Forskningsartikler

Abstract:

Introduction: Functional ability is vital for independent living. In this study, we explored functional trajectories of instrumental activities of daily living (IADL) and participation in working- or leisure activities (role function) in older adults undergoing radiotherapy (RT) and aimed to identify individuals at risk of functional decline.

Materials and methods: Patients were ≥ 65 years and received RT with curative or palliative intent. IADL was assessed by Nottingham Extended Activities of Daily Living (NEADL) scale at start and end of RT, and at 2, 8, and 16 weeks after treatment. Simultaneously, patients reported role function and symptoms using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Data were analysed by growth mixture modelling and linear mixed models.

Results: We included 258 patients, mean age 73.5 years, 129 (50%) were female, and 232 (89.9%) had an Eastern Cooperative Oncology Group performances status scale (PS) of 0-1. For both NEADL and the role function scale of the QLQ-C30, four groups with distinct trajectories were identified. The group with the poorest baseline scores showed a clinically significant decline. Patients in this group were older, had more geriatric impairments, poorer PS and received palliative RT. Fatigue, pain and loss of appetite were associated with poorer NEADL and role function scores during and after RT.

Discussion: Although most patients preserved their IADL and role function during RT treatment, patients with poor IADL and role function at the start of RT were at risk of further functional decline. This knowledge should be incorporated into treatment decision-makings. Geriatric impairments and symptom burden are important targets for supportive measures and should be identified and assessed both before and during treatment.

Heidi Marie Tjugum, Siri Rostoft, Jūratė Šaltytė Benth, May Ingvild Volungholen Sollid, Guro Falk Eriksen, Tom Borza, Bjørn Henning Grønberg, Sverre Bergh, Øyvind Kirkevold, Ola Berger Christiansen, Line Merethe Oldervoll, Asta Bye, Marit Slaaen

Abstract:

Background: Delirium is common and age, frailty and dementia are risk-factors. The pathophysiology is complex and poorly understood, but age-related immune system changes may be key. This study aimed to measure markers of immune cell migration, accelerated immune ageing and blood-brain barrier permeability in community-dwelling, older people comparing those who developed ≥1 episode of delirium over 2 years with those that did not.

Methods: Baseline samples were collected from CASCADE participants who were followed up for 2 years. Delirium screening was performed weekly; positive screens or hospital admission triggered a delirium assessment. Serum was isolated, stored and analysed using a multiplex panel comparing levels between participants with and without delirium episodes.

Results: About 98 participants were included. Median age was 88 (IQR: 81.8-92.0), with 90.8% classified as frail. Forty-three participants (43.9%) experienced ≥1 delirium episodes. CCL2 (MCP-1) and CXCL2 (MIP-2α), measured in a stable state at baseline, were significantly higher in the delirium group compared to the no delirium group (13.38 (11.21-17.93) vs. 10.83 (9.03-14.64) P = .004) and (17.23 (11.80-24.22) vs. 13.49 (10.19-17.98) P = .031), respectively. When stratified by dementia status, the associations of CCL2 with delirium were maintained in both groups, but CXCL2 was only significantly higher in delirium in the subgroup without dementia.

Discussion: CCL2 and CXCL2 are chemokines involved in immune cell recruitment and markers of accelerated immune ageing. Future work should elucidate the role of immune cell recruitment and brain infiltration in delirium, to identify treatment targets. Furthermore, work should explore whether targeting immune ageing can reduce delirium risk.

Hannah Moorey, Hannah F Botfield, Maria Krogseth, Geir Selbaek, Daisy Wilson, Torgeir Bruun Wyller, Thomas Andrew Jackson

Abstract

Background: This longitudinal cohort study aimed to determine whether mental health problems in midlife are linked to frailty after age 70, as measured using two sets of frailty criteria.

Methods: We used data from 27,958 adults aged 35-60 years in the Trøndelag Health Study (HUNT1, 1984-1986), with frailty outcomes assessed in 9,956 participants aged 70 years and older (HUNT4, 2017-2019). Mental health at baseline was self-reported. Frailty at follow-up was measured using both the Fried criteria and the 35-item HUNT4-Frailty Index. Linear regression models estimated frailty differences by baseline mental health status, adjusted for sociodemographic and lifestyle factors, stratified by age. We applied inverse probability weighting and multiple imputation to reduce selection bias.

Results: Mental health problems at age 35-49 at baseline were associated with 0.52 (95% CI: 0.35-0.69) higher Fried scores and 0.066 (95% CI: 0.048-0.084) higher HUNT4-FI scores at follow-up. For ages 50-60, Fried scores and HUNT4-FI scores were higher by 0.30 (95% CI: -0.02-0.63) and 0.037 (95% CI: 0.006-0.068), respectively.

Conclusion: We observed that midlife mental health problems were associated with higher frailty levels three decades later, across two commonly used frailty models. These findings underscore the importance of both psychological and physical factors in ageing.

