Forskningsartikler

Abstract

Background: Frail people receiving home care services face an increased risk of developing crisis, which can result in adverse events, coercive measures, and acute institutionalisation. The prevalence of frailty is expected to increase due to the ageing population in most countries. However, our knowledge of the process leading to crises among frail community-dwelling patients remains limited. The aim of our study was to explore how users of home care services and their next of kin experienced crises and how these crises were approached by home care services.

Methods: A qualitative explorative design with 21 interviews was conducted. We explored crises within the last year that had led to an acute institutionalisation (hospital or nursing home) or to an unstable situation with high risk of institutionalisation. Systematic text condensation (STC) was used to analyse the data.

Results: Our findings are summarised into one overarching theme; an organisation working mainly reactively instead of proactively, which is supported by four subthemes: (1) insufficient communication-a determinant of crises, (2) the lack of a holistic approach, (3) a sense of being a burden, and (4) the complexity of crises. The reactive approach is demonstrated in the participant’s experience of insufficient communication and the lack of a holistic approach from the service, but also in the user’s sense of being a burden, which seems to be reinforced by the experienced busyness from the staff in the home care services. This reactive approach to crises seems to have contributed to difficulties in detecting the various stressors involved in the complex process leading to crisis.

Conclusions: Our findings suggest that home care services tend to be characterised by a reactive approach to rising instability and the development of crises for users. This can be interpreted as an emergent property of the organisation and the adaptation towards exceeding demands due to insufficient capacity in health care services. We recommend the use of multicomponent care programmes comprising interdisciplinary case conferences in home care services to implement a cultural change that can shift the service from a reactive, fragmented, and task-oriented approach to a more proactive approach.

Janne Myhre, Sverre Bergh, Øyvind Kirkevold and Bjørn Lichtwarck

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

Abstract

Hand grip strength (HGS) is a key indicator of intrinsic capacity and has shown good predictive ability for morbidity and mortality. Reference values from normative populations are valuable, and such data from the Norwegian population are scarce. Normative values for the digital Jamar+ dynamometer are largely lacking. HGS was assessed in the Norwegian Tromsø study, survey 7 in 2015-2016 for 7824 participants (9324 invited) aged 40+ using a Jamar+ digital dynamometer, and three measurements for each hand were performed following the Southampton protocol. To account for non-response, full Tromsø population data, by age, education and sex, were collected from registry data from microdata.no, a service from Statistics Norway, and were then used as post-stratification weights, to provide standardized HGS values. HGS was higher in men than in women and inversely associated with age. Men and women with a history of non-communicable diseases had lower HGS than those without these conditions, while osteoarthritis was associated with lower HGS only among men. Lower height was associated with lower HGS, especially at younger ages in men. This article provides up-to-date references values for HGS in the community-dwelling population aged 40+ with or without osteoarthritis or non-communicable diseases, in Tromsø, Norway. These reference values will guide clinicians and researchers.

Odd-Einar Svinøy, Gunvor Hilde, Astrid Bergland, Bjørn Heine Strand

Background: Malnutrition is common in older adults and is associated with increased morbidity and mortality rates.

Aim: The aim of the study is to describe the prevalence of malnutrition based on low BMI, involuntary weight loss, and reduced food intake, in a Norwegian population of community-dwelling older adults and older adults living in nursing homes.

Methods: This population-based study is part of the fourth wave of the Trøndelag Health Study (HUNT4) and includes participants ≥70 years from the HUNT4 70+ cohort. The HUNT4 70+ cohort consist of 9 930 (response rate 51.2 %) participants. In the current study 8 127 older people had complete dataset for inclusion in the analyses. Participants completed a self-report questionnaire and standardised interviews and clinical assessments at field stations, in participants’ homes or at nursing homes. Malnutrition was defined using the following criteria: low BMI, involuntary weight loss and severely reduced food intake. The standardised prevalence of malnutrition was estimated using inverse probability weighting (IPW) with weights for sex, age and education of the total population in the catchment area of HUNT.

