Forskningsartikler

Background: how long older individuals prefer to live given hypothetical adverse changes in health and living conditions has been insufficiently studied.
Objectives: the objective of this study is to investigate the relationship between six adverse health and living conditions and preferred life expectancy (PLE) after the age of 60 years.
Design: cross-sectional face-to-face interviews.
Setting: population-based sample.
Participants: 825 community dwellers aged 60 years and older in Norway.
Methods: logistic regression models were used to analyse PLE, measured with a single question: ‘If you could choose freely, until what age would you wish to live?’ The impact on PLE of several hypothetical scenarios, such as being diagnosed with dementia, spousal death, becoming a burden, poverty, loneliness and chronic pain was analysed by age, sex, education, marital status, cognitive function, self-reported loneliness and chronic pain.
Results: average PLE was 91.4 years (95% CI 90.9, 92.0), and there was no difference between men and women, but those at older ages had higher PLE than those at younger ages. The scenarios that had the strongest negative effects on PLE were dementia, followed by chronic pain, being a burden to society, loneliness, poverty and losing one’s spouse. PLE among singles was not affected by the prospect of feeling lonely. The higher educated had lower PLE for dementia and chronic pain.
Conclusion: among Norwegians 60+, the desire to live into advanced ages is significantly reduced by hypothetical adverse life scenarios, with the strongest effect caused by dementia and chronic pain.

Vegard Skirbekk, Ellen Melby Langballe, Bjørn Heine Strand

Aims
To describe the prevalence and persistence of analgesic drug use (opioids and antipyretics [ie, paracetamol and acetylsalicylic acid]) in participants (≥70 years) with and without dementia receiving domiciliary care in the eastern part of Norway. In addition, to explore factors associated with persistent drug use and examine whether drug use has changed after admission to a nursing home.
Methods
A longitudinal study with 1001 participants (mean [SD] age 83.4 [5.7] years) receiving domiciliary care. Medical information including analgesic drug use was collected at baseline (A1) between August 2008 and December 2010, follow-up assessments after 18 (A2) and 36 months (A3). Analgesic drugs prescribed for regular use were recorded from the participants’ medical records. The participants’ cognitive and physical health was evaluated at all assessments. Level of care (domiciliary care or nursing home care) was recorded at A2 and A3. Generalized linear mixed models were used to examine the prevalence and persistence of analgesic drug use.
Results
The prevalence of prescribed use of antipyretics and opioids was 13.6% and 9.2%, respectively. Participants with dementia had more frequent use of antipyretics in all assessments and opioids in the last assessment than participants without dementia. Persistent use of both antipyretics and opioids was high between two consecutive assessments, both for participants with and without dementia. Persistent use of analgesics was associated with poorer physical functioning, but not by level of care. Overall, there was no difference between those admitted to a nursing home and those receiving domiciliary care at follow-up, with respect to change in analgesic drug use over time.
Conclusion
The prevalence and persistent use of analgesics were high in older adults receiving domiciliary care at baseline and especially in participants with dementia. A holistic approach and interdisciplinary collaboration are essential to effectively assess and treat pain in older adults.

Kjerstin Tevik, Jūratė Šaltytė Benth, Marte Aarøen, Marie Turmo Lornstad, Sverre Bergh, Anne-S. Helvik

Background
Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time.
Methods
In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time.
Results
We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period.
Conclusion
From NH admission most NH residents’ LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.

Karen Sverdrup, Sverre Bergh, Geir Selbæk, Jūratė Šaltytė Benth, Bettina Husebø, Irene Mari Røen, Pernille Thingstad, Gro Gujord Tangen

