Forskningsartikler

Background: While medical advancements and increased awareness have improved the life expectancy of individuals with Down syndrome (DS), studies on cohort-specific differences in mortality risk and long-term survival outcomes among individuals with DS remain limited. We assessed cohort differences in survival probabilities and mortality risk among individuals with DS born 1967–2018, using Norwegian national registry data.

Methods: Utilizing the Medical Birth Registry of Norway linked with additional registries, we included 3,014,455 eligible individuals. Kaplan–Meier survival curves and mortality rates were employed to examine birth cohort differences in survival probability between individuals with DS and the rest of the population up to age 40 years. A flexible parametric survival model was used to identify mortality risk factors among individuals with DS.

Results: Among 3,014,455 individuals, 3,484 (1.2 per 1000) were diagnosed with DS. Across birth cohorts, the most significant survival gap occurred in early childhood (less than 5 years) when compared to individuals without DS. Mortality rates for individuals with DS were consistently higher than the rest of the population across all birth cohorts. In analyses of follow-up birth to age 40 years, individuals born from 1967 to 1976 demonstrated the highest mortality risk (HR: 6.35) followed by those born from 1977 to 1986 (HR: 3.83) and from 1987 to 1996 (HR: 2.31) compared to those born between 2007 and 2018. Low birth weight (< 2,500 g) was associated with increased mortality risk (HR: 1.47) compared to those born with birth weight of 2500 g or more. Individuals born into households with income below the median showed a higher mortality risk (HR: 1.41) compared to those from higher-income households. Having one or more siblings also correlated with increased mortality risk (HR: 1.46) compared to having none. In sub-analyses restricted to follow-up from birth to five years, birth year remained a significant predictor of mortality risk for individuals with Down syndrome (DS). Compared with those born between 2007 and 2018, highest mortality risk was observed for births from 1967 to 1976 (HR: 6.18), 1977 to 1986 (HR: 3.61), and 1987 to 1996 (HR: 2.06). Low birth weight (HR: 1.66) and having one or more siblings (HR:1.56) was also showed a greater mortality risk. For the follow-up period from ages 6 to 40 years, those born into lower-income households experienced increased mortality risk (HR: 2.16).

Conclusions: This study found that individuals with DS experience significantly lower survival, particularly (with the largest gap) in early childhood. Being born in earlier birth cohort, low birth weight, lower household income, and having siblings were associated with higher mortality risk among individuals with DS. These findings underscore the need for targeted interventions (and support) to improve survival outcomes for individuals with DS.

Teferi Mekonnen, Dana Kristjansson, Bernt Bratsberg, Hans-Peter Kohler, Geir Selbæk, Frode Kibsgaard Larsen, Ellen Melbye Langballe, Jeanette Engeland, Øyvind Kirkevold, Asta Kristine Håberg, Bjørn Heine Strand, Vegard Skirbekk

Background: The 2024 Lancet Commission report on dementia identified 14 modifiable dementia risk factors. The Norwegian HUNT study uniquely includes data collection of all 14 risk factors in the same individuals throughout adulthood, as well as a study-specific dementia diagnosis. We aimed to evaluate the potential for dementia prevention associated with these 14 risk factors, along with three additional sociodemographic risk factors in this retrospective cohort.

Methods: This retrospective cohort study included data on participants with study-specific diagnosis from the HUNT4 70+ study (2017-19) and was linked with national administrative registries (1960-2018) and earlier HUNT surveys (1984-2008) with data on dementia risk factors at ages 35-92 years. Inverse probability weighting was applied to account for non-response. Logistic regression estimated dementia risk associated with exposure to less education in early adult life (age <45 years), hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use in midlife (age 45-65 years), and social isolation, air pollution, and vision loss in late life (age >65 years). Midlife occupational physical activity and marital and employment status were added to the Lancet model. The potential for dementia prevention was assessed using population attributable fraction (PAF).

Findings: Between Sept 1, 2017, and Feb 28, 2019, 19 403 individuals were invited to participate and 9745 participants (1525 with dementia, 8220 without dementia) were included. 4445 (45·6%) of 9745 participants were male and 5300 (54·4%) were female. The total PAF for the 14 Lancet risk factors was 50·9% (95% CI 37·7-61·4). Including family-related and work-related risk factors increased the PAF to 54·9% (42·3-64·7; p<0·0001). When these factors were added for women, the total PAF increased from 48·0% (95% CI 29·4-61·7) to 52·2% (34·2-65·3; p=0·0090), whereas no significant change was observed in men (56·2% [95% CI 35·5-70·2] to 56·7 [95% CI 36·1-70·6]; p=0·71).

