Forskningsartikler

Background
Physical activity (PA) is imperative for healthy ageing and is a modifiable lifestyle factor. Accurate, clinically meaningful estimates of daily PA among older adults can inform targeted interventions to maintain function and independence. This study describes daily PA in older adults across levels of care as a first step contributing to the limited evidence on potential associations between PA and the use of care services.

Methods
This study used data from the Trondheim 70 + cohort in the population-based Norwegian HUNT Study. In total, 1042 participants aged 70 years or older with valid activity data were included. PA was assessed using two accelerometers over 7 consecutive days and was classified into PA (walking, standing, running, and cycling) and sedentary behavior (sitting and lying). Data on received care services were retrieved from municipal registers and participants were classified into four levels of care: 1) independently living (81.9%), 2) independently living with low-level home care services (6.5%), 3) recipients of home care services (6.0%), and 4) nursing home residents (5.7%). Time spent in the activity types and duration of bouts are presented across levels of care.

Results
Participants mean age was 77.5 years (range: 70.1–105.4, 55% female) and PA was lower with higher age. Across levels of care, significant group differences were found in the total time spent in PA, particularly in walking and standing. Daily PA, duration of active bouts, and number of daily walking bouts were lower for participants receiving higher levels of care. Standing was the dominant type of PA and walking appeared predominantly in short bouts at all care levels.

Conclusions
This is the first population-based study using device-measured PA to describe daily PA across levels of care. The results showed that low-intensity activities constitute the primary component of everyday PA, advocating for placing greater emphasis on the significant role these activities play in maintaining daily PA at older age. Furthermore, the study demonstrated that activity types and bout durations are related to the ability to live independently among older adults. Overall, these findings can contribute to better target interventions to maintain function and independence in older adults.

Astrid Ustad, Karen Sverdrup, Gro Gujord Tangen, Øystein Døhl, Beatrix Vereijken, Pernille Thingstad, Nina Skjæret-Maroni

Abstract

The Assisted Living project (2016-2019) aimed to investigate older adults’ needs for digital technology for daily support and to develop technology solutions in collaboration with the user group. This paper presents data extracted from three sub-studies: Sub-study 1 investigated older homecare recipients’ use of and attitudes towards digital technology, sub-study 2 explored assisted living residents’ needs and requirements for technology, and sub-study 3 explored their experiences with environmental sensor technology to support safety and daily living. The aim was to explore how the occupational science concepts of doing, being, belonging, and becoming can provide a deeper understanding of technology use among participants in the Assisted Living Project. This study demonstrates that for older adults in the Assisted Living project to become technology users required both personal motivation and cognitive capacity for learning to use the device and become familiar with the technology, and access to internet and digital tools. Digitalization in society leads to new challenges for all citizens, especially those who are less familiar with using digital technology. By applying an occupational science perspective to technology use, this paper contributes to creating awareness about digital exclusion and occupational injustice. It provides a deeper understanding of use and non-use and the digital divide, such as the consequences of not having access to digital healthcare services, that may lead to breaches of democratic human rights.

Torhild Holthe, Liv Halvorsrud & Anne Lund

Abstract

Background/aims: The number of patients suffering from cognitive decline and dementia increases, and new possible treatments are being developed. Thus, the need for time efficient and cost-effective methods to facilitate an early diagnosis and prediction of future cognitive decline in patients with early cognitive symptoms is becoming increasingly important. The aim of this study was to evaluate whether an MRI based software, NeuroQuant® (NQ), producing volumetry of the hippocampus and whole brain volume (WBV) could predict: (1) conversion from subjective cognitive decline (SCD) at baseline to mild cognitive impairment (MCI) or dementia at follow-up, and from MCI at baseline to dementia at follow-up and (2) progression of cognitive and functional decline defined as an annual increase in the Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) score.

Methods: MRI was performed in 156 patients with SCD or MCI from the memory clinic at Oslo University Hospital (OUH) that had been assessed with NQ and had a clinical follow-up examination. Logistic and linear regression analyses were performed with hippocampus volume and WBV as independent variables, and conversion or progression as dependent variables, adjusting for demographic and other relevant covariates including Mini-Mental State Examination-Norwegian Revised Version score (MMSE-NR) and Apolipoprotein E ɛ4 (APOE ɛ4) carrier status.

Results: Hippocampus volume, but not WBV, was associated with conversion to MCI or dementia, but neither were associated with conversion when adjusting for MMSE-NR. Both hippocampus volume and WBV were associated with progression as measured by the annual change in CDR-SB score in both unadjusted and adjusted analyses.

Conclusion: The results indicate that automated regional MRI volumetry of the hippocampus and WBV can be useful in predicting further cognitive decline in patients with early cognitive symptoms.

Rachel Amland, Geir Selbæk, Anne Brækhus, Trine H. Edwin, Knut Engedal, Anne-Brita Knapskog, Ellen Regine Olsrud, & Karin Persson

Abstract

Background: High blood pressure and poor cardiorespiratory fitness are independent risk factors for dementia. However, few studies have examined if combined longitudinal patterns of these modifiable risk factors are associated with dementia risk.

