Forskningsartikler

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

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

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:

COVID-19 containment measures reduced older adults’ healthcare access, with uncertain long-term effects on cognitive, physical, and mental health. To investigate whether reductions in primary and specialist healthcare service use during the pandemic were associated with changes in cognitive, physical, and mental health in community-dwelling older adults, with attention to sex differences. Data from the Norwegian Trøndelag Health Study collected before (HUNT4 70 + , 2017-2019) and after the pandemic (HUNT AiT, 2021-2023) included 5387 participants (53% women) aged 70 + . Propensity score matching, accounting for baseline confounders, was used to examine associations between reduced healthcare service use and cognitive, physical, and mental health changes from pre- to post-pandemic. Reduced contact with general practitioners was associated with greater cognitive decline among women (MoCa-change – 0.32 [95% CI – 0.62, – 0.32]). No differences were observed in physical or mental health. Reductions in other primary care services (e.g., in-home nursing, practical assistance) were associated with greater decline in cognitive function (MoCa-change – 0.94 [- 1.53, – 0.36]), particularly among men (MoCa-change – 2.12 [- 3.13, – 1.11]). Men also had a decline in physical function (SPPB-change – 1.06 [- 1.79, – 0.33]). No differences in mental health were observed. Reductions in specialist healthcare services were unrelated to health changes in the overall sample but linked to improved physical function in women (SPPB-change 0.32 [0.11, 0.53]). Although associations between reduced healthcare service use during the pandemic and cognitive, physical, and mental health were limited, findings highlight the importance of sustaining access to primary care for older adults during public health crises.Trial registration The study is pre-registered at ClinicalTrials.gov 02.02.2021, with the identification number NCT04792086.

Tanja Louise Ibsen, Ekaterina Zotcheva, Sverre Bergh, Debby Gerritsen, Gill Livingston, Hilde Lurås, Svenn-Erik Mamelund, Anne Marie Mork Rokstad, Bjørn Heine Strand, Richard C Oude Voshaar, Geir Selbæk

Abstract:

Background: Cognition and frailty are sparsely studied in patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to describe the preoperative cognitive function compared with normative data and frailty profile in iNPH patients accepted for shunt surgery.

Methods: All patients were diagnosed according to international guidelines and underwent a standardized cognitive and physical examination and a geriatric assessment prior to surgery. Z-scores for the cognitive tests were calculated based on age and education adjusted population norms.

Results: The study cohort included 276 iNPH patients accepted for shunt surgery. Mean ± SD age was 73.1 ± 5.7 years, education 12.5 ± 3.8 years, and 61% were male. The median (IQR) score on the Mini-Mental State Evaluation was 27 (24–29), and the median (IQR) Clock Drawing test score was 4 (3–5). Mean (SD) z-score for immediate verbal recall was −1.74 (0.98), for delayed recall −1.66 (1.01), for figure copying −0.85 (1.35) for Trail Making Test A -1.50 (1.09), for Trail Making Test B −1.88 (1.03), for phonemic fluency −1.46 (1.10), and for semantic fluency −1.59 (1.20). Cluster analysis identified three groups, mainly differing regarding visuospatial function. The mean (SD) Frailty Index score was 0.23 (0.13), indicating mild frailty. The frailty domain most affected was physical function.

Conclusion: iNPH patients showed reduced cognitive function across all domains. The patient group is rather heterogeneous regarding cognitive symptoms, and no specific cognitive profile was identified. Cognitive assessment offers limited utility for diagnosing a typical pattern specific for iNPH but is important due to the complex needs for this patient group. Whether cognitive and frailty profile can be used to identify shunt responders, must be assessed in longitudinal studies.

Magnhild S. Dejgaard, Per Kristian Eide, Gro Gujord Tangen, Eva Skovlund, Geir Selbæk & Torgeir Bruun Wyller

Abstarct:

Background/Objectives: Multifactorial prevention of falls in persons with dementia has minimal or non-significant effects. Personalised prevention is recommended. We have previously shown that gait speed, basic activities of daily living (ADL), and depression (high Cornell scores) were independent predictors of falls in persons with mild and moderate cognitive impairment. This study explored person-specific risks of falls related to physical, mental, and cognitive functions and types of dementia: Alzheimer’s disease (AD), vascular dementia (VD), mixed Alzheimer’s disease/vascular dementia (MixADVD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB).

Methods: The study used data from “The Norwegian Registry of Persons Assessed for Cognitive Symptoms” (NorCog). Differences between the dementia groups and predictors of falls, gait speed, ADL, and Cornell scores were analysed.

