frailty in people ≥ 70 years were 10.6% and 41.9%, respectively, and for HUNT4-FI 35.8% and 33.2%, respectively. Compared to previous European estimates we identified higher overall frailty prevalence, but lower prevalence in younger age groups. Projections suggest the number of Norwegian older adults living with frailty will close to double by 2040.

Conclusion: Frailty in older people in Norway is more prevalent than previous European estimates, emphasising the imperative for effective interventions aimed to delay and postpone frailty and ensure healthcare system sustainability in an ageing population. Future planning should consider the great heterogeneity in health and functioning within the 70 + population.

Ingebjørg Lavrantsdatter Kyrdalen, Bjørn Heine Strand, Geir Selbæk, Pernille Thingstad, Heidi Ormstad, Emiel O Hoogendijk, Håvard Kjesbu Skjellegrind, Gro Gujord Tangen

Purpose
This study aims to characterize the experiences of health professionals participating in an exploratory randomized controlled trial designed to improve hearing and vision among older adults without dementia receiving the in-home health services provided by Norwegian municipalities.

Design/methodology/approach
Semistructured individual and paired interviews were conducted by nine health professionals from five municipalities to explore health professionals’ experiences with the intervention. The data were analyzed using content analysis.

Findings
Three main categories of experiences were identified: (1) participating in the intervention, (2) emerging new knowledge and (3) developing in-home health services. The mutual collaboration between health professionals and service recipients during the screening process led to a more-thorough understanding of the service recipients’ needs and resources, enabling personalized advice and guidance.

Research limitations/implications
In-home interventions have the potential to improve the quality of life of older adults with hearing and vision impairments. Given the promising outcomes of such interventions, future research should (1) investigate their effects on changes in behaviors and attitudes, (2) integrate technological advancements and (3) explore environmental modifications to further enhance the quality of life of older adults in various settings.

Practical implications
The health professionals in this study enjoyed assisting the service recipients in receiving in-home health services by screening their hearing, vision and indoor lighting conditions. The trial enabled the health professionals to provide personalized advice, and to motivate and guide the service recipients toward actions to remedy their impairments.

Social implications
The health professionals recommended hearing, vision and indoor lighting screening to be a routine municipal service because it would safeguard independence, prevent falling and maintain the quality of life of service recipients. However, additional resources are needed to implement these recommendations.

Originality/value
In-home interventions have the potential to improve the quality of life of older adults with hearing and vision impairments.

Gro Gade Haanes, Anne-Sofie Helvik, Aud Johannessen

Accepted: 08 Aug 2024. Provisionally accepted

Objective: The quality of the relationship between persons with dementia and family carers influences health and quality of life outcomes. Little is known regarding those at higher risk of experiencing a decline in relationship quality, who could potentially benefit the most from interventions. We aimed to identify these risk profiles and explore the underlying factors.

Methods: We applied a latent profile analysis to relationship quality data from a 1-year follow-up of 350 dyads of persons with dementia and their informal carers from the Actifcare cohort in eight European countries. Assessments included sociodemographic, clinical, functional, psychosocial and quality of life measures. Relationship quality was assessed with the Positive Affect Index. A discriminant analysis explored factors influencing the risk profiles.

Results: There were two relationship quality profiles among persons with dementia (gradually decreasing, 74.0%; low but improving, 24.6%) and two among carers (steadily poor, 57.7%; consistently positive, 42.3%). The ‘gradually decreasing’ profile (persons with dementia) was related to their levels of dependence and unmet needs, along with carers’ social distress and negative feelings, lower baseline RQ and sense of coherence. The ‘steadily poor’ profile (carers) was influenced by their social distress and negative feelings, lower sense of coherence and perceived social support. These two predominant profiles showed significant decreases in quality-of-life over one year.

Conclusions: Specific profiles of persons with dementia and their carers are at risk of worse relationship quality trajectories. By considering modifiable related factors (e.g., carers’ stress), our findings can help develop tailored, effective interventions.

Maria J. Marques, Bob Woods, Hannah Jelley, Liselot Kerpershoek, Louise Hopper, Kate Irving, Anja Bieber, Astrid Stephan, Anders Sköldunger, Britt‐Marie Sjölund, Geir Selbæk, Janne Røsvik, Orazio Zanetti, Daniel M. Portolani, João Marôco, Niels Janssen, Eva Y.L. Tan, Marjolein de Vugt, Frans Verhey og Manuel Gonçalves-Pereira

Abstract

Background: The Clock Drawing Test (CDT) is used to screen for Alzheimer’s disease and other dementia disorders. Normative scores on the version from the Montreal Cognitive Assessment (MoCA) do not exist in the Nordic countries.

Objective: To examine the normative scores of the CDT among adults aged 70 years and older.

Methods: We included 4,023 cognitively healthy persons aged 70-97 years from a population survey in Norway. They were examined with the CDT, which has a total score between zero and three. A multiple multinominal regression model was applied with a CDT score as the dependent categorical variable and estimated the probabilities of scoring a particular score, stratified by age, sex, and education. These probabilities correspond to an expected proportion of the normative population scoring at, or below a given percentile.

Results: None scored zero, 2.1% scored one, 14.9% scored two, and 83% scored three. Higher age, female sex and fewer years of schooling were associated with poorer performance. Scores of zero and one deviated from the normative score regardless of age, sex and education. A score of two was within the norm for a female older than 81 and a male older than 85.

Conclusions: The majority (83%) of people 70 years and older had a score of three on the CDT. Lower age, male sex, and higher education were associated with a better performance. Scores of zero and one were below the normative score. Except for the very old, a score of two was also well below the normative score.

Knut Engedal, Jūratė Šaltytė Benth, Jørgen Wagle, Linda Gjøra, Geir Selbæk, Karin Persson

Abstarct:

The cerebellum is linked to motor coordination, cognitive and affective processing, in addition to a wide range of clinical illnesses. To enable robust quantification of individual cerebellar anatomy relative to population norms, we mapped the normative development and aging of the cerebellum across the lifespan using brain scans of >54,000 participants. We estimated normative models at voxel-wise spatial precision, enabling integration with cerebellar atlases. Applying the normative models in independent samples revealed substantial heterogeneity within five clinical illnesses: autism spectrum disorder, mild cognitive impairment, Alzheimer disease, bipolar disorder, and schizophrenia. Notably, individuals with autism spectrum disorder and mild cognitive impairment exhibited increased positive and negative extreme deviations in cerebellar anatomy, while those with schizophrenia and Alzheimer disease showed predominantly negative deviations. Finally, extreme deviations were associated with cognitive scores. Our results provide a voxel-wise mapping of cerebellar anatomy across the human lifespan demonstrating the cerebellum’s nuanced role in different clinical illnesses.

Milin Kim, Esten Leonardsen, Saige Rutherford, Geir Selbæk, Karin Persson, Nils Eiel Steen, Olav B. Smeland, Torill Ueland, Geneviève Richard, Christian F. Beckmann, Andre F. Marquand, Ole A. Andreassen, Lars T. Westlye, Thomas Wolfers & Torgeir Moberget