Forskningsartikler

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

Abstarct:

Background: As life expectancy increases, the incidence of age-related chronic health conditions and functional decline rises, increasing the need for institutional long-term care such as nursing homes. In Norway, 84% of nursing home residents have mild cognitive impairment or dementia. This population is characterized by a high burden of neuropsychiatric symptoms (NPS), which contribute to limited physical activity (PA) and a largely sedentary lifestyle. Regular PA is essential for maintaining physical function (PF) and independence, yet nursing home residents spend most of their time being sedentary. The present study aims to explore sensor-based measured PA patterns and investigate how PA is associated with NPS and PF in nursing home residents.

Methods: This cross-sectional study used data from the fourth wave of the population-based Trøndelag Health Study 70-years-and-older cohort (HUNT4 70+), including activity data from a total of 163 nursing home residents. PA was measured using two accelerometers placed on the lower back and thigh. PA patterns were described through the activity types walking, standing, sitting, and lying, activity bouts, and transitions. NPS was assessed using the Nursing Home Version of the Neuropsychiatric Inventory (NPI-NH), and PF using the Short Physical Performance Battery (SPPB). All outcome variables were grouped based on cognitive impairment and dementia severity, set by clinical experts using the DSM-5 diagnostic criteria and the Clinical Dementia Rating (CDR) scale.

Results: Participants’ mean age was 87.8 years, and 62% were female. With a daily average of 17.6 min walking, 1.1 h standing, 9.9 h sitting, and 12.7 h lying, our nursing home residents spent approximately 94% of the day being sedentary. Walking and standing appeared predominantly in bouts under 10 min across cognitive impairment and dementia severity. No association was found between time spent walking, standing, sitting, lying and transitions from sedentary behavior to activity with NPS. Time spent walking, standing, lying and transitions from sedentary behavior to activity was significantly associated with PF.

Conclusions: PA mainly occurred in bouts shorter than 10 min and sitting and lying accounted for most of the daily behavior. No association was detected between time spent in different activities and NPS. Although time spent walking and standing was limited in all groups, it showed an association with PF. This may suggest that even small amounts of PA play a significant role in maintaining or improving physical capabilities in nursing home residents.

Stine Øverengen Trollebø, Karen Sverdrup, Atle Skjelbred, Kristin Taraldsen, Ellen Marie Bardal, Nina Skjæret-Maroni

ABSTRACT

Objectives:
The study aims to conduct a systematic review of peer-reviewed articles about psychosocial interventions to reduce the caregiver burden in family caregivers of people with dementia to explore the effectiveness and the type of intervention and methodology used.

Methods:
Five databases were searched (AgeLine, CINAHL, MEDLINE, PsycINFO, PubMed) for studies reporting on experimental research of psychosocial interventions for dementia-related caregiver burden. Data quality checks were completed for included papers.

Results:
Forty-three studies were included in the analysis; about half of them (n = 24) were randomized controlled trials. The types of interventions most often used were psychoeducation (n = 21) and multi-component interventions (n = 12). The caregiver burden was after the intervention successfully reduced in about half of the studies (n = 19). Additionally, 10 studies had success in reducing caregiving burden in one of several assessment measures used. The studies using psychoeducation (57%) and multi-component (58%) intervention approaches had the highest success rates.

Conclusion:
Health professionals should be encouraged to implement psychosocial interventions for caregivers of patients with dementia.

Hande Kirisik Surer, Nilufer Korkmaz Yaylagul & Anne-Sofie Helvik