Forskningsartikler

ABSTRACT

Objectives:
The study aims to conduct a systematic review of peer-reviewed articles about psychosocial interventions to reduce the caregiver burden in family caregivers of people with dementia to explore the effectiveness and the type of intervention and methodology used.

Methods:
Five databases were searched (AgeLine, CINAHL, MEDLINE, PsycINFO, PubMed) for studies reporting on experimental research of psychosocial interventions for dementia-related caregiver burden. Data quality checks were completed for included papers.

Results:
Forty-three studies were included in the analysis; about half of them (n = 24) were randomized controlled trials. The types of interventions most often used were psychoeducation (n = 21) and multi-component interventions (n = 12). The caregiver burden was after the intervention successfully reduced in about half of the studies (n = 19). Additionally, 10 studies had success in reducing caregiving burden in one of several assessment measures used. The studies using psychoeducation (57%) and multi-component (58%) intervention approaches had the highest success rates.

Conclusion:
Health professionals should be encouraged to implement psychosocial interventions for caregivers of patients with dementia.

Hande Kirisik Surer, Nilufer Korkmaz Yaylagul & Anne-Sofie Helvik

Introduction: Frontotemporal symptoms are usually associated with frontotemporal dementia (FTD), but people with all forms of dementia may develop these symptoms as the dementia disease progresses. Knowledge about psychosocial interventions that meet the needs of people with FTD symptoms, and literature on the subject, is hard to find. The aim of the study was to describe current practice as it is experienced by healthcare experts in the clinical field in Norway.

Method: Three focus groups were conducted. Healthcare personnel with clinical experience in care and treatment to people with FTD and other dementia diseases with frontotemporal symptoms were eligible for inclusion. Qualitative directed content analysis with open coding focusing on both manifest and latent content was applied.

Results: Four categories were described: (1) Dilemmas of anosognosia, (2) establishment of a diagnosis, (3) establishment of post-diagnostic support at home, and (4) establishment of care in the nursing home.

Conclusion: People with FTD and other dementias with frontotemporal symptoms need rigid, easy-to-understand, predictable surroundings and healthcare personnel that are clear, friendly, and respectful in their communication. Post-diagnostic support provided in flexible systems ensuring smooth transitions between services and levels of care is required. To ensure quality of care, frontline healthcare staff should be able to recognize FTD symptoms. To achieve this, supervision and training are needed. More research about clinical care interventions and how to derive good nursing practice should be prioritized.

Marit Mjørud, Anne-Brita Knapskog, Marit Nåvik & Janne Røsvik

Abstract

Background: Alcohol is a leading risk factor for disease burden. We examined longitudinal trends in sex and age-specific alcohol consumption among middle-aged and older subjects who had participated in the population-based Trøndelag Health Study (HUNT) in Norway since the 1990s.

Methods: This study included 23,151 individuals aged ≥43 years when they participated in the HUNT2 Survey (1995-1997) and who also had participated in the HUNT3 Survey (2006-2008), and/or the HUNT4 Survey (2017-2019). We used self-reported data to examine trends and identify sex- and age-specific differences in abstinence from alcohol, current drinking, risky drinking (≥8 units of alcohol/week), and heavy episodic drinking (≥5 or ≥6 units of alcohol in one sitting at least monthly). Concentrations of the objective alcohol marker phosphatidylethanol (PEth) were available in subsamples from HUNT3 to HUNT4.

Results: The proportion of subjects with self-reported alcohol abstinence and with PEth concentrations <0.03 µmol/l increased from HUNT2 and/or HUNT3 to HUNT4, while heavy episodic drinking and PEth concentrations ≥0.03 µmol/l decreased from HUNT3 to HUNT4 in both sexes in most age groups, and more in men than in women. There was an increase in risky drinking from HUNT2 to HUNT4 in women and men aged 43-64 years in HUNT2. Men were more likely to consume alcohol than women measured with both self-report and with PEth in most age groups. Among those aged ≥65 years in HUNT2 a convergence between the sexes regarding abstinence and heavy episodic drinking was observed which was mostly caused by changes in men.

Conclusion: Drinking patterns among middle-aged and older Norwegians have changed since the 1990s with a trend toward more abstinence and less heavy episodic drinking and PEth concentrations ≥0.03 µmol/l in both women and men with increasing age. There is a trend of more risky drinking with age among both sexes.

Kjerstin Tevik, Ragnhild Bergene Skråstad, Jūratė Šaltytė Benth, Geir Selbæk, Sverre Bergh, Olav Spigset, Steinar Krokstad, Anne-Sofie Helvik

Abstract:

Objectives: The prevalence of clinically significant depressive symptoms (CSDS) in community-living older adults ≥70 years living at home in Norway has not been investigated for years. This study aimed to examine the prevalence and variables related to CSDS in older adults 70+, with a sub-analysis among the oldest (80+).

Methods: In the Trøndelag Health Study (HUNT), Norway, 8911 inhabitants comprising 47.1 % men (mean age in women 77, SD 5.6 and men 76.5, SD 5.3, range 70-102.7) completed the Depression subscale in the Hospital Anxiety and Depression Scale (HADS-D). Chi-square and multivariable logistic regression were used to test variables associated with CSDS.

Results: The prevalence of CSDS (HADS-D ≥ 8) was in the total sample 8.4 % among women and 11.5 % among men, while among the oldest (80+), the prevalence was 14.4 % and 16.6 %, respectively. Feeling lonely or perceiving health as poor was associated with CSDS. Reported impaired functioning was associated with CSDS than in those without such limitations in men, but not in women.