Results: Of the 8 127 included participants, 7 671 (94.4 %) met at field stations, 356 (4.4 %) were examined in their home, and 100 (1.2 %) in nursing homes. In total, 14.3 % of the population were malnourished based on either low BMI, weight loss, or reduced food intake, of which low BMI was the most frequently fulfilled criterion. The prevalence of malnutrition was less common among men than among women (10.1 vs 18.0 %, p < 0.001), also after adjustment for age (OR 0.53, 95 % confidence interval (CI) 0.46-0.60). The prevalence increased gradually with increasing age and the regression analysis adjusted for sex showed that for each year increase in age the prevalence of malnutrition increased with 4.0 % (OR 1.04, 95 % CI 1.03-1.05). The prevalence was higher both among older adults examined in their homes (26.4%) and residents in nursing home (23.6%), as compared to community-dwelling older adults who met at field stations (13.5%).

Conclusion: The prevalence of malnutrition is high in the older population. Special attention on prevention and treatment of malnutrition should be given to older women, the oldest age groups, and care-dependent community-dwelling older adults and nursing home residents.

Marit Kolberg, Ingvild Paur, Yi-Qian Sun, Linda Gjøra, Håvard Kjesbu Skjellegrind, Pernille Thingstad, Bjørn Heine Strand, Geir Selbæk, Tone Natland Fagerhaug & Lene Thoresen

Abstract

The aging population and increasing evidence of the detrimental health impacts of loneliness emphasize the importance of studying and predicting changes in loneliness prevalence among older adults. To understand and project changes in loneliness over time, we examined 35-year trends in adults aged 70 and older, considering factors such as sex, age, and living situation. Cross-sectional data from 27,032 home-dwelling adults aged 70 years and older who participated in at least one of the four Norwegian HUNT surveys from 1984 to 2019, and Norwegian population data from Statistics Norway were used for the analyses. Loneliness was self-reported, and the prevalence of loneliness was standardized to the Norwegian population at the survey year by age and sex. The results showed that the prevalence of loneliness significantly decreased between each survey. The higher categories of loneliness (a good amount, very much) decreased, from 11.4% (1995-97), 6.7% (2006-08), and 5.8% (2017-19). Across surveys, loneliness was significantly more common among women, the oldest, and those living alone. The prevalence of loneliness among the oldest adults living alone increased from 2006 to 2019. The gradual decline in loneliness observed from 1995 to 2019 coincided with notable societal changes in Norway. We estimated that the number of older adults experiencing loneliness in Norway could rise from 184,000 in 2020 to 286,000 in 2035, and potentially reach 380,000 in 2050.

Ragnhild Holmberg Aunsmo, Ellen Melbye Langballe, Thomas Hansen, Geir Selbæk & Bjørn Heine Strand

Abstract

Evidence suggests that in old age, women are lonelier than men. Gender differences in loneliness are often explained by gender differences in longevity, social status and loss, health, and mobility-well-established predictors that may influence loneliness differently in “younger” (40-59 years) and “older” (60-80 years) groups of men and women in the second part of life. This study explores loneliness in men and women ages 40 to 80 years at baseline over a 15-year period using panel data from three waves of the Norwegian Life Course, Ageing and Generation Study (N = 2,315). Our analyses show that women were more lonely than men also in adjusted analyses. Logistic regression analyses indicated that loss of a partner and poor mental health are prospectively related to loneliness among men and women, whereas other factors like becoming a partner, stable singlehood, and poor physical health were related to loneliness among women but not men.

Magnhild Nicolaisen og Kirsten Thorsen

Abstract

Background: Pre-frailty is an intermediate, potentially reversible state before the onset of frailty. Healthy dietary choices may prevent pre-frailty. Fish is included in most healthy diets, but little is known about the association between long-term habitual fish intake and pre-frailty. We aimed to elucidate the longitudinal association between the frequency of fish intake and pre-frailty in a cohort of older adults in Norway.

