Forskningsartikler

Background: The coronavirus disease 2019 (COVID-19) pandemic had significant consequences for relatives’ opportunities to communicate with and offer care to seriously ill and dying nursing home residents with COVID-19. Residents in nursing homes were urged to protect themselves through social distancing, and visits have been permanently regulated and limited. These restrictions have been challenging, and the limitations have raised many questions and led to difficult choices. The aim of this study was to explore the experiences of relatives of nursing home residents with COVID-19. We investigated the following two research questions: How did relatives of COVID-19 patients in Norwegian nursing homes experience the situation and how did the physical distancing and precepts of infection control affect the relationship between the long-term residents and the relatives?

Methods: The study has a qualitative explorative design with a phenomenological-hermeneutic approach, with individual in-depth interviews used for data collection. The study included ten relatives of nursing home residents with COVID-19.

Results: Three main perspectives were identified from the participants’ experiences: (1) the difficult choices; (2) maintaining the relationship; and (3) experiencing support. The relatives experienced ethical dilemmas when weighing the risk of getting COVID-19 if they visited the patient versus the consequences of not visiting their loved one. In this situation, they needed good information and support from health care professionals.

Conclusion: To enable relatives of COVID-19 patients to make choices in line with their goals and intrinsic motivations, it is important that staff members possess competence in infection control, updated knowledge about the residents’ situations, and the skills to facilitate a safe and confident dialogue. Trust in the care staff and a feeling of safety are essential for relatives in a stressful situation with difficult choices, while a lack of confidence, routines, and/or dialogue might increase relatives’ feelings of insecurity and stress and make their caring role difficult.

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

Background
Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions.

Methods
Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records.

Results
We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91–0.99) per year), female gender (2.17 (1.15–4.00)) and higher MMSE score (1.03 (1.00–1.06) per point) were significant risk factors for readmission.

Conclusions
Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.

Marte Sofie Wang-Hansen , Hege Kersten, Jūratė Šaltytė Benth, Torgeir Bruun Wyller

Abstract:

Background: A systematic assessment of problems that are frequent in older age (geriatric assessment [GA]) provides prognostic information for patients undergoing cancer surgery and systemic cancer treatment. We aimed to investigate the prevalence of geriatric impairments and their impact on survival in older patients with cancer receiving radiotherapy (RT).

Material and methods: A single-centre prospective observational study was conducted including patients ≥65 years referred for curative or palliative RT. Prior to RT, we performed a modified GA (mGA) assessing comorbidities, medications, nutritional status basic- and instrumental activities of daily living (IADL) mobility, falls, cognition and depressive symptoms. Impairments in each mGA domain were defined. Overall survival (OS) was presented by Kaplan Meier plots for groups defined according to the number of impairments, and compared by log-rank test. The association between mGA domains and OS was assessed by Cox proportional hazard regression analysis.

Results: Between February 2017 and July 2018, 301 patients were included, 142 (47.2%) were women. Mean age was 73.6 (SD 6.3) years, 162 (53.8%) received curative RT. During the median observation time of 24.2 months (min 0.3, max 25.9), 123 (40.9%) patients died. In the overall cohort, 49 (16.3%) patients had no geriatric impairment, 81 (26.9%) had four or more. OS significantly

decreased with an increasing number of impairments (p < .01). Nutritional status (HR 0.90, 95% CI [0.81; 0.99], p = .038) and IADL function (HR 0.98, 95% CI [0.95; 1.00], p = .027) were independent predictors of OS.

Conclusion: Geriatric impairments were frequent among older patients with cancer receiving RT and nutritional status and IADL function predicted OS. Targeted interventions to remediate modifiable impairments may have the potential to improve OS.

Guro Falk Eriksen, Jūratė Šaltytė Benth, Bjørn Henning Grønberg, Siri Rostoft, Lene Kirkhus, Øyvind Kirkevold, Anne Hjelstuen, Marit Slaaen

Abstract:
Background: There is a lack of standardization regarding how to assess and categorize alcohol intake in older adults. The aim of this study was to systematically review methods used in epidemiological studies to define drinking patterns and measure alcohol consumption among older adults.

Methods: A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, EMBASE, and CINAHL databases for studies published from January 2009 to April 2021. Studies were included if they were observational studies with a quantitative design; the mean age of the participants was ≥ 65 years; questionnaires, screening tools, or diagnostic tools were used to define alcohol consumption; and alcohol consumption was self-reported.

Results: Of 492 studies considered, 105 were included. Among the 105 studies, we detected 19 different drinking patterns, and each drinking pattern had a wide range of definitions. The drinking patterns abstaining from alcohol, current drinking, and risk drinking had seven, 12 and 21 diverse definitions, respectively. The most used questionnaire and screening tools were the quantity-frequency questionnaire, with a recall period of 12 months, and the full and short versions of the Alcohol Use Disorders Identification Test, respectively.

Conclusion: No consensus was found regarding methods used to assess, define, and measure alcohol consumption in older adults. Identical assessments and definitions must be developed to make valid comparisons of alcohol consumption in older adults. We recommend that alcohol surveys for older adults define the following drinking patterns: lifetime abstainers, former drinkers, current drinkers, risk drinking, and heavy episodic drinking. Standardized and valid definitions of risk drinking, and heavy episodic drinking should be developed. The expanded quantity-frequency questionnaire including three questions focused on drinking frequency, drinking volume, and heavy episodic drinking, with a recall period of 12 months, could be used.

Kjerstin Tevik, Sverre Bergh, Geir Selbæk, Aud Johannessen, Anne-S Helvik

Abstract:
Elevated peripheral expression of homocysteine (Hcy) is associated with an increased risk of coronary heart disease and stroke, diabetes, and cancer. It is also associated with cognitive impairment as it has been reported that high levels of Hcy cause cognitive dysfunction and memory deficit. Among several etiological factors that contribute to the pathogenesis of neurodegenerative diseases, including Alzheimer’s disease (AD), Hcy seems to directly contribute to the generation of neurotoxicity factors. This study aims to hypothesize the molecular mechanism by which exercise can reduce the risk of neurological complications promoted by hyperhomocysteinemia (HHcy), and discuss how exercise could reduce the risk of developing AD by using bioinformatics network models. According to the genes network, there are connections between proteins and amino acids associated with Hcy, exercise, and AD. Studies have evidenced that exercise may be one of several processes by which acid nitric availability can be maximized in the human body, which is particularly important in reducing cell loss and tau pathology and, thereby, leading to a reduced risk of complications associated with HHcy and AD.

Luana Lemos Leão, Laís Francielle Francisca Felício, Knut Engedal, Gro Gujord Tangen, Kari Midtbø Kristiansen, Sérgio Henrique Sousa Santos, Alfredo Maurício Batista de Paula, Renato Sobral Monteiro-Junior