Forskningsartikler

Purpose
Information about outcomes of particular relevance to older prostate cancer survivors is limited. This study aimed to compare health, activities of daily living (ADL), and use of health care services between survivors and matched controls.

Methods
A single-centre study on men treated for prostate cancer with curative intent at the age ≥ 70 years 2 to 7 years earlier. Controls matched on age and education were drawn (1:3) from the Trøndelag Health Study (HUNT) in Norway. Self-reported general health, independence in ADL and instrumental activities of daily living (IADL), hospital admissions and emergency room visits were compared by estimating non-adjusted and adjusted (age, education, comorbidity, cohabitant status and pack years of smoking) regression models.

Results
The majority of both survivors (N = 233) and controls (N = 699) reported good (58.7% vs. 62.7%) or very good (11.2% vs. 6.8%) health and independence in ADL (95.6% vs. 96.3%) and IADL (82.7% vs. 81.9%). Hospital admission was reported by 17.3% vs. 18.2% and emergency room visit by 23.6% vs. 26.7%. Regression models showed no significant differences between survivors and controls.

Conclusions
Older prostate cancer survivors reported similar health, independence in ADL and use of emergency room and hospital admissions as matched controls.

Implications for Cancer Survivors.

This study shows that survivors after curatively intended treatment of prostate cancer have as good health as matched controls, indicating that many patients tolerate such treatment well despite being of old age and that current practice for selection of patients offered such treatment is appropriate.

Sletten, Reidun & Jordhoy, Marit & Oldervoll, Line & Skjellegrind, Håvard & Saltyte Benth, Jurate & Åstrøm, Lennart & Kirkevold, Øyvind & Bergh, Sverre & Grønberg, Bjørn & Rostoft, Siri & Bye, Asta & Mork, Paul & Christiansen, Ola

Abstract

Background
Cardiorespiratory fitness (CRF) refers to the capacity of the cardiovascular and respiratory system to process oxygen. CRF is associated with depressive symptoms and findings suggest that CRF decreased significantly in older adults during the COVID-19 pandemic. However, purchase of prescribed antidepressants before and after the pandemic lockdown by CRF level in older adults has not yet been described.

Methods
This longitudinal study included 1221 community-dwelling older adults ≥70 years old participating in the Norwegian HUNT4 Trondheim 70+ study (2018–2019). Data on estimated CRF (eCRF) were linked to the Norwegian Prescribed Drug Registry and utilized defined daily doses (DDDs) of antidepressants from January 2019 throughout December 2021. Paired t-tests were performed to assess changes in DDDs before and after the Norwegian COVID-19 lockdown in March 2020.

Results
Participants had a mean (M) and standard deviation (SD) age of 76.5 (5.2) years, 53.6% were women. In the total sample, the results showed a significant rise in purchase of antidepressants from before (M = 1.25, SD = 7.17) compared to after the lockdown (M = 1.52, SD = 7.86); t (1220) = −2.47, p = 0.014). The number of participants purchasing antidepressants also increased in the total sample and within each of the eCRF groups. In the different eCRF groups, only individuals in the highest eCRF tertile showed a significant higher purchase of antidepressants after the lockdown (M = 1.44, SD = 6.65); t (413) = −2.63, p = 0.009) compared to the year before (M = 0.99, SD = 5.21).

Conclusions
Compared to before the COVID-19 pandemic lockdown, the utilization of antidepressants increased in community-dwelling older adults, with the steepest increase observed among those with the highest eCRF levels.

Maren Lerfald, Linn Marita Hagen, Ekaterina Zotcheva, Federico Palumbo, Audun Havnen, Linda Ernstsen

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: High levels of occupational physical activity (PA) have been linked to an increased risk of dementia. We assessed the association of trajectories of occupational PA at ages 33–65 with risk of dementia and mild cognitive impairment (MCI) at ages 70+.

Methods: We included 7005 participants (49.8% were women, 3488/7005) from the HUNT4 70+ Study. Group-based trajectory modelling was used to identify four trajectories of occupational PA based on national registry data from 1960 to 2014: stable low (30.9%, 2162/7005), increasing then decreasing (8.9%, 625/7005), stable intermediate (25.1%, 1755/7005), and stable high (35.2%, 2463/7005). Dementia and MCI were clinically assessed in 2017–2019. We performed adjusted multinomial regression to estimate relative risk ratios (RRR) with 95% confidence intervals (CI) for dementia and MCI.