Ingebjørg L Kyrdalen, Geir Selbæk, Emiel O Hoogendijk, Ellen Melbye Langballe, Heidi Ormstad, Håvard Kjesbu Skjellegrind, Bjørn Heine Strand, Karen Sverdrup, Pernille Thingstad, Gro Gujord Tangen

Abstract

Purpose: To describe intrinsic capacity (IC) distribution across age and sex and investigate its subdomains’ association with self-perceived health in home-dwelling older adults.

Methods: This cross-sectional study used population-based data from the Trøndelag Health Study (HUNT). Self-perceived health was assessed by a 4-point Likert scale and dichotomized into good or poor health. IC consists of five subdomains (vitality, locomotion, cognition, psychological, and sensory capacity), assessed in line with the WHO recommendations. Capacity in locomotion and cognition was assessed by the SPPB and MoCA, while the remaining subdomains were assessed through questionnaires. Associations between subdomains and self-perceived health were examined using simple and multiple regression models, adjusting for age and education.

Results: We included 8718 home-dwelling older adults (aged 70-101 years; 52.5% women). Good health was reported by 69.8% among those < 85 years and by 48.6% among those ≥ 85 years. High capacity in ≥ 3 subdomains was observed in 79.3% and 40.9% among individuals < 85 years and ≥ 85 years, respectively. High locomotor capacity showed the strongest association with good self-perceived health. The probability of poor self-perceived health increased with lower IC, but among women, significantly less by older age and more by higher education.

Conclusion: We observed a strong association between IC and self-perceived health, suggesting that IC is closely linked to individuals’ self-perceived health. Our findings support IC as a relevant tool in the shift toward preventive, health-promoting care, and we believe the use of IC can help tailor interventions to optimize functional ability and well-being.

Kjerstin Næss Melsæter, Turid Follestad, Gro Gujord Tangen, Beatrix Vereijken, Pernille Thingstad

Abstract

Background: This longitudinal study explored the one-year change in device-measured daily physical activity in patients attending a memory clinic.

Methods: Physical activity was recorded in 27 memory clinic patients over four days using accelerometers (activPAL3 micro) at baseline and one-year follow-up. Daily physical activity outcomes included upright time, standing time, walking time, number of steps, number of transitions, mean upright event length, and maximum upright event length. Changes between baseline and follow-up were analysed using paired sample t-tests.

Results: Patients’ mean (SD) age was 69.4 (8.1) years, and 14 (51.9%) were women. The only significant change was a decrease in maximum upright event length from a mean (SD) of 84.3 (31.6) minutes at baseline to 59.2 (22.5) minutes at one-year follow-up (p < 0.001).

Conclusion: Daily physical activity volume remained stable over one year, but the reduction in maximum upright event length indicates a shift in activity distribution.

Kim Frederik Gundrosen, Kristin Taraldsen, Karen Sverdrup, Anne-Brita Knapskog, Geir Selbæk & Gro Gujord Tangen

Abstract

Background
Dry mouth is a common and burdensome condition in older adults and its severity may increase with use of anticholinergic medications. The aims were to describe anticholinergic medication use among acutely ill older adults, examine the association between anticholinergic burden and dry mouth severity using the composite Dry Mouth Severity Points (DMSP) measure and investigate whether the association differs by sex.

Methods
Patients ≥70 years admitted to Oslo municipal inpatient acute care unit were eligible. Anticholinergic burden (ACB) was assessed using the ACB calculator and classified as 0, lower (ACB = 1–2) or high (ACB = ≥ 3). Dry mouth severity was quantified with DMSP, range 0–4, assigning one point for each indicator above cut-off: General Xerostomia Question ≥ 3, Summated Xerostomia Inventory ≥ 11, Clinical Oral Dryness Score ≥ 6 and unstimulated whole saliva secretion rate ≤ 0.1 mL/min. Associations were examined with ordinal logistic regression.

Results
Of 382 examined patients, 256 (mean age 84 ± 7 years, 70% women) had complete data. Mean [standard deviation (SD)] ACB score was 2.0 (1.7); 18% had ACB = 0, 50% had ACB = 1–2 and 32% had ACB = ≥ 3. DMSP scores of 0, 1, 2 and ≥ 3 were present in 29%, 36%, 23% and 12%, respectively.

Compared with patients with ACB = 0, those with ACB = 1–2 [odds ratio (OR) = 2.06, 95% confidence interval (CI) 1.07–3.97) and ACB = ≥ 3 (OR = 2.25, 95% CI 1.09–4.63) had higher odds of more severe dry mouth. Women had significantly higher ACB and DMSP scores than men.

Conclusions
Even lower anticholinergic burden was associated with greater dry mouth severity, highlighting the need for early recognition and proactive management in acutely ill older adults.