Introduction: Dementia diseases are still incurable, and in order to assist in living well with the disease, researchers are increasing their attention to the value of control beliefs. Control beliefs are associated with coping and psychological well-being; however, knowledge on how they relate to well-being outcomes in people with dementia is limited. This review aimed to synthesize knowledge about control beliefs in this group to guide future interventions and research.
Method: A systematic search of 6 databases (MEDLINE, CINAHL, PsychINFO, AgeLine, Embase, and the Cochrane Library) with broad search terms related to dementia, control, and coping was conducted. Studies that investigated people with a confirmed dementia diagnosis and that used a questionnaire to measure control beliefs quantitatively were included.
Results: Eighteen studies were identified, examining self-efficacy, personal control/mastery, or locus of control. The studies varied in aim and design, with fair to good methodological quality. However, 10 studies included <50 participants with dementia, leaving findings unreliable due to low power. Participants with dementia in the mild to moderate stages were included, with average age in the seventies. Except for one validation study, the control belief questionnaires had not been validated for people with dementia. Conclusion: There is a lack of knowledge about control beliefs among people with dementia, due to few and low-powered studies. Although we cannot conclude regarding control beliefs, our findings support the feasibility of quantitative research on control beliefs among people with dementia and we recommend that they be included in this type of research.

Ingeborg Halse, Guro Hanevold Bjørkløf, Knut Engedal, Geir Selbæk, Maria Lage Barca

Abstract:
Introduction: There is a dearth of evidence about the effects of Sonas, a multisensory stimulation on people with dementia (PWD). The main aim of this study was to examine the effects of the Sonas program on anxiety and depression in nursing home (NH) residents with dementia.

Methods: In all, 120 PWD ≥65 years of age from 6 NHs were included in a randomized control trial and were allocated to 1 of 3 groups for 24 weeks: a Sonas program group (n = 48), a reading group (n = 32), and a control group (n = 40). One hundred and five participants completed follow-up assessments. Anxiety and depression were assessed by the Rating Anxiety in Dementia (RAID) scale and the Cornell Scale for Depression in Dementia (CSDD), respectively. Generalized linear mixed models were estimated to assess trends in the proportion of participants with anxiety (a RAID score ≥11) and depression (a CSDD score ≥10).

Results: No significant reduction in anxiety from baseline to follow-up was observed in any of the groups. Participants in the Sonas group showed a significant reduction in depression from baseline to 12 weeks (p = 0.001) and from baseline to 24 weeks (p = 0.009).

Conclusion: The Sonas program had no effect on severity of anxiety but a reduction in depressive symptoms was found in PWD.

Alka R Goyal, Knut Engedal, Jūratė Šaltytė Benth, Benedicte Sørensen Strøm

The aim of this study was to investigate whether cognitive performance was equally influenced by Apolipoprotein E (APOE, with its three alleles, e2, e3, and e4) in patients with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer’s disease (AD). In addition, we examined a group of patients with a combination of Vascular dementia (VaD) and AD (VaD/AD). We asked if the APOE e4 allele influenced cognition in these patient groups in the same way. Our study comprised data from 1,991 patients (55% women), with a mean age of 70.9 years (SD 10.8) and 12.1 years of education (SD 3.8). Of them, 1,111 (56%) had at least one APOE e4 allele; 871 (44%) had one and 240 (12%) had two e4 alleles. Three neurocognitive tests were used to measure cognition: the Mini Mental State Examination (MMSE), the 10-word test of the Consortium to Establish a Registry for Alzheimer’s Disease Word List (CERAD-WL) (immediate and delayed recall), and the Trail Making Test Part A (TMTA). The APOE genotypes were regressed against cognitive function using linear regression, adjusting for diagnosis, age, sex, and education. The interaction diagnosis∗APOE was investigated. The allele type had the largest effect on cognitive performance assessed by the CERAD-WL delayed recall test, less for the other tests. Those without the e4 type scored 0.7 units better than those with e4 allele(s) (p < 0.001). Furthermore, there was a significant inverse dose-response pattern between number of e4 alleles and cognitive performance; those with one allele scored 0.4 units better than those with two alleles (p = 0.006), and those without e4 scored 0.7 units better than those with one e4 (p < 0.001). This pattern did not differ between the four diagnostic groups studied.

