Forskningsartikler

There is a focus on how to provide care for the increasing number of people with dementia, and day care services have been highlighted as an important service. The present study aims to provide an in-depth comparison of the emotional well-being of participants at farm-based and regular day care services related to different aspects of the care environments. We used the Maastricht Electronic Daily Life Observation-tool to observe and register aspects of the care environment at the services. Observations took place at ten farm-based day care services, with 42 participants, and seven regular day care centres, with 46 participants. Observed mood was considered an indicator for the emotional well-being of the participants and used as the primary outcome. The analyses showed a general positive mood for all participants, regardless of type of day care service. The unadjusted analyses showed more emotional well-being for the participants at farm-based day care across a range of factors compared to regular day care. The linear mixed model found that regardless of service type the activities (1) exercise and dancing, and (2) quiz, music and spiritual activities were associated with emotional well-being. In addition, social interaction, either with one person or two or more people, were also associated with emotional well-being regardless of service type. The mixed model further demonstrated an association between attending farm-based day care services and positive mood compared to regular day care services. Based on the findings social interaction and social activities seem important to emotional well-being. This highlights the social aspect of the day care services and future research should investigate how one can facilitate good social interactions at day care services. The positive association between farm-based day care services and emotional well-being may potentially reflect a positive influence of the farm setting and the farm service providers.

Bjørnar Finnanger-Garshol, Ingeborg Pedersen, Grete Patil, Siren Eriksen, Lina Harvold Ellingsen-Dalskau

Background/aims: The aim was to explore the impact of sex on prevalence, patterns and trends in the prescription of psychotropics and analgesics in users of acetylcholinesterase inhibitors (AChEIs), before and after AChEI initiation, compared to the general population.

Methods: A prospective study applying data from the Norwegian Prescription Database (NorPD) in the period 2004-2016. Prescription of antidepressants, antipsychotics, analgesics including opioids, benzodiazepines and z-hypnotics in persistent AChEI users was studied in a follow-up period from four years before to two years after AChEI initiation in men and women of four age groups: 37-64, 65-72, 73-80 and 81-88 years.

Results: Use of antidepressants, antipsychotics and weaker analgesics increased in both sexes during the follow-up period in 11.764 persistent AChEI users. Women with pre-dementia and dementia stages of AD showed a prescription pattern with more use of psychotropics and opioids than men, except for antipsychotics.

Conclusion: Female sex showed to have a significant influence on the prescriptions of psychotropics and analgesics in AD patients in a pre-dementia and dementia stage. The exception is for antipsychotics, that men used more than women. The prescription pattern showed a higher extent of polypharmacy of psychotropics and/or opioids in women than in men. The total prescription pattern of analgesics could indicate an undertreatment of pain in pre-dementia and dementia stages, most pronounced in men.

Anne Sverdrup Efjestad, Hege Ihle-Hansen, Vidar Hjellvik, Knut Engedal, Hege Salvesen Blix

Background: In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription.

Methods: We used data from the Resource Use and Disease Course in Dementia – Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period.

Results: PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%-42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92-0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85-0.94, p < 0.001).

Conclusions: PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs.

Enrico Callegari, Jūratė Šaltytė Benth, Geir Selbæk, Cato Grønnerød, Sverre Bergh

Abstract:
Background: Ongoing shifts in economic structure from automation and globalisation can affect employment and mortality, yet these relations are not well described.

Objective: We assess whether long-term employment and health outcomes relate systematically to structural change in the labour market, using the occupational Routine Task Intensity (RTI) score as indicator of exposure is to risks of outsourcing and technology-induced job loss.

Methods: Using a cohort design and administrative data with national population coverage, we categorise all Norwegian employees in 2003 by the RTI score of their occupation and examine how this score correlates with employment and health outcomes measured in 2018 and 2019. The study sample counts 416 003 men and 376 413 women aged 33-52 in 2003.

Results: The occupational RTI score at baseline is robustly associated with long-term employment, disability and mortality outcomes. Raw correlations are reduced after adjustment for potential confounders, but associations remain substantial in models controlling for individual covariates and in sibling comparisons. Working in an occupation with RTI score 1 SD above the mean in 2003 is associated with a raised probability of being deceased in 2019 of 0.24 percentage points (95% CI: 0.18 to 0.30) for men and 0.13 percentage points (95% CI: 0.02 to 0.24) for women, corresponding to raised mortality rates of 6.7% and 5.5%.

Conclusions: Individuals in occupations characterised by high routine intensity are less likely to remain employed in the long term, and have higher rates of disability and mortality.

Bernt Bratsberg, Ole Rogeberg, Vegard Skirbekk

Objective: The main objective of this study was to explore how health care professionals experience adaptation of user-involvement for people with dementia receiving health and social care.

Method: A qualitative explorative design was used with eight focus groups as the method of data collection. A total of 49 health care professionals were included representing a variety of professions, municipal and specialized health services, and all health regions of Norway. The transcribed focus group interviews were analyzed using qualitative content analysis following six steps to identify categories and the overall theme.

Results: Six main categories were identified: 1) facilitation of self-determination, 2) challenges of reduced or lack of awareness, 3) family caregivers’ concern and protection, 4) open communication, 5) establishing a trustworthy relationship, and 6) clarifying expectations. To maintain independent lives for people with dementia, health care professionals must facilitate and support shared decision-making using an open and trustworthy communication.

Conclusion: To facilitate user-involvement, health care professionals need to develop and implement strategies that consider the perspectives of people with dementia and support the relationship between people with dementia and their informal caregivers.

Anne Marie Mork Rokstad, Siren Eriksen, Guro Hanevold Bjørkløf

Background and purpose: Persons with mild cognitive impairment (MCI) and Alzheimer dementia (AD) often experience gait and balance disturbances and depressive symptoms alongside their cognitive impairment. The aim of this study was to explore the relationship between mobility and depressive symptoms in community-dwelling persons with MCI and mild to moderate AD.
Methods: Ninety-nine participants with MCI and AD from the memory clinic at Oslo University Hospital, Ullevål, Norway, were included. The Balance Evaluation Systems Test (BESTest), 10-m walk test regular (gait speed), and dual task (naming animals, dual-task cost in percent) were used to assess mobility. The Cornell Scale for Depression in Dementia, with validated cut-off 5/6 points, was used to assess presence of depressive symptoms. Multiple regression analysis was used to explore the relationship between mobility (3 separate models) and depressive symptoms, controlled for demographic factors, comorbidity, and Mini-Mental State Examination.
Results: One-third of the participants had depressive symptoms, mean (SD) gait speed was 1.09 (0.3) m/s, and median (interquartile range) BESTest percent score was 81.5 (17.6). No statistically significant associations were found between depression and BESTest, gait speed or dual-task cost, neither in the simple models (P = 0.15-0.85), nor in the 3 multivariate models (P = 0.57-0.69).

Discussion and conclusions: In this study, we found no associations between mobility and depressive symptoms in persons with MCI and AD recruited at a memory clinic. Few participants had major symptoms of depression, which may have influenced the results. Longitudinal studies are needed to explore the long-time associations between mobility and depression.

Susannah Julie Flugon, Nina Jøranson, Gro Gujord Tangen