Ingrid Beate Ringstad, Eva Skovlund, Leonor Roa Santervas, Hege Kersten, Katrine Gahre Fjeld, Lene Hystad Hove, Torgeir Bruun Wyller, Janicke Liaaen Jensen, Rita Romskaug

Article in press, 26. january 2026

Abstract:

Comprehensive mapping of key physical activity (PA) types, postures, and sleep among older adults is important for informing public health policies and interventions. This study aimed to describe the 24-h time distribution of key PA types, postures, and sleep in a population-based sample of community-dwelling older adults and explore whether age, sex, and educational level influenced this distribution. Participants 65 years and older from the fourth survey of the Trøndelag Health Study (HUNT4, 2017-19) with ≥ 1 day of complete accelerometer recording were included (n = 8,114). PA types (walking, running, cycling), postures (standing, sitting, lying (awake)), and sleep were derived from the accelerometer data using validated machine learning models. Survey-weighted regression models were applied to describe the 24-h time distribution of PA types, postures, and sleep by age, sex, and education. Participants spent 4.1 h standing (SD 85.3 min), 82.8 min (SD 40.3 min) walking, 0.2 min (SD 1.7 min) running, 4.6 min (SD 7.2 min) cycling, 9.2 h (SD 115.5 min) sitting, 2.1 h (SD 86.6 min) lying (awake), and 7.1 h (SD 50.4 min) sleeping per day. Time spent standing and walking decreased, while time spent sitting, lying (awake), and sleeping increased with higher age. Women spent more time standing and sleeping, and less time walking, sitting, and lying (awake) than men. Higher education was associated with more time standing and walking and less time sitting. This study provides novel insights into the distribution of 24-h movement behaviors among older adults and can serve as a benchmark for future research on key PA types, postures, sleep, and their interactions.

Karen Sverdrup, Astrid Ustad, Gro Gujord Tangen, Atle Kongsvold, Beatrix Vereijken, Bjørn Heine Strand, Geir Selbæk, Linda Ernstsen & Paul Jarle Mork

Sammendrag

Hensikt: Beboere på langtidsopphold på sykehjem har omfattende helsebehov og krever tverrfaglig oppfølging. Til tross for krav om at fysioterapi-tjenester skal være tilgjengelige, er kunnskap om faktisk bruk begrenset. Hensikten med studien er å kartlegge organisering, tidsbruk og omfang av fysioterapitjenester under langtidsopphold på sykehjem.

Design: Tverrsnittstudie

Metode og materiale: Digital undersøkelse med spørsmål om tidsbruk, omfang og organisering av fysioterapiressurser under langtidsopphold på sykehjem ble sendt til leder for kommunale fysioterapeuter i alle kommuner i Norge.

Resultat: Totalt 262 av 357 kommuner besvarte undersøkelsen. De fleste kommunene (n=214, 82 %) hadde ikke avsatt fysioterapistilling(er) til beboere på langtidsopphold på sykehjem. Median tidsbruk for alle kommunene var 2,9 (0-50) minutter fysioterapi pr. langtidsplass pr. uke og 0,3 (0-2,1) henvisninger pr. langtidsplass pr. år. Kommuner med avsatt stilling til langtidsplasser (n=48) og mindre kommuner leverte mer fysioterapi til langtidsopphold på sykehjem enn kommuner uten avsatt stilling og større befolkning. Den vanligste henvisningsårsaken var brudd og andre skader etter fall, og funksjonsfall etter sykdom eller sykehusinnleggelse.

Konklusjon: Fysioterapi under langtidsopphold organiseres som regel via henvisning til kommunal fysioterapitjeneste. Det er betydelige variasjoner i antall henvisninger og tidsbruk mellom kommunene, men både antall henvisninger og tidsbruk fremstår som lavt, gitt beboernes funksjonsnivå og behov for tiltak som opptrening, mobilisering og veiledning av pleiepersonell.

Elisabeth Wiken Telenius, Kristine Bjorheim Bøe, Nina Skjæret-Maroni, Kristin Taraldsen, Gro Gujord Tangen, Karen Sverdrup

Abstract: 

Background: Immersive technologies such as virtual reality (VR) that has been developed the recent years, are now increasingly accessible and offers new opportunities for VR environments combined with games that may enhance physical activity. However, these games may require adaptation and further customization for use among older users. In this pilot study, we investigate the experiences of older adults using a head-mounted VR exercise game that was developed in close collaboration with end users.

Methods: We included ten community-dwelling older adults aged 65 years and older who undertook six VR exercise sessions across a two-week period, each session lasting 15 min. Descriptive information included age, gender, mobility (Timed Up and Go test, TUG), and gait speed (10 m walk test), and daily steps from ankle-worn accelerometers. Semi-structured individual interviews were conducted, transcribed verbatim and analyzed by use of reflexive thematic analysis.

Results: We included four men and six women, age range from 66 to 77 years, with an average gait speed of 1.4 m/sec and an average TUG-time of 7.6 s. Their average activity levels were close to 4200 steps per day. After the trial period, participants’ experiences were that VR is a new and exciting development. They found VR to be more of a game than exercise, and they suggested integrating more challenging activities, physical movement and social engagement to enhance the exercise part of the game. They did not feel that the game facilitated any more physical activity in their daily lives.

Discussion/conclusion: VR is a promising tool that older adults in this trial enjoyed, but the game was not physically demanding enough for the participants. Future adaptations should include more challenges. Game development should focus on tasks that keep players interested and engaged over longer times, without jeopardizing safety.

Bård Bogen, Martin Moum Hellevik, Gro Gujord Tangen, Lars Peder Bovim, Nina Øye, Kristin Taraldsen