Findings: 902 participants were diagnosed with dementia and 2407 were diagnosed with MCI. Absolute unadjusted risks for dementia and MCI were 8.8% (95% CI: 7.6–10.0) and 27.4% (25.5–29.3), respectively, for those with a stable low PA trajectory, 8.2% (6.0–10.4) and 33.3% (29.6–37.0) for those with increasing, then decreasing PA; while they were 16.0% (14.3–17.7) and 35% (32.8–37.2) for those with stable intermediate, and 15.4% (14.0–16.8) and 40.2% (38.3–42.1) for those with stable high PA trajectories. In the adjusted model, participants with a stable high trajectory had a higher risk of dementia (RRR 1.34, 1.04–1.73) and MCI (1.80, 1.54–2.11), whereas participants with a stable intermediate trajectory had a higher risk of MCI (1.36, 1.15–1.61) compared to the stable low trajectory. While not statistically significant, participants with increasing then decreasing occupational PA had a 24% lower risk of dementia and 18% higher risk of MCI than the stable low PA group.

Interpretation: Consistently working in an occupation with intermediate or high occupational PA was linked to an increased risk of cognitive impairment, indicating the importance of developing strategies for individuals in physically demanding occupations to prevent cognitive impairment.

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

Sammendrag

Hensikt: Studien belyser hvilke erfaringer fysioterapeuter har med å gi fysioterapibehandling til beboere med langtidsopphold i norske sykehjem, og hvordan fysioterapeutene er involvert i behandlingen av beboere i livets sluttfase.

Design, materiale og metode: Artikkelen er basert på eksplorerende kvalitative intervjuer med seks fysioterapeuter som jobber i sykehjem. Intervjuene var semistrukturerte og datamaterialet ble analysert med systematisk tekstkondensering.

Funn: Deltakerne inntar i stor grad en tradisjonell fysioterapeutrolle med fokus på trening. De anerkjenner at fysioterapeuter har kunnskap og ferdigheter som er relevante for beboerne i livets sluttfase, men er i liten grad involvert i det tverrfaglige teamet rundt den døende.

Konklusjon: Fysioterapeutene som jobber i langtidsavdelinger i sykehjem bruker mesteparten av arbeidstiden sin på tradisjonell fysioterapi. De er ikke er involvert i lindrende behandling og omsorg i livets sluttfase, men mener at de har relevant kunnskap – og således er en ubrukt ressurs. Mangelen på fysioterapeuter i det tverrfaglige palliative teamet er et resultat av at fysioterapeutene selv ikke gir uttrykk for at de ønsker å bidra, samtidig som leger og sykepleiere ikke etterspør deres kunnskap på dette området. Organiseringen av fysioterapitjenesten i sykehjem ser også ut til å kunne påvirke det tverrfaglige samarbeidet.

Kristine Bjorheim Bøe, Tone Dahl-Michelsen & Elisabeth Wiken Telenius

Background: Mobility impairments, in terms of gait and balance, are common in persons with dementia. To explore this relationship further, we examined the associations between mobility and cerebrospinal fluid (CSF) core biomarkers for Alzheimer’s disease (AD).
Methods: In this cross-sectional study, we included 64 participants [two with subjective cognitive decline (SCD), 13 with mild cognitive impairment (MCI) and 49 with dementia] from a memory clinic. Mobility was examined using gait speed, Mini-Balance Evaluation Systems test (Mini-BESTest), Timed Up and Go (TUG), and TUG dual-task cost (TUG DTC). The CSF biomarkers included were amyloid-β 42 (Aβ42), total-tau (t-tau), and phospho tau (p-tau181). Associations between mobility and biomarkers were analyzed through correlations and multiple linear regression analyses adjusted for (1) age, sex, and comorbidity, and (2) SCD/MCI vs. dementia.
Results: Aβ42 was significantly correlated with each of the mobility outcomes. In the adjusted multiple regression analyses, Aβ42 was significantly associated with Mini- BESTest and TUG in the fully adjusted model and with TUG DTC in step 1 of the adjusted model (adjusting for age, sex, and comorbidity). T-tau was only associated with TUG DTC in step 1 of the adjusted model. P-tau181 was not associated with any of the mobility outcomes in any of the analyses.
Conclusion: Better performance on mobility outcomes were associated with higher levels of CSF Aβ42. The association was strongest between Aβ42 and Mini-BESTest, suggesting that dynamic balance might be closely related with AD-specific pathology.

Gro Gujord Tangen, Karen Sverdrup, Kristin Taraldsen, Karin Persson, Knut Engedal, Peter Bekkhus-Wetterberg and Anne-Brita Knapskog

Objective: To study the association between hearing loss severity, hearing aid use, and subjective memory complaints in a large cross-sectional study in Norway.

Methods: Data were drawn from the fourth wave of the Trøndelag Health Study (HUNT4 Hearing, 2017–2019). Hearing threshold was defined as the pure tone average of 0.5, 1, 2 and 4 kHz in the better ear. The participants were divided into five groups: normal hearing or slight/mild/moderate/severe hearing loss. Subjective self-reported short-term and long-term memory complaints was measured by the nine-item Meta-Memory Questionnaire (MMQ). The sample included 20,092 individuals (11,675 women, mean age 58,3 years) who completed both hearing and MMQ tasks. Multivariate analysis of variance (adjusted for covariates of age, sex, education, and health cofounders) was used to evaluate the association between hearing status and hearing aid use (in the hearing-impaired groups) and long-term and short-term subjective memory complaints.

