Forskningsartikler

Abstract: The objectives of the study were (a) to compare self-reported Quality of Life (QoL) in a 24-month follow-up of people with dementia attending day care designed for people with dementia (day-care group, DC) with people with dementia who did not attend day care (control group, CG) and (b) to explore factors associated with QoL. A quasi-experimental design with a 24-month follow-up period was used. The DC group included 181 participants recruited from 53 day-care services. The CG included 76 participants recruited from 19 municipalities with no available day care designed for people with dementia. The sample covered the four health regions of Norway and inclusion period lasted from December 2013 to July 2015. The Quality of Life in Alzheimer’s Disease (QoL-AD) scale was used as the outcome measure. The differences in QoL between groups and the associations between participant characteristics and QoL, such as depressive symptoms and functional dependency, were examined using a linear mixed model. In the multiple model, the overall trend in QoL did not differ significantly between the DC and CG. However, the DC group exhibited significantly higher self-reported QoL than the CG at all time points (p < 0.001 at T0, p = 0.018 at T12, and p = 0.006 at T24). Participants with shallow or no awareness who attended day care had significantly higher scores on QoL-AD than persons with full awareness (p = 0.017). More depressive symptoms (p < 0.001) and higher functional dependency (p < 0.001) were associated with lower self-reported QoL. The study revealed higher scores of self-reported QoL among people attending day care compared with those who did not attend, showing that day care might have positive impact on the lives of people with dementia.

Margit Gausdal Strandenæs, Anne Lund, Knut Engedal, Øyvind Kirkevold, Geir Selbæk, Jūratė Šaltytė Benth, Anne Marie Mork Rokstad

Bakgrunn: Eldre med psykiske lidelser er særlig utsatt for å rammes av negative konsekvenser av smitteverntiltakene som er blitt iverksatt som følge av covid-19-pandemien.

Materiale og metode: En spørreundersøkelse ble sendt til 18 alderspsykiatriske avdelinger fra alle fire helseregionene i Norge.

Resultater: Tilsammen 83 behandlere fra ulike yrkesgrupper responderte, med representanter fra alle helseregioner. Nesten halvparten (45,8 %) rapporterte forverring i pasientens psykiske tilstand på grunn av sosial isolasjon i stor eller svært stor grad, og like mange (48,2 %) at vanlig oppfølging ble begrenset. Kontakten mellom spesialist- og primærhelsetjenesten var lavere, og 15,6 % rapporterte at pasienter ikke hadde fått nødvendig somatisk helsehjelp i stor eller svært stor grad.

Fortolkning: Tilbudet til eldre med psykiske lidelser i spesialisthelsetjenesten ble redusert som en følge av covid-19-pandemien, samtidig som samhandlingen med primærhelsetjenesten ble redusert, og mange pasienter ble psykisk dårligere som følge av smitteverntiltakene. Samarbeid mellom spesialist- og primærhelsetjenesten kan være et viktig satsningsområde for denne pasientgruppen.

Marit Tveito, Maria Barca, Cecilie Bhandari Hartberg

Background: Adults with intellectual disability (ID) have poorer physical and perceived health than the general population. Knowledge of perceived health predictors is both limited and important for guiding the development of preventive actions. The aims of this study were to investigate (1) the associations between perceived health and demographics, degree of ID, physical health conditions, and weight and physical activity level and (2) lifestyle factors and multimorbidity as predictors for perceived health adjusted for age, gender, and level of ID.

Method: The North Health in Intellectual Disability study is a community based cross‐sectional survey. The POMONA‐15 health indicators were used. Univariate and multivariate logistic regression analyses with poor versus good health as the dependent variable were applied.

Results: The sample included 214 adults with a mean age 36.1 (SD 13.8) years; 56% were men, and 27% reported perceiving their health as poor. In univariate analyses, there were significant associations between poor health ratings and female gender, lower motor function, number of physical health conditions and several indicators of levels of physical activity. In the final adjusted model, female gender [odds ratio (OR) 2.4, P < 0.05], level of ID (OR 0.65, P < 0.05), numbers of physical health conditions (OR 1.6, P < 0.001) and lower motor function (OR 1.5 P < 0.05) were significant explanatory variables for poor perceived health, with a tendency to independently impact failure to achieve 30 min of physical activity daily (OR 2.0, P = 0.07).