Results: Among study participants, 537/1321 (40.7%) reported a fall in the past year, with significant variations between dementia diagnoses. Fall incidence increased with age, comorbidity/polypharmacy, depression, and MAYO fluctuation score and with reduced physical activity, gait speed, and ADL. Persons with VD and MixADVD had high fall incidences and impaired gait speed and ADL. Training of physical fitness, endurance, muscular strength, coordination, and balance and optimising treatment of comorbidities and medication enhance gait speed. Improving ADL necessitates, in addition, relief of cognitive impairment and fluctuations. Relief of depression and fluctuations by psychological and pharmacological interventions is necessary to reduce the high fall risk in persons with DLB.

Conclusions: The fall incidence and fall predictors varied significantly. Personalised interventions presuppose knowledge of each individual’s fall risk factors.

Per G. Farup, Knut Hestad and Knut Engedal

Abstract:

Introduction: Understanding factors that influence care service use is crucial for developing preventive strategies to maintain independence among older adults. In this study, we aimed to identify distinct trajectory groups of municipal care service use among community-dwelling older adults to determine whether daily physical activity is associated with future care service use.

Methods: This prospective cohort study included 981 community-dwelling older adults from the HUNT4 Trondheim 70+ study. At baseline, physical activity was assessed over seven consecutive days using two accelerometers attached to the thigh and lower back. An activity type machine learning model was used to classify the physical activity types: walking, standing, cycling, running, sitting, and lying. Municipal care service use was retrieved monthly from medical records for 3 years. Using group-based trajectory modeling, we identified distinct trajectories of care service use. Multinomial regression models adjusted for age, sex, education level, dementia, and physical performance were used to evaluate the associations between daily physical activity at baseline and care service group belonging.

Results: We identified four distinct trajectory groups of municipal care service use, labeled steady low (72.7%), low increasing (9.0%), medium increasing (12.0%), and high increasing (6.3%). Daily time spent in total physical activity was not associated with trajectory group belonging when adjusted for age, sex, education level, dementia, and physical performance. However, more time spent walking, in bouts lasting longer than a minute, was associated with a reduced relative risk of belonging to the high increasing compared to the steady low group. Furthermore, age, physical performance, and dementia were all significantly associated with trajectory group belonging, and sex differences were observed. Compared to women, men had a reduced relative risk of belonging to the low increasing, medium increasing, or high increasing trajectory groups.

Conclusion: This study identified four distinct trajectories of municipal care service use among older adults over 3 years. Total daily physical activity was not associated with trajectories of care service use, but more time spent walking in longer bouts was independently associated with lower care service use, even when adjusted for the strong predictors of physical performance, dementia diagnosis, and age.

Astrid Ustad, Trine Holt Edwin, Kjerstin Næss Melsæter, Karen Sverdrup, Gro Gujord Tangen, Øystein Døhl, Pernille Thingstad, Beatrix Vereijken and Nina Skjæret-Maroni

Background: Spatial orientation is required for independent mobility in society. Deficits in spatial orientation can be an early symptom of Alzheimer’s disease and other dementias, and there is a need for brief assessment tools to identify impairments.

Objective: The aim of this study was to evaluate the construct and known-group validity of our newly developed Spatial Orientation Screening (SOS) questionnaire.

Methods: We included 132 patients with subjective cognitive decline (n = 16), mild cognitive impairment (n = 32), or all-cause dementia (n = 84) from a memory clinic and a reference group of cognitively unimpaired older adults (n = 108). The patients and their next-of-kin answered the self- and proxy-rated versions of the 4-item SOS (0-8 points) and the 10-item Questionnaire of Everyday Navigational Ability (QuENA, 0-30 points). The patients also performed the Floor Maze Test (FMT) for performance-based spatial abilities.

Results: Mean ages (SD) of the patient and reference groups were 68.6 (±7.6) years and 73.7 (±6.7) years, respectively. Construct validity between self-rated versions of the SOS and QuENA was satisfactory with rs = 0.66, between the proxy-rated versions rs = 0.61, and between the proxy-reported SOS and FMT rs = 0.49 (all p < 0.001). Known-group validity was also acceptable, with significantly higher median (IQR) SOS self-reported scores in patients 1.0 (2.0) compared to the reference group 0.2 (0.5) points, (p < 0.001). Informants reported more severe impairments compared to the patients’ self-reports on both SOS and QuENA (both p < 0.001).

Conclusions: The SOS had satisfactory validity for use as a screening instrument for assessment of spatial orientation in memory clinic patients.

Gro Gujord Tangen, Knut Engedal, Karin Persson, Geir Selbæk, Shams Dakhil, Riona McArdle, Marit Mjørud, Janne Røsvik, Anne Marit Mengshoel, Anne Brita Knapskog