Knut Hestad, Knut Engedal, Peter Horndalsveen and Bjørn Heine Strand

Objective: This study aimed to explore the magnitude and significance of associations among nutritional status, functional status, comorbidities, age, and gender in older adults receiving assistance from the in-home nursing care service.

Method: In this cross-sectional study, 210 home-dwelling persons 65 years or older who received in-home nursing care service were evaluated. Demographic variables, nutritional status, comorbidities, and the dependency levels of activities of daily living were analyzed. To assess the correlation among the factors that influence nutritional status, a theoretical model was developed and adjusted using the path analysis model.

Results: The primary finding is that functional status is directly associated with nutritional status (β = 0.32; p < 0.001) and severity of comorbidities is indirectly associated with nutritional status (β = −0.07; p < 0.017).
Conclusion: The elicited outcomes in this study reinforce the concept that nutritional status is linked with functional status in older adults receiving in-home care nursing service.

Luana Lemos Leão, Knut Engedal, Renato Sobral Monteiro-Junior, Gro Gujord Tangen and Maria Krogseth

Abstract

Tom Borza, Magnus Harneshaug, Lene Kirkhus, Jūratė Šaltytė Benth, Geir Selbæk, Sverre Bergh, Marit Slaaen

Abstract: Psychotic symptoms, defined as the occurrence of delusions or hallucinations, are frequent in Alzheimer disease (AD with psychosis, AD + P). AD + P affects ~50% of individuals with AD, identifies a subgroup with poor outcomes, and is associated with a greater degree of cognitive impairment and depressive symptoms, compared to subjects without psychosis (AD − P). Although the estimated heritability of AD + P is 61%, genetic sources of risk are unknown. We report a genome-wide meta-analysis of 12,317 AD subjects, 5445 AD + P. Results showed common genetic variation accounted for a significant portion of heritability. Two loci, one in ENPP6 (rs9994623, O.R. (95%CI) 1.16 (1.10, 1.22), p = 1.26 × 10−8) and one spanning the 3′-UTR of an alternatively spliced transcript of SUMF1 (rs201109606, O.R. 0.65 (0.56–0.76), p = 3.24 × 10−8), had genome-wide significant associations with AD + P. Gene-based analysis identified a significant association with APOE, due to the APOE risk haplotype ε4. AD + P demonstrated negative genetic correlations with cognitive and educational attainment and positive genetic correlation with depressive symptoms. We previously observed a negative genetic correlation with schizophrenia; instead, we now found a stronger negative correlation with the related phenotype of bipolar disorder. Analysis of polygenic risk scores supported this genetic correlation and documented a positive genetic correlation with risk variation for AD, beyond the effect of ε4. We also document a small set of SNPs likely to affect risk for AD + P and AD or schizophrenia. These findings provide the first unbiased identification of the association of psychosis in AD with common genetic variation and provide insights into its genetic architecture.

Mary Ann A. DeMichele-Sweet, Lambertus Klei, Byron Creese, Janet C. Harwood, Elise A. Weamer, Lora McClain, Rebecca Sims, Isabel Hernandez, Sonia Moreno-Grau, Lluís Tárraga, Mercè Boada, Emilio Alarcón-Martín, Sergi Valero, NIA-LOAD Family Based Study Consortium, Alzheimer’s Disease Genetics Consortium (ADGC), Yushi Liu, Basavaraj Hooli, Dag Aarsland, Geir Selbaek, Sverre Bergh, Arvid Rongve, Ingvild Saltvedt, Håvard K. Skjellegrind, Bo Engdahl, Eystein Stordal, Ole A. Andreassen, Srdjan Djurovic, Lavinia Athanasiu, Davide Seripa, Barbara Borroni, Diego Albani, Gianluigi Forloni, Patrizia Mecocci, Alessandro Serretti, Diana De Ronchi, Antonis Politis, Julie Williams, Richard Mayeux, Tatiana Foroud, Agustin Ruiz, Clive Ballard, Peter Holmans, Oscar L. Lopez, M. Ilyas Kamboh, Bernie Devlin & Robert A. Sweet