Methods: In this prospective cohort study, we used data from the population-based HUNT Study, Norway. We applied group-based multidimensional trajectory modeling to identify age-specific multidimensional trajectories of SBP, DBP and estimated cardiorespiratory fitness across three surveys (HUNT1, 1984-86 – HUNT3, 2006-08). Dementia was diagnosed in the HUNT4 70+ substudy in 2017-19. We used multivariate logistic regression to estimate odds ratios (ORs) and risk differences (RDs) of dementia.

Results: In total, 7594 participants (54.9% women) were included, with a mean age of 44.7 (SD 6.3) years at HUNT1. Dementia was diagnosed in 1062 (14.0%) participants. We identified two multidimensional trajectories throughout adulthood within three age groups: one with higher SBP and DBP, and lower estimated cardiorespiratory fitness (the poorer group), and one with lower SBP and DBP, and higher cardiorespiratory fitness (the better group). After adjustment for sex, APOE ε4 status, education, marital status and diabetes, the better group had consistently lower risk of dementia in all age groups with the lowest OR in the middle-aged group of 0.63 (95% CI 0.51, 0.78) with corresponding RD of -0.07 (95% CI -0.10, -0.04).

Conclusions: Having a beneficial multidimensional trajectory of SBP, DBP and cardiorespiratory fitness in adulthood was associated with reduced dementia risk. Aiming for optimal SBP, DBP and estimated cardiorespiratory fitness throughout adulthood may reduce dementia risk.

Maren Lerfald, Heather Allore, Tom I L Nilsen, Rannveig S Eldholm, Nicolas Martinez-Velilla, Geir Selbæk & Linda Ernstsen

Abstract

Purpose: Coronavirus disease 2019 (COVID-19) placed a significant strain on nursing homes, leading to numerous outbreaks and high mortality rates. This situation created considerable stress and challenges for residents, their physicians and nurses, as well as family caregivers. By understanding these challenges, we can gain new insights and learn valuable lessons. Thus, the purpose of this study is to examine the treatment and care provided to nursing home residents with COVID-19, as experienced by physicians, nurses, and family caregivers.

Participants and Methods: This study is a secondary analysis of 35 interviews with physicians, nurses, and family caregivers, each with personal experience caring for nursing home residents diagnosed with COVID-19. The interviews took place from December 2020 to April 2021. We analyzed the transcriptions based on Braun and Clarke’s reflexive thematic analysis model and followed a qualitative descriptive design as outlined by Sandelowski.

Findings: The analysis produced three themes: 1) Balancing medical treatment, 2) The need for increased systematic monitoring of vital functions, and 3) Determining the treatment level for nursing home residents. These themes were explored through the unique perspectives of the three participant groups: physicians, nurses, and family caregivers. The findings revealed several challenges related to treatment and care for nursing home residents diagnosed with COVID-19. This applied both to relief of symptoms, monitoring of vital functions, assessment of treatment level and use of advance care planning.

Conclusion: Drawing from the experiences of physicians, nurses, and family caregivers, there should be a unified plan at the municipal or national level for competency development in nursing homes to prepare for future crises like pandemics or epidemics. Additionally, the safe engagement of family caregivers and relatives should be given priority.

Anita Nilsen, Siren Eriksen, Bjørn Lichtwarck, Adelheid Hummelvoll Hillestad, Signe Gunn Julnes, Signe Tretteteig & Anne Marie Mork Rokstad

Abstract
Spousal bereavement is associated with health declines and increased mortality risk, but its specific impact on physical and cognitive capabilities is less studied. A historical cohort study design was applied including married Tromsø study participants (N=5739) aged 50-70 years with baseline self-reported overall health and health-related factors and measured capability (grip strength, finger tapping, digit symbol coding, and short-term recall) at follow-up. Participants had data from Tromsø4 (1994-1995) and Tromsø5 (2001), or Tromsø6 (2007-2008) and Tromsø7 (2015-2016). Propensity score matching, adjusted for baseline confounders (and baseline capability in a subset), was used to investigate whether spousal bereavement was associated with poorer subsequent capability. Spousal bereavement occurred for 6.2% on average 3.7 years (SD 2.0) before the capability assessment. There were no significant bereavement effects on subsequent grip strength, immediate recall, or finger-tapping speed. Without adjustment for baseline digit symbol coding test performance, there was a negative significant effect on the digit symbol coding test (ATT -1.33; 95% confidence interval -2.57, -0.10), but when baseline digit symbol coding test performance was taken into account in a smaller subsample, using the same set of matching confounders, there was no longer any association (in the subsample ATT changed from -1.29 (95% CI -3.38, 0.80) to -0.04 (95% CI -1.83, 1.75). The results in our study suggest that spousal bereavement does not have long-term effects on the intrinsic capacity components physical or cognition capability to a notable degree.

