Forskningsartikler

Objectives: To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times.
Design: Markov multistate survival analysis and flexible parametric models.
Setting: Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data.
Participants: 2,938 home-dwelling persons with dementia, ages 40-97 years at time of diagnosis (mean 76.1, SD 8.5).
Results: During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group.
Conclusion: Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.

Marit Mjørud, Geir Selbæk, Espen Bjertness, Trine Holt Edwin, Knut Engedal, Anne-Brita Knapskog, Bjørn Heine Strand.

Abstract: Protein intake is considered important in the maintenance of muscle health in ageing. However, both the source and mealtime distribution of protein might affect the intake of protein and its effect on muscle protein synthesis. In this study, protein intake, mealtime distribution of protein, and seafood consumption were assessed in 92 older adults (aged 65+), and associations with physical performance (Short Physical Performance Battery (SPPB)), grip strength and gait speed were assessed in a multiple linear regression analysis. The participants had a mean age of 73 ± 8.9 years. Mean protein intake was 1.1 g/kg body weight. Protein intake was well distributed, with coefficient of variance between meals (CV meals) 0.6 ± 0.3. However, dinner had the highest protein intake. No associations were found between the nutrition factors and physical performance or strength; however, this result might have been caused by a ceiling effect in the chosen test batteries, as the mean score on SPPB was 10.3 ± 2.7, and 48.9% of the participants reached the top score of 12 points. Mean grip strength was 44.4 ± 9.4 kg (men) and 26.2 ± 6.8 kg (women). Mean gait speed was 1.0 ± 0.3 m/s. The interaction analysis suggests that there might be gender differences in the effect of seafood consumption on gait speed.

Linda Kornstad Nygård, Lisbeth Dahl, Ingunn Mundal, Jūratė Šaltytė Benth, Anne Marie Mork Rokstad.

Background: Nursing home (NH) residents are in most cases in older ages and use prescription drugs. As alcohol interacts with many commonly prescribed drugs, NH residents may be more vulnerable to the effects of alcohol.
Aim: To investigate the experiences of health professionals in
Norwegian NHs when it comes to residents’ alcohol consumption and use of psychotropic drugs, and the facilitation of such use in the NH.
Method: Focus-groups and individual interviews with NH health professionals were performed in 2017 and 2018. The data were analysed using content analysis.
Findings: Two main themes emerged: (1) the balancing of alcohol consumption, and (2) the use of psychotropic drugs. Each of these themes involved reasoning, which revealed that the informants in general had little attention regarding alcohol consumption among residents, and few institutions had policies regarding serving and consumption of alcohol. The informants reported an increased attention regarding use of psychotropic drugs and a tendency towards less use of psychotropic drugs among the residents than before, but few informants reported use of standardised observations tools of symptoms related to prescribing and discontinuation of drugs.
Conclusion: Alcohol policies or procedures related to alcohol consumption were uncommon at the NH that the interviewees of this study represented, and the professionals regarded infrequent serving and consumption of alcohol among the residents as a part of everyday life. In cases when residents frequently consumed alcohol, the professionals used dialogue to underpin the adherent risks and they also tried to control the consumption of the resident in different ways. The interviewees were aware of various side-effects of psychotropic drugs; they were also aware of their effects in combination with alcohol.