Results: Multivariate analysis of variance, followed by univariate ANOVA and pairwise comparisons showed that hearing loss was associated only with more long-term subjective memory complaints and not with short-term subjective memory complaints. In the hearing-impaired groups, the univariate main effect of hearing aid use was only observed for subjective long-term memory complaints and not for subjective short-term memory complaints. Similarly, the univariate interaction of hearing aid use and hearing status was significant for subjective long-term memory complaints and not for subjective short-term memory complaints. Pairwise comparisons, however, revealed no significant differences between hearing loss groups with respect to subjective long-term complaints.

Conclusion: This cross-sectional study indicates an association between hearing loss and subjective long-term memory complaints, but not with subjective short-term memory complaints. In addition, an interaction between hearing status and hearing aid use for subjective long-term memory complaints was observed in hearing-impaired groups, which calls for future research to examine the effects of hearing aid use on different memory systems.

Shahram Moradi, Bo Lars Engdahl, Aud Johannessen, Geir Selbæk, Lisa Aarhus og Gro Gade Haanes

Background:
The spread of the coronavirus in spring 2020 led to a lockdown of physical activity (PA) offers. The aim of this study was to investigate how PA, as well as general and mental health, in community-dwelling older adults were affected by the COVID-19 restrictions in Norway.

Methods:
Invitation to participate in the study was sent via Facebook and the Norwegian Pensioners’ Association. Inclusion criteria were being ≥ 65 years old and living at home. Participants completed a questionnaire either digitally or on paper in June–August 2020. The questionnaire included questions on PA, general health, and mental health both before (13th of March) and during lockdown.

Results:
We included 565 participants (mean age 74 ± 5.3 years, 60.4% female); almost 60% had a university degree, 84% reported performing PA more than once per week, and 20% reported a fall in the previous 12 months. The Wilcoxon signed-rank test indicated that the corona lockdown significantly reduced activity level (Z = -4.918, p < 0.001), general health (Z = -6,910, p < 0.001) and mental health (Z = -12.114, p < 0.001). Those who were less active during lockdown had higher odds of experiencing worse health than those who maintained their activity level, odds ratio: 9.36 (95% CI = 4.71–18.58, p < 0.001) for general health and 2.41 (95% CI = 1.52–3.83, p < 0.001) for mental health. Those who attended organized exercise offers before lockdown had higher odds of being less active during lockdown compared to those who did not exercise in an organized setting, odds ratio: 3.21 (95% CI = 2.17–5.76, p < 0.001).

Conclusion:
In a relatively highly educated and active group of older participants, COVID-19 restrictions still negatively affected level of activity as well as general and mental health. These short-term decreases in activity level and health suggest that preventive actions and increased focus on measures to support older adults in maintaining an active lifestyle are needed.

Arnhild J Nygård, Kristin Taraldsen, Randi Granbo, Geir Selbæk, Jorunn L Helbostad

Background: Population-based studies on physical performance provide important information on older people’s health but rarely include the oldest and least-healthy segment of the population. The aim of this study was to provide representative estimates of physical performance by age, sex, and educational level based on recent data from a population-based health study in Norway that includes older people with a wide range in age and function.

Methods: In the fourth wave of the Trøndelag Health Study (2017-2019), all participants aged 70 + were invited to an additional examination of physical performance assessed by the Short Physical Performance Battery (SPPB), either by attending a testing station or by visits from ambulatory teams. The distribution and variation in SPPB total and subscores, as well as gait speed, are presented by sex, age, and educational level.

Results: The SPPB was registered in 11,394 individuals; 54.8% were women; the age range was 70-105.4 years, with 1,891 persons aged 85 + . SPPB scores decreased by 0.27 points (men) and 0.33 points (women) for each year of age, and gait speed by 0.02 m/sec (men) and 0.03 m/sec (women). Using a frailty cut-off for gait speed at < 0.8 m/sec, the proportion of participants categorized as frail increased from 13.9% in the 70-74 years cohort to 73.9% in participants aged 85 + . Level of education [Formula: see text] 10 years corresponded to 6 years (men) and 4 years (women) earlier onset of frailty (SPPB [Formula: see text] 9) compared to education [Formula: see text] 14 years.

Conclusion: We found that the SPPB captured a gradual decline and wide distribution in physical performance in old age. The results provide information about physical performance, health status, and risk profiles at a population level and can serve as reference data for clinicians, researchers, and healthcare planners.

Kjerstin N. Melsæter, Gro G. Tangen, Håvard K. Skjellegrind, Beatrix Vereijken, Bjørn H. Strand and Pernille Thingstad