Forskningsartikler

Abstract:

The Norwegian health care system is built on individual rights and the principles of universal access, decentralization, and free choice of provider. Norway has universal health coverage, funded primarily by general taxes and by payroll contributions shared by employers and employees. Local authorities at the municipal level organize and finance primary health care services according to local demand and within national frameworks. Habilitation services are offered both in the primary health care and as a part of the specialist health services. They offer both inpatient and outpatient services for people with intellectual/developmental disabilities (IDD). National guidelines, known as Good health and care services for people with IDD, have recently (2021) been launched after various reports over the years of serious breaches and challenges in the health and care services provided to people with IDD.

Stine Skorpen & Erik Søndenaa

Sammendrag
Bakgrunn: Assistert død er ikke tillatt i Norge, men sykepleiere får forespørsler fra terminale pasienter og opplever det som vanskelig. Forskning viser at sykepleiere har begrenset faglig kunnskap om assistert død. Hensikten med studien er å utforske sykepleieres kompetanse og rolle i møte med pasienters forespørsel om assistert død.
Metode: Studien har et kvalitativt design med en fenomenologisk hermeneutisk tilnærming. Individuelle intervjuer av kliniske sykepleiere ble analysert med tematisk analyse.
Funn: Sykepleierne hadde begrenset teoretisk og klinisk kunnskap om temaet assistert død fra grunnutdanningen, men hadde kjennskap til temaet fra media. Sykepleiere med videreutdanning i palliativ smertelindring hadde fått opp-læring om temaet. Sykepleierne opplevde sin egen rolle som uklar i håndteringen av forespørsler om assistert død, og samtalene om døden ble ofte overlatt til andre profesjoner.
Konklusjon: Mangelfull kunnskap om assistert død blant sykepleiere krever trygge og faglige rammer, veiledning og støtte for faglig utvikling fra de mer erfarne sykepleierne og det tverrfaglige teamet. Kunnskapsutvikling om assistertdød trenger å bli belyst både i klinikken, i utdanningen og i forskningssammenheng.

Hege Hol & Anne Marie Mork Rokstad

Abstract:
Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization–Observation–Behavior–Intensity–Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = −0.15, 95% CI [−0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [−0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [−0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain.

Myrenget, Martin Elstad, Rustøen, Tone, Myskja, Audun, Småstuen, Milada, Rangul, Vegar, Håpnes, Odd, Borchgrevink, Petter C., Butler, Stephen, Selbæk, Geir, Husebø, Bettina and Sandvik, Reidun

Purpose:
To evaluate the associations between hearing status and hearing aid use and performance on the Montreal Cognitive Assessment (MoCA) in older adults in a cross-sectional study in Norway.
Methods:
This study utilized data from the fourth wave of the Trøndelag Health Study (HUNT4, 2017–2019). Hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz (or PTA4) in the better hearing ear were used to determine participants’ hearing status [normal hearing (PTA4 hearing threshold, ≤ 15 dB), or slight (PTA4, 16–25 dB), mild (PTA4, 26–40 dB), moderate (PTA4, 41–55 dB), or severe (PTA4, ≥ 56 dB) hearing loss]. Both standard scoring and alternate MoCA scoring for people with hearing loss (deleting MoCA items that rely on auditory function) were used in data analysis. The analysis was adjusted for the confounders age, sex, education, and health covariates.
Results:
The pattern of results for the alternate scoring was similar to that for standard scoring. Compared with the normal-hearing group, only individuals with moderate or severe hearing loss performed worse in the MoCA. In addition, people with slight hearing loss performed better in the MoCA than those with moderate or severe hearing loss. Within the hearing loss group, hearing aid use was associated with better performance in the MoCA. No interaction was observed between hearing aid use and participants’ hearing status with performance on the MoCA test.
Conclusion:
While hearing loss was associated with poorer performance in the MoCA, hearing aid use was found to be associated with better performance in the MoCA. Future randomized control trials are needed to further examine the efficacy of hearing aid use on the MoCA performance. When compared with standard scoring, the alternate MoCA scoring had no effect on the pattern of results.

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

Aims. This study aimed to explore workload whether Nursing Activities Scores on one shift could predict workload for the next shift.
Method. This was a retrospective observational exploratory study of cross-sectional design carried out in a postoperative and intensive care unit at a local, nonpro3t hospital in Norway. Data were collected from the hospital’s internal database from January 1st to June 30th, 2016.
Results. A total of 2,695 patients and 5,916 Nursing Activities Scores were included. The model could predict a 55.1% to 66.9% variation in Nursing Activities Scores for the next shift. When the number of patients was added, the mode explained up to 80% of the variation.
Conclusions.
The Nursing Activities Score can be used to predict nursing workload from one shift to another and as an instrument for managers to adjust their staffing requirements.
Implications for Nursing Management.
Nursing Activities Score as asessing nursing workload for all patients in a unit can support the resource planning with accuracy for nurse staffing.

Ann-Margret Hasselgård, Siv K. Stafseth and Øyvind Kirkevold

Abstract

A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the “LIfestyle for BRAin health” (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts.