Interpretation: Addressing all 14 Lancet risk factors could prevent over half of all dementia cases. Adding factors related to marital and occupational status offers additional preventive potential, particularly among women.

Merete Ellingjord-Dale, Bjørn Heine Strand, Vegard Skirbekk, Bernt Bratsberg, Teferi Mekonnen, Ekaterina Zotcheva, Geir Selbæk, Yaakov Stern, Asta Kristine Håberg, Bo Engdahl

Background
Smoking is considered a risk factor for dementia. Nevertheless, uncertainty regarding the associations with dementia subtypes and the effects of quitting remains. In this large longitudinal population-based cohort study, we investigated smoking as an independent risk factor for all-cause dementia. Second, we investigated the associations with dementia subtypes.

Methods
We included participants from the Trøndelag Health Study (HUNT) and collected their smoking status at baseline (HUNT2, 1995-97). We assessed cognitive status at follow-up two decades later (HUNT4 70+, 2017-19, N = 8,532) and collected pack-years. We handled missing data with multiple imputations and estimated relative risks (RRs) with Poisson regression after adjustment for covariates and stratification by age and sex.

Results
Current smokers had a 31% increased dementia risk (RR 1.31, 95% confidence interval (CI) 1.12–1.52), women <85 at follow-up had a 54% increased risk (RR 1.54, 95% CI 1.20–1.98), and men <85 had a 36% increased risk (RR 1.36, 95% CI 1.01–1.82). We found no associations in persons 85+. Current smokers had an increased risk for vascular dementia but not for Alzheimer’s dementia. Pack-years were not associated with increased dementia risk, and former smoking was only associated with vascular dementia in men.

Conclusions
Current smoking was associated with an increased risk of dementia. Among those 85+ at follow-up, being a smoker 20+ years earlier was not associated with an increased risk of dementia, probably because death was a competing risk. In former smokers, there were no significant associations with dementia. Our results add to the literature an optimism about the effects of changing smoking habits and may encourage smoking cessation.

Christian Myrstad, Marie Larssen, Bo Engdahl & Geir Selbæk

Abstarct:

The prevalence of Alzheimer’s disease neuropathological changes (ADNCs), the leading cause of cognitive impairment, remains uncertain. Recent blood-based biomarkers enable scalable assessment of ADNCs¹. Here we measured phosphorylated tau at threonine 217 in 11,486 plasma samples from a Norwegian population-based cohort of individuals over 57 years of age as a surrogate marker for ADNCs. The estimated prevalence of ADNCs increased with age, from less than 8% in people 58–69.9 years of age to 65.2% in those over 90 years of age. Among participants aged 70 years or older, 10% had preclinical Alzheimer’s disease, 10.4% had prodromal Alzheimer’s disease and 9.8% had Alzheimer’s disease dementia. Furthermore, among those 70 years of age or older, ADNCs were present in 60% of people with dementia, in 32.6% of those with mild cognitive impairment and in 23.5% of the cognitively unimpaired group. Our findings suggest a higher prevalence of Alzheimer’s disease dementia in older individuals and a lower prevalence of preclinical Alzheimer’s disease in younger groups than previously estimated.

Dag Aarsland, Anita Lenora Sunde, Diego A. Tovar-Rios, Antoine Leuzy, Tormod Fladby, Henrik Zetterberg, Kaj Blennow, Kübra Tan, Giovanni De Santis, Yara Yakoub, Burak Arslan, Hanna Huber, Ilaria Pola, Lana Grötschel, Guglielmo Di Molfetta, Håvard K. Skjellegrind, Geir Selbaek & Nicholas J. Ashton

Abstarct:

Introduction: Goal-setting interviews in randomised controlled trials (RCTs), such as the Bangor Goal-Setting Interview (BGSI), provide personalised, measurable outcomes that are meaningful to participants because they reflect their unique needs. The PRACTIC (PReventing and Approaching Crises for frail community-dwelling patients Through Innovative Care) RCT (2023– 2024) evaluates a biopsychosocial intervention to approach and prevent crises for frail community-dwelling patients. The PRACTIC Goal Setting Interview (PGSI), adapted from the BGSI, focuses on individual goal attainment and readiness to change and was chosen as the primary outcome in the PRACTIC RCT. This study aimed to translate and develop the PGSI, exploring its feasibility, content validity and interrater reliability.