Aud Johannessen, Kjerstin Tevik, Knut Engedal, Anne-Sofie Helvik

Objectives: Patients with dementia follow different trajectories of progression. We aimed to investigate which factors at the time of diagnosis could predict trajectory group membership.
Design: Longitudinal observational study.
Setting: Specialized memory clinic, Oslo University Hospital in Norway.
Participants: Patients assessed at the memory clinic, between 12 January 2009 and 31 July 2016, who were registered in the Norwegian Registry of persons assessed for cognitive symptoms (NorCog) and diagnosed with dementia after the baseline examination period (n = 442). The patients were followed up to 3 years, with an average of 3.5 examinations.
Measurements: Clinical Dementia Rating Scale Sum of Boxes (CDR-SB), Mini-Mental State Examination (MMSE), the Consortium to Establish a Registry of Alzheimer’s disease (CERAD) 10-item word list delayed recall, the Clock Drawing Test, (CDT) Trail Making Test A (TMT-A), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Based on changes in scores on the CDR-SB, we used group-based trajectory modeling (GBTM) to explore the presence of trajectory groups. Multinomial logistic regression was used to explore whether a set of baseline variables could predict trajectory group membership.
Results: Three trajectory groups were identified, one with a slow progression rate and two with more-rapid progression. Rapid progression was associated with older age, lower cognitive function (MMSE and TMT-A), and more-pronounced neuropsychiatric symptoms (NPI-Q) at the time of diagnosis.
Conclusions: Our findings demonstrate the heterogeneity of dementia progression and describe risk factors for rapid progression, emphasizing the need for individual follow-up regimes. For future intervention studies, our results may guide the selection of patients.

Trine Holt Edwin, Bjørn Heine Strand, Karin Persson, Knut Engedal, Geir Selbæk and Anne-Brita Knapskog.

Background: Dementia is affecting both the person with the disease and the family members. It is associated with nursing home admission, and a reduced ability to perform personal activities of daily living (P-ADL). The aim of this study was to examine the association between the severity of dementia and P-ADL function, and to study if additional factors such as neuropsychiatric symptoms, type of nursing home unit, and use of medication were associated with P-ADL function.
Methods: A total of 582 nursing home residents with dementia, included at admission to the nursing home, were followed with biannual assessments for 36 months. P-ADL was assessed using the Physical Self-Maintenance scale, and severity of dementia was measured with the Clinical Dementia Rating scale. In addition, neuropsychiatric symptoms, general physical health, and use of medications were assessed at the same time points. Demographic information was collected at baseline. Linear mixed models were estimated.
Results: There was a significant (p < 0.05) non-linear decline in P-ADL function over time in analysis not adjusting for any characteristics. More severe dementia at baseline and at the follow-up assessments was associated with lower P-ADL function (p < 0.001), with the association being stable over time. A higher level of neuropsychiatric symptoms, not using anti-dementia medication, being in a regular care unit as compared to a special care unit and having poor/fair general physical health as compared to good/excellent, were associated with a lower P-ADL function.
Conclusion: The association between more severe dementia and lower P-ADL function was stable over a 36-month follow-up period of nursing home residents with dementia. Health care planners and clinicians should be aware of this when planning for and treating nursing home residents.

Reidun Haarr Johansen, Karoline Olsen, Sverre Bergh, Jūratė Šaltytė Benth, Geir Selbæk and Anne-Sofie Helvik

Background: Persons living with aphasia have unique needs and challenges that would benefit from greater understanding among all health professionals.

Aim: To explore which factors influence social dignity in persons with aphasia in their contact with healthcare professionals.

Methods: A literature search was conducted in CINAHL, MEDLINE, Embase, PSYCINFO, ProQuest, Web of Science, ERIC and Epistemonikos. A total of 317 studies were read and eight were finally included. Qualitative content analysis methods were applied for data extraction and interpretation.

Results: One overarching theme emerged: enabling person-centred communication among healthcare professionals. This covered two main themes – the experiences of empathy and of empowerment. The first of these is based on the subthemes of openness and awareness of feelings, and being acknowledged as a unique person. The second covers three subthemes: involvement in care and rehabilitation; capacity building to gain control and confidence in communication; and enabling communication in community aphasia groups.

Conclusions: Healthcare professionals’ ability to safeguard the social dignity of persons with aphasia is contingent on enabling them to communicate in a person-centred manner. Without such communication, persons with aphasia may perceive that their feelings, uniqueness, involvement and confidence are being disregarded.

Signe Vallumrød, Aud Johannessen and Anne Lyberg.