Colin Rosenau, Sebastian Köhler, Lion M. Soons, Kaarin J. Anstey, Carol Brayne, Henry Brodaty, Knut Engedal, Francesca R. Farina, Mary Ganguli, Gill Livingston, Constantine G. Lyketsos, Francesca Mangialasche, Laura E. Middleton, Marcel G. M. Olde Rikkert, Ruth Peters, Perminder S. Sachdev, Nikolaos Scarmeas, Geir Salbæk, Martin P. J. van Boxtel, Kay Deckers

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
Hearing impairment is strongly associated with future dementia. No studies have reported objectively measured hearing impairment in a cohort with a long period of follow-up (>20 years), and few have reported follow-up over 10 years. Hence, there is a need for high quality studies with sufficient follow-up time and data to account for reverse causality and confounding. We aimed to address this knowledge gap.

Methods
This cohort study used individual participant data from The Trøndelag Health Study (HUNT) in Norway. All current residents aged at least 20 years in the former Norwegian Nord-Trøndelag County were invited to participate in four decennial surveys: HUNT1 (1984–1986), HUNT2 (1995–1997), HUNT3 (2006–2008), and HUNT4 (2017–2019) with individuals aged at least 70 years included in a substudy, known as HUNT4 70+. Here, we report the findings of this substudy. HUNT4 70+ comprised 7135 participants who were assessed for dementia using the Diagnostic and Statistical Manual of Mental Disorders 5 criteria and who had audiometry between 1996 and 1998. The primary objective was to investigate, with gold standard audiometric testing and dementia diagnostic assessment, whether hearing impairment was an independent risk factor for all-cause dementia. The secondary objective was to investigate if a risk also applied to Alzheimer dementia and non-Alzheimer dementia. We analysed the association using Poisson regression and adjusted for confounders. This study is registered with ClinicalTrials.gov (NCT04284384).

Findings
At baseline, 1058 (15%) individuals had acquired hearing impairment with a hearing threshold of at least 25 decibel (dB) and, at follow-up, 1089 (15%) had dementia. In the total group, people with hearing impairment had a relative risk (RR) 1.04 (95% confidence interval (CI) 1.00–1.09) per 10 dB increase in hearing thresholds. For individuals younger than 85 years at follow-up the RR was 1.12 (95% CI 1.05–1.21). Associations between hearing impairment and Alzheimer dementia and non-Alzheimer dementia were similar. There was no association for individuals aged at least 85 years.

Interpretation
We found a moderate association between objectively measured hearing impairment and dementia in the younger age group (<85 years). The findings of no association in the older age group (≥85 years) might be due to the competing risk of death. The present study adds to the literature showing that acquired hearing impairment is a risk for dementias over a period which is too long for reverse causation, and with thorough consideration of confounders. Further research is needed to investigate associations between the different aetiologies of hearing loss and dementia subtypes, and risk differences for sexes.

Christian Myrstad, Bo Lars Engdahl, Sergi Gonzales Costafreda, Steinar Krokstad, Frank Lin, Gill Livingston, Bjørn Heine Strand, Beate Øhre, Geir Selbæk

Abstract

Background: Alzheimer’s disease and related dementias (ADRD) involve biological processes that begin years to decades before onset of clinical symptoms. The plasma proteome can offer insight into brain aging and risk of incident dementia among cognitively healthy adults.

Objective: To identify biomarkers and biological pathways associated with neuroimaging measures and incident dementia in two large community-based cohorts by applying a correlation-based network analysis to the plasma proteome.

Methods: Weighted co-expression network analysis of 1,305 plasma proteins identified four modules of co-expressed proteins, which were related to MRI brain volumes and risk of incident dementia over a median 20-year follow-up in Framingham Heart Study (FHS) Offspring cohort participants (n = 1,861). Analyses were replicated in the Cardiovascular Health Study (CHS) (n = 2,117, mean 6-year follow-up).

Results: Two proteomic modules, one related to protein clearance and synaptic maintenance (M2) and a second to inflammation (M4), were associated with total brain volume in FHS (M2: p = 0.014; M4: p = 4.2×10-5). These modules were not significantly associated with hippocampal volume, white matter hyperintensities, or incident all-cause or AD dementia. Associations with TCBV did not replicate in CHS, an older cohort with a greater burden of comorbidities.

Conclusions: Proteome networks implicate an early role for biological pathways involving inflammation and synaptic function in preclinical brain atrophy, with implications for clinical dementia.

Meghan I Short, Alison E Fohner, Håvard K Skjellegrind, Alexa Beiser, Mitzi M Gonzales, Claudia L Satizabal, Thomas R Austin, W T Longstreth, Joshua C Bis, Oscar Lopez, Kristian Hveem, Geir Selbæk, Martin G Larson, Qiong Yang, Hugo J Aparicio, Emer R McGrath, Robert E Gerszten, Charles S DeCarli, Bruce M Psaty, Ramachandran S Vasan, Habil Zare, Sudha Seshadri