Conclusions: Men had a higher prevalence of CSDS than women in the total sample and among the oldest (80+). Loneliness and poor health are important variables associated with CSDS.

Heidi Emly Sivertsen, Gørill Haugan & Anne-Sofie Helvik

Abstract

Background
Infections may contribute to Alzheimer’s disease (AD) pathogenesis. Prior studies on the relationship between Helicobacter pylori (H. pylori) infection and AD or dementia have shown differing results.ObjectiveWe investigated whether H. pylori serology is associated with the risk of AD and dementia in the Trøndelag Health Study (HUNT).
Methods
The HUNT cohort study measured serum H. pylori antibody titers using the Pyloriset EIA-IgG test. 22 years after baseline serum sampling, cognitive assessments were conducted using standardized tests and proxy interviews. We performed logistic regression (n = 1364) adjusted for sex and age to estimate odds ratios for cognitive outcomes. Subgroup analyses were stratified by sex, age, Apolipoprotein E4 (APOE ε4) carrier status and high sensitivity serum C-reactive protein levels and sensitivity analyses further adjusted for lifestyle and co-morbidity risk factors. Cox regression models (n = 4689) were used to estimate hazard ratios for all-cause mortality.
Results
H. pylori titers were not associated with AD (OR 0.99 per 1 SD higher titer, 95% CI 0.82-1.20) or dementia (OR 0.98, 95% CI 0.84-1.15). There were no associations between H. pylori seropositivity (≥ 300 titers) and AD (OR 1.10, CI 0.75-1.63) or dementia (OR 0.96, CI 0.68-1.32). Stratifications by sex, age, CRP, or APOE ε4 genotype and adjusting for additional covariates showed no associations. All-cause mortality was higher with H. pylori positivity (HR 1.07, CI 1.03-1.11).
Conclusions
H. pylori was not associated with later AD or dementia in this study. The relationship between specific versus multi-pathogenic infection burden and neurodegenerative diseases warrants further clarification.

Pieta T Kelsey, Geir Selbæk, Hugo Lövheim, Bjørn Olav Åsvold, Kristian Hveem, Brooke N Wolford & Håvard K Skjellegrind

Abstract

Introduction: Efficient and cost-effective diagnostic tools for supporting dementia assessment are increasingly important. We aimed to evaluate whether providing neuroradiologists with volumetric data from an automatic MRI software, NeuroQuant, enhanced the diagnostic accuracy of their visual MRI assessment.

Methods: Two neuroradiologists assessed brain MRIs from 366 patients (mean age 67.5 years, SD 9.2, and 52% females) with subjective cognitive decline (SCD, n 79), mild cognitive impairment (MCI, n 86), or dementia (n 201). The MCI and dementia patients were further diagnosed according to an etiology of Alzheimer’s disease (AD, n 217) versus non-AD (n 70). In random order the neuroradiologists visually evaluated medial temporal lobe atrophy (MTA, scale 0-4) with and without having access to the NeuroQuant report of age and sex adjusted volumetric percentiles of the hippocampus. Receiver operating characteristics (ROCs) analyses were conducted to calculate the area under the curves (AUCs) for the visual MTA, the automated NeuroQuant percentile, and the combined NeuroQuant-assisted MTA in discriminating dementia from SCD and AD from non-AD.

Results: The AUC of the visual MTA for dementia versus SCD discrimination increased slightly but not significantly when the neuroradiologists were provided with NeuroQuant results (AUC 0.76-0.79, p 0.28). Yet, the isolated NeuroQuant evaluation reached the highest accuracy (AUC 0.85, p < 0.001), significantly better than the MTA assessment (p 0.002) and the NeuroQuant-assisted MTA (p 0.04). Only the isolated NeuroQuant assessment discriminated AD from non-AD (AUC 0.60, p 0.006).

Conclusion: On the basis of our findings, we suggest an increased use of clinically approved automatic volumetry methods in radiological departments.

Karin Persson, Hanneke F M Rhodius-Meester, Trine Holt Edwin, Anne-Brita Knapskog, Peter Bekkhus-Wetterberg, Geir Selbæk, Knut Engedal, Till Schellhorn

Abstract

Bernt Bratsberg, Jennifer R Harris, Vegard Skirbekk, Yaakov Stern, Asta Kristine Håberg, Geir Selbæk, Bjørn Heine Strand, Trine Holt Edwin

Abstract

Background: It is of interest to local authorities to better understand cultural adaptation among immigrant groups who came to a new culture and country at a young age. There is a gap in the literature on the cultural adaptation of Turkish immigrants from arrival until and during old age. This study aimed to explore the experiences of cultural adaptation among long-term older Turkish immigrants in Norway.

Methods: This study had a qualitative, explorative design and employed reflexive thematic analysis and face-to-face semi-structured individual interviews to improve the understanding of cultural adaptation. A total of 15 Turkish immigrants aged 60 years and over were interviewed once between March and June 2023.

Results: The following two main themes and five subthemes about cultural adaptation were generated: (a) encouraging cultural adaptation (experiencing social equality, tolerance, and economic prosperity; meeting supportive people and functioning welfare systems; learning and liking the culture and people); (b) restricting cultural adaptation (a continuing language barrier: struggling to communicate; preserving one’s own culture and heritage).

Conclusion: To enhance cultural adaptation, researchers should conduct interventional studies that consider encouragement and restriction. For long-term older migrants, nursing is an essential tool for enhancing cultural adaption and promoting healthy aging in the host country. This study recommends further education and research for nurses to be more effective in overcoming cultural barriers and supporting older immigrants.

Ayşegül Ilgaz, Büşra Nur Temür, Süleyman Şahin, Sebahat Gözüm, Anne-Sofie Helvik

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