Vitenskapelig artikkel.
Hensikt: Kartlegge og sammenligne fysisk funksjon hos eldre personer som får fysioterapi hos avtalefysioterapeuter og fastlønnede fysioterapeuter. Beskrive karakteristika av behandlingen som blir gitt.
Design: Tverrsnittsundersøkelse.
Materiale: 250 pasienter fra fysioterapitjenesten i Kongsberg kommune, 179 deltagere ble inkludert fra avtalefysioterapeuter og 71 fra fastlønnede fysioterapeuter.
Metode: Spørreskjema og fysiske tester (Short Physical Performance Battery og ganghastighet).
Resultat: Pasientene som mottar fysioterapi fra de fastlønnede fysioterapeutene har et lavere funksjonsnivå enn de de som mottar fysioterapi fra avtaleterapeutene. De er også eldre, har flere sykdommer og bruker flere offentlige tjenester.
Konklusjon: Kartleggingen av pasienter over 70 år som mottar fysioterapi i Kongsberg kommune viser at avtaleterapeuter og fastlønnede terapeuter følger opp ulike pasientgrupper, men at det hos begge grupper er en stor andel sårbare eldre med begrenset reservekapasitet.

Gro Gujord Tangen, Jon-Håvard Hurum, Ragnhild Karlsen, Kjersti Haugan, Einar Frogh, Anne Kari Skarbekk, Hilde Stendal Robinson.

Introduction:  For people with dementia, lived time is important to understand, as the condition affects memory, perceptions of time, and life expectancy. The aim of this study was to locate, interpret, and synthesize the experience of lived time for people with dementia.
Method: This article presents a qualitative systematic meta-synthesis. The theoretical framework of lifeworlds by van Manen provided the context for the study. The Critical Appraisal Skills Programme criteria for qualitative studies were used to appraise the studies. Sixty-one qualitative research studies based on interviews with people with dementia were included in the review. The analysis followed the principles of interpretive synthesis.
Results: Four categories were revealed: (1) rooted in the past – “I am the same as before”; (2) focussing on the present – “Nobody has tomorrow”; (3) thinking about the future – “What is going to happen to me?”; and (4) changes in the experience of self over time – “I used to….” The latent overall meaning was expressed as “being engaged with the dimensions of time.”
Discussion/conclusion: The experience of lived time is an active and important one, enabling people to manage the dementia journey. Future work involving people with dementia should foreground the experience of lived time.

Siren Eriksen, Ruth Louise Bartlett, Ellen Karine Grov, Tanja Louise Ibsen, Elisabeth Wiken Telenius, Anne Marie Mork Rokstad.

Background: Awareness of functional status may underlie specific profiles and differences related to stage severity in
individuals with Alzheimer’s disease (AD).
Objective: This study aimed to assess self-reported experiences of awareness of functional activity in people with mild and
moderate AD.
Methods: This is a mixed methods approach. The qualitative part was conducted through semi-structured interviews concerning the experiences and awareness of deficits in 38 older adults with mild or moderate AD. The quantitative approach
included a comparison between groups with regard to concerns of awareness and clinic and demographic data.
Results: Impairment on awareness of disease and awareness of functional deficits was observed even in the mild stages of
AD. There was also a noticeable progression of impairments of both kinds of awareness from mild to moderate stage of
disease. The majority of participants with mild and moderate AD were partially aware of their functional deficits. Both groups
of participants reported some negative impact; however, they were not able to entirely describe their functional status. Also,
deficits to recognize the need for help with hygiene and general tasks were observed. Significant differences were found in
awareness of need for help with general tasks and awareness of need for help with hygiene tasks.
Conclusion: People with mild and moderate AD may describe their aware of the disease better than specific functional
deficits, and most of them can provide some reports concerning to the impact of the disease.

Paula Gasparini Emery Trindade, Raquel Luiza Santos, Aud Johannessen, Jose Pedro Simoes Neto, Marcia Cristina Nascimento Dourado.