Conclusion: Adults with ID with female gender, reduced motor function and more physical health conditions are at increased risk of lower perceived health and should be given attention in health promoting interventions. A lack of physical activity tends to negatively influence perceived health.

M. I. Olsen,  M. B. Halvorsen,  E. Søndenaa,  E. M. Langballe,  E. Bautz‐Holter,  E. Stensland,  S. Tessem,  A. Anke

Background: Citizen involvement is important for ensuring the relevance and quality of many research and innovation efforts. Literature shows that inadequate citizen involvement poses an obstacle during the research, development, and implementation of assistive technology. Previous studies have addressed the advantages and disadvantages of citizen engagement in health research and technology development, and there is concern about how to ensure valuable engagement to avoid situations where they don’t have influence. Frail older adults are often excluded from being active partners in research projects. The overall objective of this commentary is to describe a case where dialogue cafés was used as a method for involving assisted living residents in technology discussions, elaborating on the following research question: In what ways are dialogue cafés useful for directing research and development and for engaging residents in assisted living facilities in assistive technology discussions?
Method: Six dialogue cafés with assisted living residents as participants were carried out over a period of 3 years (2016-19). Reports that were written after each café by the group leaders and rapporteurs provide the material for the analyses in this paper.

Results: This study demonstrates an example of facilitating user involvement where the participants felt useful by contributing to research and discussions on assistive technology and where this contribution in fact directed the research and development in the overall Assisted Living Project.
Conclusion: This study demonstrated that dialogue cafés enable older residents at an assisted living facility to contribute with opinions about their needs and perspectives on assistive technologies. This negates the view of older adults as too frail to participate and demonstrates the importance of including and collaborating with older adults in research.

Anne Lund, Torhild Holthe, Liv Halvorsrud, Dag Karterud, Adele Flakke Johannessen, Hilde Margrethe Lovett, Erik Thorstensen, Flávia Dias Casagrande, Evi Zouganeli, Reidun Norvoll, Ellen Marie Forsberg

Objective: It is unknown whether systolic blood pressure (SBP) drop is part of the normal aging process or due to the onset of dementia for some people. SBP drop is referring to the decrease in blood pressure often seen before death. Thus, the aim of this study was to examine whether SBP at time of diagnosis of dementia, mild cognitive impairment, or subjective cognitive decline was associated with years prior to death, and whether these associations were modified by diagnoses, age, and sex.

Methods: Participants were 2,236 patients from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog), who died during follow‐up (2009–2017) for whom we had valid blood pressure measurements. Mean age at diagnosis was 77.5 years (SD 8.3), and patients were followed for an average of 3.9 years (SD 2.2, maximum 10.5 years). The patients had subjective cognitive decline (95), mild cognitive impairment (573), dementia (1,401), or no diagnoses related to cognitive deficits (167). SBP as dependent variable was regressed against years prior to death.

Results: In men, SBP was 1.8 mmHg lower per year closer to death (p < .01), and this trend was linear without any acceleration. This association between years prior to death and SBP in men was not modified by age, year of diagnosis, or diagnosis. There was no such association in women.

Conclusion: SBP was significantly lower for those diagnosed close to death in men, but not in women. This association was not modified by either age or onset of diagnosis. Thus, the lowering of SBP is more related to closeness to death and sex than to dementia or age. The downward trend was linear all 10 years prior to death, with no acceleration closer to death.

Knut Asbjørn Hestad, Knut Engedal, Geir Selbæk, Bjørn Heine Strand

Alzheimers sykdom er den hyppigste årsaken til demens i verden. Forekomsten vil øke betydelig i årene som kommer, i takt med at andelen eldre øker. Det er foreløpig ingen sykdomsmodifiserende behandling tilgjengelig. Risikoforebyggende tiltak midt i livet kan potensielt forhindre eller utsette opptil 40 % av demenstilfellene på gruppenivå.