Design and Methods: This study used a convergent mixed-method design; quantitative and qualitative data were collected with equal priority, analysed separately, and compiled for the results and discussion. Two substudies are included: 1) translation and development of the BGSI towards the PGSI and 2) feasibility, content validity and interrater reliability of the PGSI. Substudy 1 comprised field notes from meetings with municipal staff (n=7) across two municipalities. Substudy 2 included data from 28 municipalities participating in the PRACTIC RCT; patient (n=126), next of kin (n=72), and data from focus groups with staff members (n=13) and data collectors (n=5), as well as individual interviews; patients (n=8) and next of kin (n=4).

Results: The PGSI was well received in the home care services and helped strengthen patient involvement. However, there were challenges in using the PGSI, such as time pressure and workload for the staff. After 12 weeks, participants with high motivation showed a significant increase in PGSI compared with those with low motivation (p = 0.010). Analyses also revealed strong positive correlations between participants and staff members assessments of goal attainment at 12 weeks (Spearman’s ρ = 0.87– 0.92, p < 0.001). The results indicate that the PGSI is a valid and reliable tool for improving patient care through structured goal setting and the active involvement of patients and their next of kin.

Conclusion: The PGSI appears to be a useful and feasible tool for goal setting in home care services. The tool strengthens patient engagement and goal attainment with high content validity and interrater reliability.

Væringstad A , Kirkevold Ø , Dalbak ETG , Myhre J, Feiring IH , Bergh S , Lichtwarck B

Abstract

Background: Malnutrition and frailty frequently affect older adults receiving domiciliary care services, increasing their vulnerability to adverse events such as delirium. Despite this, the role of malnutrition as a risk factor for delirium in this population remains under-researched. The aim of this study was to examine the relationship between nutritional status and the development of delirium over a 2-year period among older adults who received domiciliary care services.

Method: In this 2-year prospective cohort study, we included 210 participants aged 65 years or older who received domiciliary care services at least once per week. Nutritional status was assessed using the Mini Nutritional Assessment at the time of inclusion, while delirium was assessed weekly, upon admission to hospital, and upon clinical indication according to DSM-5 criteria. Logistic regression analysis was used to examine the relationship between malnutrition and delirium.

Results: Of the sample, 116 (55.2%) were malnourished/at risk of malnutrition at the time of inclusion. Over a 2-year period, 42.4% developed delirium. The odds ratio for developing delirium was 2.00 (95% CI 1.08-3.72, P = 0.028), for the group with malnutrition/risk of malnutrition, adjusted for covariates.

Conclusion: Malnutrition is an independent risk factor for delirium in older adults receiving domiciliary care services. These findings highlight the importance of regular nutritional assessments and interventions to potentially reduce the risk of delirium in this vulnerable population.

Benedicte Huseby Bøhn, Maria Krogseth, Nina Jøranson, Torgeir Bruun Wyller, Geir Selbæk & Gro Gujord Tangen

Abstract: 

Background: Immersive technologies such as virtual reality (VR) that has been developed the recent years, are now increasingly accessible and offers new opportunities for VR environments combined with games that may enhance physical activity. However, these games may require adaptation and further customization for use among older users. In this pilot study, we investigate the experiences of older adults using a head-mounted VR exercise game that was developed in close collaboration with end users.

Methods: We included ten community-dwelling older adults aged 65 years and older who undertook six VR exercise sessions across a two-week period, each session lasting 15 min. Descriptive information included age, gender, mobility (Timed Up and Go test, TUG), and gait speed (10 m walk test), and daily steps from ankle-worn accelerometers. Semi-structured individual interviews were conducted, transcribed verbatim and analyzed by use of reflexive thematic analysis.

Results: We included four men and six women, age range from 66 to 77 years, with an average gait speed of 1.4 m/sec and an average TUG-time of 7.6 s. Their average activity levels were close to 4200 steps per day. After the trial period, participants’ experiences were that VR is a new and exciting development. They found VR to be more of a game than exercise, and they suggested integrating more challenging activities, physical movement and social engagement to enhance the exercise part of the game. They did not feel that the game facilitated any more physical activity in their daily lives.

Discussion/conclusion: VR is a promising tool that older adults in this trial enjoyed, but the game was not physically demanding enough for the participants. Future adaptations should include more challenges. Game development should focus on tasks that keep players interested and engaged over longer times, without jeopardizing safety.

