Forskningsartikler

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

Maria Krogseth, Daniel Davis, Thomas Andrew Jackson, Henrik Zetterberg, Leiv Otto Watne, Morten Lindberg, Petronella Chitalu, Alex Tsui, Geir Selbæk, Torgeir Bruun Wyller

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

Abstract

Background: One of the most widely used instruments for assessing agitation in dementia patients is the Cohen-Mansfield Agitation Inventory (CMAI), nevertheless no global score has been proposed. The aim of this study is: (a) to conduct a confirmatory (CFA) and exploratory factor analysis (EFA) of CMAI on people with dementia and Psychological and Behavioral Symptoms (BPSD), and (b) to propose an alternative structure, based on clinical criteria including all CMAI items.

Methods: Confirmatory and exploratory factor analyses were carried out on the CMAI 29 items administered at baseline to 505 patients with dementia (PwD) and BPSD enrolled in the international observational RECage study.

Results: The three-factor structure has not been confirmed by the CFA, whilst the EFA was carried out respectively on 25 items disregarding 4 items with a prevalence ≤5% and then on 20 items disregarding 9 items with a prevalence ≤10%. The four-factor structure explaining 56% of the variance comprised Physically Aggressive behavior, Verbally Aggressive behavior, Physically non-aggressive behavior, and Physically and verbally aggressive behavior.

Conclusions: A new grouping of all items according to a clinical criterion is proposed, allowing for a more sensible evaluation of the symptoms leading to better differentiation.

Bruno Mario Cesana, Eleni Poptsi, Magda Tsolaki, Sverre Bergh, Alfonso Ciccone, Emmanuel Cognat, Andrea Fabbo, Sara Fascendini, Giovanni B Frisoni, Lutz Frölich, Maria Cristina Jori, Patrizia Mecocci, Paola Merlo, Oliver Peters, Carlo Alberto Defanti

Abstract

Objectives: Dementia is a major healthcare challenge; however, there is evidence that modifiable risk factors may contribute to reduce dementia risk. The aim of the study was to explore the knowledge and motivation for adopting recommended health behaviours among older adults in Norway.
Study design: The study has a qualitative, descriptive design.

Methods: Individual interviews were used for data collection. The study population comprised 15 participants, five men and 10 women, aged ≥73 years, recruited from a region in the centre of Norway. Interviews were analysed according to qualitative content analysis.

Results: Three categories were identified and presented as the main findings, as follows: (1) sufficient knowledge about risk reduction for dementia, including the media as the main source of information; (2) current prevention activities and motivation for risk reduction, including physical, social and cognitive activities and a healthy diet; and (3) motivation for prevention of dementia from a life-course perspective, including experience of health problems, desire to live independently and limited awareness of dementia risk factors in midlife.

Conclusions: To tailor information about the modifiable risk factors of dementia and develop preventive interventions, knowledge about motivating factors is essential. Promotion of healthy ageing is required in addition to addressing the fear of future illness and dependency.

Grete Kjelvik, Geir Selbæk, Anne Marie Mork Rokstad

Abstract
Purpose
The aim of the present study was to explore the next of kin’s experiences with the transition for people with dementia from a farm-based daycare (FDC) to another service in the municipality.
Methods
The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis.
Results
Through the analysis three main categories were developed: (1) Bearing the burden, (2) Being in transition, and (3) Feeling supported. The transition period was highly stressful for next of kin due to the exacerbation of their relatives’ dementia symptoms. The next of kin focussed on optimizing the everyday lives of their relatives with dementia, even at the expense of their own well-being. Most participants experienced support from FDC, healthcare services and their informal network.
Conclusions
The study contributes important insights into the next of kin’s experiences. Good quality service, close dialog, information, and support between the different part in the transition process, can be useful for the further development of services with good quality and to reduce the negative effects of care on next of kin.