Anne-Brita Knapskog, Knut Engedal, Geir Selbæk, Anne-Rita Øksengård

Aim: Understanding whether increasing Life Expectancy (LE) translates to improved health and function among older adults is essential, but results are inconclusive. We aimed to estimate trends in Disability-Free Life Expectancy (DFLE) in the older Norwegian population by sex and education from 1995 to 2017.
Method: National life table data were combined with cross-sectional data on functional ability for 70+ year-olds from the population-based Trøndelag Health Surveys 2-4 (1995–1997, 2006–2008 and 2017–2019) (n=24,733). Self-reported functional ability was assessed on a graded scale by a combination of Instrumental Activities of Daily Living (IADL) such as paying bills, going out or shopping (mild disability) and Personal Activities of Daily Living (PADL) such as washing, dressing or eating (severe disability). LE, DFLE, Mild-Disability LE and Severe-Disability LE at age 70 were estimated by the Sullivan method.
Results: From 1995 to 2017 DFLE at age 70 increased from 8.4 to 13.0 years in women, and from 8.0 to 12.1 years in men. DFLE increased in the basic and high educational groups, but more so in the high educational group among men. Educational inequalities in years spent with disability however, remained low.
Conclusions: From the mid-1990s and over the past three decades both LE and DFLE at 70 years increased in the older Norwegian population, for both men and women, and across basic and high educational levels. Educational inequalities in DFLE increased, especially in men, but years spent with disability were similar across the three decades.

Siri H Storeng, Simon Øverland, Vegard Skirbekk, Laila Arnesdatter Hopstock, Erik R Sund, Steinar Krokstad, Bjørn H Strand.

Abstract: Young onset dementia has become a growing challenge in national healthcare systems. Concerns about the situation have already been expressed; however, they mostly report the views of services end-users. Aimed at finding out useful further improvement, interviews documenting the working experiences of professionals addressing healthcare services to people with young onset dementia (YOD) were analysed qualitatively. The interviews resulted in four themes and twelve categories. The themes regarded services’ complexity and responsiveness, the levels of education and knowledge on YOD, the impact that serving people with YOD reflects on staff working experience and quality of life, and a series of proposals aimed at improving services by giving people with YOD and families the provision of care they deserve. Although some of the themes recapped the ones reported in the previous literature, the mixture of internally and externally driven instances represented in the themes depict the complexity of care delivery in the services. Findings are discussed in the light of a pragmatical framework capable of suggesting what changes services should implement to be timely responsive.

Giovanni Ottoboni, Vasileios Stamou, Ilaria Chirico, Laura De Riso, Luisa Allione, Aud Johannessen, Rabih Chattat

Introduction: The western world is seeking increased implementation of assistive technology (AT) to meet the challenges of an ageing population. The objective of this study is to explore perspectives on AT use among home-dwelling older adults with or without cognitive impairment.
Methods: This study combines findings from a cross-sectional study with a questionnaire package (n = 83) and from qualitative individual interviews (n = 7) and is part of a larger study, the Assisted Living Project. Combining methods promotes complementary inquiries into a phenomenon.
Results:  The participants already use ATs: TVs, social alarms, mobile phones, stove timers, electronic medical dispensers, PCs and tablet computers. They were both optimistic and skeptical of AT, and expressed different perspectives and expressed different perspectives on ATs in relation to usability, privacy and fear of losing personal face-to-face care.
Conclusions: This study reveals that older adults’ perspectives on AT are multifaceted and complex, and can partly be explained by the interacting factors in the HAAT model: person, technology, environment, and context. Further exploration in relation to older adults with health challenges, as well as ethical perspectives on AT implementation, is required for this group.

Liv Halvorsrud, Torhild Holthe, Dag Karterud, Erik Thorstensen, Anne Lund