Bård Bogen, Martin Moum Hellevik, Gro Gujord Tangen, Lars Peder Bovim, Nina Øye, Kristin Taraldsen

Abstarct:

Background: Knowledge about how older adults walk is crucial for the effective prevention and treatment of various mobility issues as well as treatment evaluation, but it is currently largely limited to laboratory-based measurements. Although laboratory-based data provide relevant information about what older adults can do under standardized conditions, they do not provide insight into how they actually walk in their daily life, a gap that needs to be addressed urgently.

Objective: The objective of this study was to describe how older adults walk in daily life, in relation to age, sex, and level of physical function, using wearable sensor data from a large sample of older adults with a wide range of age and function from the HUNT4 Trondheim 70+ study.

Methods: The current study is based on 1-week accelerometer data (Axivity AX3) from 1289 older adults (mean age 77.41, SD 6.06 years; age range 70-105 years; n=705, 54.7% women). Physical function was assessed using the Short Physical Performance Battery (SPPB). To investigate the effect of age and SPPB score on gait metrics (daily number of steps, 95th percentile speed, mode speed, 95th percentile cadence, mode cadence, and maximum walking bout [WB] distance) for women and men, univariate gamma regression models with log link were used for each outcome measure, with age and SPPB score in separate models. Sex differences were investigated using Mann-Whitney U tests.

Results: Older adults showed a large variation in how and how much they walked in daily life across age, sex, and physical function, particularly younger participants and those with better physical function. Most gait metrics decreased at an increasing rate with higher age, with men maintaining their levels up to higher ages than women. Poorer physical function led to an exponential or close-to-linear decrease in all gait metrics apart from habitual cadence, which remained stable up to a high age. Women had a lower daily number of steps, gait speed, and maximum distance but higher cadence than men (P<.001 for all). On average, 63% of all WBs lasted <10 seconds, corresponding to a median accumulated time of 99 (IQR 66-128) minutes. For WBs lasting 10 to 30 seconds, 30 to 60 seconds, and >60 seconds, the median accumulated time was 105 (IQR 65-154) minutes, 31 (IQR 18-47) minutes, and 113 (IQR 37-219) minutes, respectively.

Conclusions: Daily-life walking performance was affected more by functional ability than by age itself, except for the highest ages, and differed significantly between sexes. Although most WBs were very short, the total accumulated walking time in WBs shorter than 30 seconds was longer than that in longer WBs. Future research can build upon our findings by considering both the impact of short WBs and relevant group and sex differences when implementing daily-life mobility assessment in both clinical studies and patient follow-up.

Karoline Blix Grønvik, Anisoara Paraschiv-Ionescu, Gro Gujord Tangen, Øyvind Salvesen, Jorunn Lægdheim Helbostad, Nina Skjæret-Maroni & Beatrix Vereijken

Abstract:

Purpose:
Suicide rates are high among older adults, yet research on risk factors associated with suicide in this age group remain largely unexplored. This study aims to examine the relationship between suicide and sociodemographic characteristics among individuals aged 60 and older.

Methods:
We utilized data from Norwegian national registries, identifying individuals aged 60 and older who died by suicide between 2005 and 2019 (n = 2060, 70.7% males), and used a case-control design. To examine the relationships between suicide and sociodemographic factors, we used descriptive analyses and conditional multivariate logistic regression analyses, stratified by sex and age categories.

Results:
Among individuals aged 60 to 69, risk factors for suicide included receiving a disability pension (odds ratio (OR) = 2.79 males, OR = 7.71 females), having mixed income sources (OR = 1.79 males, OR = 3.70 females), living alone (OR = 2.49 males, OR = 2.46 females), and living in urban areas, which was associated with an increased risk for females (OR = 1.85). Among males, living alone was also a significant risk factor for suicide in the 70 to 79 age group (OR = 1.85), and those aged 80 and above (OR = 2.16). Living in rural areas reduced risk for females aged 80 and above (OR = 0.05).

Conclusion:
This first register-based study of suicide in older adults in Norway highlights that living arrangements, urbanization level, and income source are significant risk factors for suicide among older adults. Interventions to improve social connectedness, with a focus on the urban-rural divide, could potentially reduce suicide risk. Sex and age categories should be considered in future research and when implementing preventive measures.

Anna Torp Johansen, Sissel Marguerite Bélanger, Anne Reneflot, Erlend Hem, Eivind Aakhus, Carine Øien-Ødegaard, Kim Stene-Larsen & Cecilie Bhandari Hartberg