Forskningsartikler

Article in press, 26. january 2026

Abstract:

Comprehensive mapping of key physical activity (PA) types, postures, and sleep among older adults is important for informing public health policies and interventions. This study aimed to describe the 24-h time distribution of key PA types, postures, and sleep in a population-based sample of community-dwelling older adults and explore whether age, sex, and educational level influenced this distribution. Participants 65 years and older from the fourth survey of the Trøndelag Health Study (HUNT4, 2017-19) with ≥ 1 day of complete accelerometer recording were included (n = 8,114). PA types (walking, running, cycling), postures (standing, sitting, lying (awake)), and sleep were derived from the accelerometer data using validated machine learning models. Survey-weighted regression models were applied to describe the 24-h time distribution of PA types, postures, and sleep by age, sex, and education. Participants spent 4.1 h standing (SD 85.3 min), 82.8 min (SD 40.3 min) walking, 0.2 min (SD 1.7 min) running, 4.6 min (SD 7.2 min) cycling, 9.2 h (SD 115.5 min) sitting, 2.1 h (SD 86.6 min) lying (awake), and 7.1 h (SD 50.4 min) sleeping per day. Time spent standing and walking decreased, while time spent sitting, lying (awake), and sleeping increased with higher age. Women spent more time standing and sleeping, and less time walking, sitting, and lying (awake) than men. Higher education was associated with more time standing and walking and less time sitting. This study provides novel insights into the distribution of 24-h movement behaviors among older adults and can serve as a benchmark for future research on key PA types, postures, sleep, and their interactions.

Karen Sverdrup, Astrid Ustad, Gro Gujord Tangen, Atle Kongsvold, Beatrix Vereijken, Bjørn Heine Strand, Geir Selbæk, Linda Ernstsen & Paul Jarle Mork

Abstract:

Aim: The aim of this study is to explore the lessons that nursing home staff learned from the COVID-19 pandemic related to the management of pandemic infectious diseases.

Methods: Four focus groups were conducted with nursing home staff who had experienced COVID-19 infections at the nursing home where they were employed. The focus groups, conducted during September and October 2023 at the respective nursing homes, were audio recorded and transcribed verbatim. Data were analyzed using reflexive thematic analysis as described by Braun and Clarke (2022).

Findings: The analysis resulted in three themes: 1) organization of infection control measures, 2) framework for training in infection control routines, and 3) clinical assessments and measures when suspecting infection. The participants experienced challenges regarding access to personal protective equipment, a lack of knowledge about infection control routines, and the difficulty of limiting infection given the building layout. Using clinical tools or assessments to detect signs of infection in nursing home residents improved nursing home staff’s ability to detect symptoms of contagious infections.

Conclusion: For nursing homes to be more prepared and resilient in the event of a new pandemic, overall planning of nursing homes’ needs should take place at both the national and municipal levels, as well as at the management level within each nursing home. This planning must ensure sufficient staffing, access to infection control equipment, and the updating of employees’ professional and clinical knowledge.

Anita Nilsen, Bjørn Lichtwarck, Siren Eriksen, Anne Marie Mork Rokstad

Abstract:

Purpose: To document use and impact of potentially inappropriate medications on two-year progression of dementia in individuals with cognitive declines.

Methods: A retrospective study of 397 patients with Mild Cognitive Impairment (MCI) or dementia diagnosed and followed-up in outpatient memory clinics in Norway during 2009 − 18. Beers (2019)- and STOPP-2 criteria were used to identify Potentially Inappropriate Medications (PIMcogs) in individuals with cognitive impairments at baseline and two-year-follow-up. PIMcog use in terms of dementia severity, cognitive function, and neuropsychiatric and depressive symptoms were analyzed in regression models.

Results: The prevalence of PIMcogs increased from 16% at baseline to 23% at follow-up. PIMcog users were more likely to be women (63.5%), and they used more drugs, with a median of 5 drugs at baseline and 4 drugs at follow-up, compared to non-users who had a median of 3 used drugs at both time points. PIMcog users had higher median Neuropsychiatric Inventory severity sum scores (6 [3.0–11.0] versus 4.0 [2.0–7.0]) and median Cornell Scale for Depression in Dementia scores (6.5 [3.0–11.0] versus 4.0 [1.0–7.0]) compared to non-users at follow-up (p ≤ 0.002). PIMcog users exhibited more severe dementia, with a Clinical Dementia Rate-Sum of Boxes (CDR-SB) score of 7.0 (4.0–13.0) compared to 6.0 (3.5–10.0) in non-users. The median annual increase in CDR-SB was one unit, and PIMcog use at follow-up was significantly associated with more rapid progression of dementia severity.