Bjørn Heine Strand, Asta K Håberg, Harpa Sif Eyjólfsdóttir, Almar Kok, Vegard Skirbekk, Oliver Huxhold, Gøril Kvamme Løset, Carin Lennartsson, Henrik Schirmer, Katharina Herlofson, Marijke Veenstra

Background
Geriatric assessment and management (GAM) improve outcomes in older patients with cancer treated with surgery or chemotherapy. It is unclear whether GAM may provide better function and quality of life (QoL), or be cost-effective, in a radiotherapy (RT) setting.

Methods
In this Norwegian cluster-randomised controlled pilot study, we assessed the impact of a GAM intervention involving specialist and primary health services. It was initiated in-hospital at the start of RT by assessing somatic and mental health, function, and social situation, followed by individually adapted management plans and systematic follow-up in the municipalities until 8 weeks after the end of RT, managed by municipal nurses as patients’ care coordinators. Thirty-two municipal/city districts were 1:1 randomised to intervention or conventional care. Patients with cancer ≥ 65 years, referred for RT, were enrolled irrespective of cancer type, treatment intent, and frailty status, and followed the allocation of their residential district. The primary outcome was physical function measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Secondary outcomes were overall quality of life (QoL), physical performance, use and costs of health services. Analyses followed the intention-to-treat principle. Study registration at ClinicalTrials.gov ID NCT03881137.

Results
We included 178 patients, 89 in each group with comparable age (mean 74.1), sex (female 38.2%), and Edmonton Frail Scale scores (mean 3.4 [scale 0–17], scores 0–3 [fit] in 57%). More intervention patients received curative RT (76.4 vs 61.8%), had higher irradiation doses (mean 54.1 vs 45.5 Gy), and longer lasting RT (mean 4.4 vs 3.6 weeks). The primary outcome was completed by 91% (intervention) vs 88% (control) of patients. No significant differences between groups on predefined outcomes were observed. GAM costs represented 3% of health service costs for the intervention group during the study period.

Conclusions
In this heterogeneous cohort of older patients receiving RT, the majority was fit. We found no impact of the intervention on patient-centred outcomes or the cost of health services. Targeting a more homogeneous group of only pre-frail and frail patients is strongly recommended in future studies needed to clarify the role and organisation of GAM in RT settings.

Marit Slaaen, Inga Marie Røyset, Ingvild Saltvedt, Bjørn Henning Grønberg, Vidar Halsteinli, Øystein Døhl, Corinna Vossius, Øyvind Kirkevold, Sverre Bergh, Siri Rostoft, Line Oldervoll, Asta Bye, Line Melby, Tove Røsstad, Guro Falk Eriksen, May Ingvild Volungholen Sollid, Darryl Rolfson & Jūratė Šaltytė Benth

Background: Changes in alcohol consumption may affect older adults’ health. We examined prevalence and changes in the alcohol consumption of older women and men (≥65 years) in Norway over a 24-year period.

Methods: Data from three population-based health surveys (The Trøndelag Health Study-HUNT2 1995-97, HUNT3 2006-08, HUNT4 2017-19) were used. Alcohol consumption was measured using self-reported measures and an objective measure of alcohol consumption (Phosphatidylethanol 16:0/18:1, PEth). Self-reported lifetime abstinence, former drinking, current drinking, frequent drinking (≥4 times/week), and risk drinking (≥8 units/week) were measured. The PEth concentrations were stratified: <0.03 μmol/l (abstinence/very low level of alcohol consumption); >0.06 μmol/l (indicating >1 unit/day); >0.10 μmol/l (indicating >3 units/day), and >0.30 μmol/l (heavy alcohol consumption).

Results: In HUNT4, the prevalence of self-reported lifetime abstinence, frequent drinking, and risk drinking was 5.2%, 4.4%, and 5.6%, respectively, while prevalence of PEth <0.03 μmol/l was 68.1% and PEth >0.06 μmol/l was 21.2%. Over the course of the three surveys, the prevalence of self-reported lifetime abstinence decreased, while the prevalence of frequent drinking and risk drinking increased. Men were less often abstainers and more often frequent and risky drinkers than women in all three surveys. Gender differences for abstinence and current drinking reduced with time. From HUNT3 to HUNT4, the prevalence of PEth <0.03 μmol/l decreased, while the prevalence of PEth >0.06 μmol/l increased. Men compared to women, had less often PEth <0.03 μmol/l and more often PEth >0.06 and >0.10 μmol/l in HUNT3 and HUNT4. Women and men ≥75 years were just as likely to have PEth >0.30 μmol/l in HUNT4. The gender differences in PEth concentrations were reduced in HUNT4 among those aged 70-74 years or ≥75 years.

Conclusion: Alcohol consumption has increased among Norwegian older adults over a 24-year period, but at a slower pace during the last decade.

Kjerstin Tevik, Ragnhild Bergene Skråstad, Jūratė Šaltytė Benth, Geir Selbæk, Sverre Bergh, Rannveig Sakshaug Eldholm, Steinar Krokstad & Anne-Sofie Helvik