Methods: 4350 participants (52% women, ≥65 years at follow-up) were included in this prospective cohort study. Data was obtained from three waves of the population-based Tromsø Study in Norway; Tromsø4 (1994–1995), Tromsø6 (2007–2008) and Tromsø7 (follow-up, 2015–2016). Frailty status at follow-up was defined by a modified version of Fried’s phenotype. Fish intake was self-reported in the three surveys and assessed as three levels of frequency of intake: low (0–3 times/month), medium (1–3 times/week) and high (≥ 4 times/week). The fish–pre-frailty association was analysed using multivariable logistic regression in two ways; (1) frequency of intake of lean, fatty and total fish in Tromsø6 and pre-frailty at follow-up, and (2) patterns of total fish intake across the three surveys and pre-frailty at follow-up.

Results: At follow-up, 28% (n = 1124) were pre-frail. Participants with a higher frequency of lean, fatty and total fish intake had 28% (odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.53, 0.97), 37% (OR = 0.63, 95% CI = 0.43, 0.91) and 31% (OR = 0.69, 95% CI = 0.52, 0.91) lower odds of pre-frailty 8 years later compared with those with a low intake, respectively. A pattern of stable high fish intake over 21 years was associated with 41% (OR = 0.59, 95% CI = 0.38, 0.91) lower odds of pre-frailty compared with a stable low intake.

Conclusions: A higher frequency of intake of lean, fatty and total fish, and a pattern of consistent frequent fish intake over time, were associated with lower odds of pre-frailty in older community-dwelling Norwegian adults. These results emphasise the important role of fish in a healthy diet and that a frequent fish intake should be promoted to facilitate healthy ageing.

Dina Moxness Konglevoll, Lene Frost Andersen, Laila Arnesdatter Hopstock, Bjørn Heine Strand, Magne Thoresen, Torunn Holm Totland, Anette Hjartåker & Monica Hauger Carlsen

Abstract

Background: Research shows that retirement age is associated with later-life cognition but has not sufficiently distinguished between retirement pathways. We examined how retirement age was associated with later-life dementia and mild cognitive impairment (MCI) for people who retired via the disability pathway (received a disability pension prior to old-age pension eligibility) and those who retired via the standard pathway.

Methods: The study sample comprised 7210 participants from the Norwegian Trøndelag Health Study (HUNT4 70+, 2017–2019) who had worked for at least one year in 1967–2019, worked until age 55+, and retired before HUNT4. Dementia and MCI were clinically assessed in HUNT4 70+ when participants were aged 69–85 years. Historical data on participants’ retirement age and pathway were retrieved from population registers. We used multinomial regression to assess the dementia/MCI risk for women and men retiring via the disability pathway, or early (<67 years), on-time (age 67, old-age pension eligibility) or late (age 68+) via the standard pathway.

Results: In our study sample, 9.5% had dementia, 35.3% had MCI, and 28.1% retired via the disability pathway. The disability retirement group had an elevated risk of dementia compared to the on-time standard retirement group (relative risk ratio [RRR]: 1.64, 95% CI 1.14–2.37 for women, 1.70, 95% CI 1.17–2.48 for men). MCI risk was lower among men who retired late versus on-time (RRR, 0.76, 95% CI 0.61–0.95).

Conclusion: Disability retirees should be monitored more closely, and preventive policies should be considered to minimize the dementia risk observed among this group of retirees.

Ekaterina Zotcheva, Bjørn Heine Strand, Catherine E. Bowen, Bernt Bratsberg, Astanand Jugessur, Bo Lars Engdahl, Geir Selbæk, Hans-Peter Kohler, Jennifer R. Harris, Jordan Weiss, Maja Weemes Grøtting, Sarah E. Tom, Steinar Krokstad, Yaakov Stern, Asta Kristine Håberg, Vegard Skirbekk