Conclusion: Faster dementia progression was documented among PIMcog users although, the prevalence of PIMcogs was generally low in Norwegian memory clinic patients with cognitive impairments.

Hege Kersten, Maria L. Barca, Rannveig Sakshaug Eldholm, Karin Persson, Lara Thomasgaard, Keson Jaioun, Ingvild Saltvedt, Geir Selbæk & Knut Engedal

Sammendrag

Hensikt: Beboere på langtidsopphold på sykehjem har omfattende helsebehov og krever tverrfaglig oppfølging. Til tross for krav om at fysioterapi-tjenester skal være tilgjengelige, er kunnskap om faktisk bruk begrenset. Hensikten med studien er å kartlegge organisering, tidsbruk og omfang av fysioterapitjenester under langtidsopphold på sykehjem.

Design: Tverrsnittstudie

Metode og materiale: Digital undersøkelse med spørsmål om tidsbruk, omfang og organisering av fysioterapiressurser under langtidsopphold på sykehjem ble sendt til leder for kommunale fysioterapeuter i alle kommuner i Norge.

Resultat: Totalt 262 av 357 kommuner besvarte undersøkelsen. De fleste kommunene (n=214, 82 %) hadde ikke avsatt fysioterapistilling(er) til beboere på langtidsopphold på sykehjem. Median tidsbruk for alle kommunene var 2,9 (0-50) minutter fysioterapi pr. langtidsplass pr. uke og 0,3 (0-2,1) henvisninger pr. langtidsplass pr. år. Kommuner med avsatt stilling til langtidsplasser (n=48) og mindre kommuner leverte mer fysioterapi til langtidsopphold på sykehjem enn kommuner uten avsatt stilling og større befolkning. Den vanligste henvisningsårsaken var brudd og andre skader etter fall, og funksjonsfall etter sykdom eller sykehusinnleggelse.

Konklusjon: Fysioterapi under langtidsopphold organiseres som regel via henvisning til kommunal fysioterapitjeneste. Det er betydelige variasjoner i antall henvisninger og tidsbruk mellom kommunene, men både antall henvisninger og tidsbruk fremstår som lavt, gitt beboernes funksjonsnivå og behov for tiltak som opptrening, mobilisering og veiledning av pleiepersonell.

Elisabeth Wiken Telenius, Kristine Bjorheim Bøe, Nina Skjæret-Maroni, Kristin Taraldsen, Gro Gujord Tangen, Karen Sverdrup

Abstract:

Background:
High levels of alcohol consumption and cognitive impairment both drain our healthcare budget, but it is unknown whether alcohol use disorders (AUDs) influence healthcare costs among people with suspected cognitive impairment specifically.

Methods:
This study aims to examine the association between alcohol-related ICD-10 diagnoses and healthcare costs among 2,736 Norwegians aged ≥60 years being assessed for cognitive impairment in Norwegian specialist healthcare and included in the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog). Linear regression analysis was applied to assess the relationship between ICD-10 alcohol-related diagnoses and the primary outcome variable: healthcare costs. Healthcare costs one year before and one year after clinical assessment were used to account for the expected shift in healthcare use after assessment.

Results:
Median costs of healthcare use were €2,226 (Q1-Q3 1,076−4,107) one year before assessment and €2,217 (Q1-Q3 1,160−4,006) after. One year prior to NorCog assessment, participants with AUDs had approximately 50% higher costs compared to participants without an AUD (median of €3,286 and €2,190, respectively). One year after NorCog assessment, this difference was negligible. An interaction between AUD status and time was significant, implying that post-diagnostic care for cognitive impairment may simultaneously mitigate the healthcare burden associated with AUDs or its related sequelae.

Conclusion:
Our findings indicate that alcohol consumption is a potentially important and amenable determinant of healthcare use, knowledge which could be valuable in planning treatment and care. Such knowledge could also possibly curtail the higher healthcare costs among older adults with AUDs. Thus, we urge healthcare providers to routinely ask patients about their alcohol consumption.

Ben Kamsvaag  ,Sverre Bergh ,Jūratė Šaltytė Benth ,Richard C. Oude Voshaar ,Kjerstin Tevik ,Geir Selbaek ,Anne-Sofie Helvik

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