Liv Bjerknes Taranrød, Øyvind Kirkevold, Ingeborg Pedersen & Siren Eriksen

Bakgrunn
Antallet personer med demens forventes tredoblet innen 2050. Vi presenterer forekomsttall for demens og mild kognitiv svikt i Trondheim og viser hvordan vekting for frafall og bostatus påvirker forekomsttallene når vi sammenligner Trondheim med Nord-Trøndelag.
Materiale og metode
Personer i alderen 70 år og eldre i Trondheim ble invitert til å delta i helseundersøkelsen HUNT4 (den fjerde Helseundersøkelsen i Trøndelag) Trondheim 70+. Deltakerne ble intervjuet og gjennomgikk kognitiv testing. Et diagnoseteam satte diagnosene demens og mild kognitiv svikt. Frafallsvekter som justerte for utvalgsskjevheter, ble benyttet i sammenligningen av Trondheim og Nord-Trøndelag.
Resultater
Demensforekomsten i Trondheim ble estimert til 16,2 % for aldersgruppen 70 år og eldre etter vekting for skjevt frafall med henblikk på alder, kjønn, utdanning og andel sykehjemsbeboere. Ujustert demensforekomst var 21,0 % i Trondheim og 15,7 % i Nord-Trøndelag. Etter vekting ble forekomsten tilnærmet identisk i de to utvalgene.
Fortolkning
Å vekte for skjevt frafall har stor betydning for å få representative tall i forekomstundersøkelser av demens.
Hovedfunn
Forekomsten av demens og mild kognitiv svikt hos personer i alderen 70 år og eldre i Trondheim ble estimert til henholdsvis 16,2 % og 35,6 %.
Ujustert demensforekomst var 21,0 % for Trondheim og 15,7 % for Nord-Trøndelag, men etter vekting for skjevt frafall med hensyn til alder, kjønn, utdanning og sykehjem ble forekomsten tilnærmet identisk i de to utvalgene.

Linda Gjøra, Bjørn Heine Strand, Knut Engedal, Linda Ernstsen, Christian Myrstad, Håvard Skjellegrind, Pernille Thingstad, Geir Selbæk

Abstract

Physical activity (PA) might influence the risk or progression of chronic pain through pain tolerance. Hence, we aimed to assess whether habitual leisure-time PA level and PA change affects pain tolerance longitudinally in the population. Our sample (n = 10,732; 51% women) was gathered from the sixth (Tromsø6, 2007-08) and seventh (Tromsø7, 2015-16) waves of the prospective population-based Tromsø Study, Norway. Level of leisure-time PA (sedentary, light, moderate, or vigorous) was derived from questionnaires; experimental pain tolerance was measured by the cold-pressor test (CPT). We used ordinary, and multiple-adjusted mixed, Tobit regression to assess 1) the effect of longitudinal PA change on CPT tolerance at follow-up, and 2) whether a change in pain tolerance over time varied with level of LTPA. We found that participants with high consistent PA levels over the two surveys (Tromsø6 and Tromsø7) had significantly higher tolerance than those staying sedentary (20.4 s. (95% CI: 13.7, 27.1)). Repeated measurements show that light (6.7 s. (CI 3.4, 10.0)), moderate (CI 14.1 s. (9.9, 18.3)), and vigorous (16.3 s. (CI 6.0, 26.5)) PA groups had higher pain tolerance than sedentary, with non-significant interaction showed slightly falling effects of PA over time. In conclusion, being physically active at either of two time points measured 7-8 years apart was associated with higher pain tolerance compared to being sedentary at both time-points. Pain tolerance increased with higher total activity levels, and more for those who increased their activity level during follow-up. This indicates that not only total PA amount matters but also the direction of change. PA did not significantly moderate pain tolerance change over time, though estimates suggested a slightly falling effect possibly due to ageing. These results support increased PA levels as a possible non-pharmacological pathway towards reducing or preventing chronic pain.

Anders Pedersen Årnes, Christopher Sievert Nielsen, Audun Stubhaug, Mats Kirkeby Fjeld, Aslak Johansen, Bente Morseth, Bjørn Heine Strand, Tom Wilsgaard, Ólöf Anna Steingrímsdóttir

Background: Observational tools can support the understanding of the complex needs of older people with dementia and aid delivery of person-centred care. However, existing tools are complex and resource intensive to use.

Objectives: To develop and evaluate the acceptability and feasibility of a low-resource, observational tool to support staff reflection and practice development.

Methods: Intervention development of the Person-Centred Observation and Reflection Tool (PORT) and acceptability and feasibility study, using surveys and focus groups in the UK, Norway and Spain.

Results: PORT was reported as easy, accessible and acceptable to use. The observation was identified as powerful for individual staff development and provided an evidence-based source for underpinning individualised care planning. Potential time challenges associated with implementation were identified.

Conclusion: Initial evaluation indicates PORT is an acceptable and feasible tool for use in health and social care settings for older people. Further research is needed on implementation models and the impacts of PORT use.

Implications for practice: PORT may be a useful tool to support individual staff development in care settings and person-centred care planning for people with dementia.

Claire Surr, Anne Marie Mork Rokstad, Josep Vila Miravent, Elena Fernandez, Aukje Post, Carol Fusek, Dawn Brooker