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Biomedical subjects

J Valvanne

Publications and source records attributed to J Valvanne.

At least 19 recordsLinked to original sources
PubMed2001

Secular trends in self-reported functioning, need for assistance and attitudes towards life: 10-year differences of three older cohorts.

OBJECTIVES: To compare the self-reported functional status of cohorts, born 10 years apart, when they were at equivalent ages: 75, 80, or 85. DESIGN: Cross-sectional mailed survey of three birth cohorts in 1989 and 1999. PARTICIPANTS: Random samples of older home-dwelling residents from birth cohorts 1904, 1909, and 1914 in 1989 ( N = 685) and the birth cohorts 1914, 1919, and 1924 in 1999 ( N = 2,047) were asked the same questions. MEASUREMENTS: Self-reported physical functioning, need for assistance in daily living, and attitudes toward life. RESULTS: Among 85-year-olds born in 1914 there was a significantly larger proportion able to go outdoors compared with 85-year-olds born in 1904 (72.9% vs 60.6% in women (P <.01) and 84.6% vs 63.6 % in men (P <.01), respectively). Similar trends were observed between the oldest cohorts concerning the need for assistance. The amount of publicly funded domestic help had reduced in the two oldest cohorts in 1999 compared with 1989 (20.3% vs 29.8% in 85-year-old women born in 1914 vs 1904 (P <.05); and 10.2 % vs 25.0% in 85-year-old men born 1914 vs 1904 (P <.05), but at the same time 75-year-old women born in 1924 had increased the use of private domestic help compared with 75-year-old women born in 1914. Significantly larger proportions of both men and women had plans for the future in all the cohorts in 1999 than in 1989. CONCLUSIONS: Consistent yet small differences between the corresponding cohorts suggest that physical functioning and more-optimistic attitude toward life have increased and need for assistance has decreased over 10 years in the older population up to the age of 85.

Activities of Daily Living↗
PubMed1999

Coexistence of lowered mood and cognitive impairment of elderly people in five birth cohorts.

The prevalences of lowered mood and cognitive impairment, and their combination were investigated in 1993 random subjects of five birth cohorts (at age of 65, 70, 75, 80 and 85 years). The frequency of a high Zung-score (> 45), indicating depressive symptoms, in the five age groups was 11%, 13%, 20%, 16%, and 36%, respectively. The corresponding figures for a low MMSE-score (Mini Mental State Examination < 24) were 11%, 9%, 25%, 46%, and 60%; the respective frequencies of subjects fulfilling both criteria simultaneously were 2%, 3%, 8%, 12% and 24%, respectively. Overall, about 30% of the subjects with a low MMSE-score had a high Zung-score. However, more than half of the old subjects (over 75 years) with a high Zung-score also had low MMSE-scores. The data indicate that the combination of impaired cognition and lowered mood doubles in frequency by five-year intervals after the age of 70 years in the general aged population, and that this condition is present in one of four subjects at the age of 85 years.

Affect↗
PubMed1997

Impacts of components of the metabolic syndrome on health status and survival in an aged population.

The clinical significances of different components of the multiple metabolic syndrome were studied in a five-year follow-up study of random persons (n = 1,199) of four birth cohorts at ages 65, 75, 80, and 85 years. The subjects were examined clinically and their serum lipids, blood glucose, plasma insulin, blood pressure, and health score were determined. The health score was measured using a visual analogue scale. All subjects were followed for 5 years. Health score, diastolic blood pressure and body mass index declined over age, but serum triglycerides, and blood glucose were similar, whilst serum high density lipoprotein (HDL)-cholesterol increased. Among women fasting plasma insulin was lowest in the age group of 65 years. The associations of components of the multiple metabolic syndrome varied by age. In the age groups of 65 and 75 years high body mass index, plasma insulin, glucose, triglycerides and low HDL-cholesterol were associated with impaired health. In the age group of 85 years high blood pressure, total cholesterol, and HDL-cholesterol were associated with good health. The baseline health score was consistently lower in the decedents than survivors of all age groups, but components of the metabolic syndrome were generally not associated with impaired survival.

Aged↗
PubMed1997

Functional assessment scales in detecting dementia.

AIM: to evaluate the use of different functional scales in detecting dementia in a population study. METHODS: the study is part of the Helsinki Ageing Study. A random sample of 795 subjects aged 75 (n = 274), 80 (n = 266) and 85 years (n = 255) was taken. The prevalences of dementia (DSM-III-R criteria) in these age groups were 4.6, 13.1 and 26.7% respectively. The functional scale scores were known for 71% of the non-demented and 66% of the demented subjects. A structured questionnaire completed by a close informant included four functional scales: the index of activities of daily living (ADL), the modified Blessed dementia scale (DS), the instrumental activities of daily living scale (IADL) and the Functional Assessment Questionnaire (FAQ). RESULTS: all the functional scales discriminated demented from non-demented subjects. Based on receiver operating characteristics analysis, the area under the curve (95% confidence interval) was 0.90 (0.80-0.94) for the ADL, 0.94 (0.87-0.97) for the DS, 0.95 (0.90-0.98) for the IADL and 0.96 (0.92-0.98) for the FAQ. The effects of age, sex and education in detecting dementia were minor or non-existent in the ADL, DS and FAQ scales, but age had an effect on the performance of the IADL scale. All the scales detected even mild dementia adequately. CONCLUSIONS: functional scales can be used in detecting dementia when functional assessment is already used for other purposes, such as among elderly primary care patients.

Activities of Daily Living↗
PubMed1997

Elevated fasting plasma insulin in a general aged population: an innocent companion of cardiovascular diseases.

OBJECTIVE: Although high insulin levels have been linked to cardiovascular disease, the role of insulin as an independent risk factor has been questioned. Our objective was to examine the association of fasting plasma insulin with cardiovascular disease as well as to investigate the prognostic value of insulin with respect to survival. DESIGN: A 5-year follow-up of random samples from four birth cohorts age 65 (n = 660), 75 (n = 194), 80 (n = 179), and 85 (n = 162) years at baseline. SETTING: Two urban communities in southern Finland. MEASUREMENTS: Clinical and laboratory investigation at base line with collection of date and cause of death information during follow-up. RESULTS: Subjects with cardiovascular disease generally had higher levels of fasting plasma insulin than did subjects without cardiovascular disease (13.9 mU/L vs 11.2 mU/L, P < .001). Heart failure and hypertension were associated with significant 30 to 80% elevations of insulin levels in all but the oldest group. In the 65-year-old group, all vascular diseases were associated with significantly elevated insulin. The associations were generally not explained by body mass index or by use of diuretics or beta-blockers. During the follow-up insulin was generally not associated with an impaired survival. On the contrary, in subjects with manifest cardiovascular disease, high insulin was associated with a rather favorable 5-year survival prognosis. Exclusion of subjects who died during the first 500 days of follow-up did not change these associations. CONCLUSION: Albeit fasting plasma insulin appeared to be secondarily associated with cardiovascular disease in this general aged population, it was related to a fair or favorable survival prognosis.

Activities of Daily Living↗
PubMed1996

High plasma insulin is associated with lower LDL cholesterol in elderly individuals.

To investigate possible relationships between plasma low density lipoprotein (LDL) cholesterol and fasting plasma insulin in the elderly, cross-sectional random samples of age cohorts (65, 75, 80 and 85 years, n = 1188, M/F 38/62 percent) were studied in the neighbouring cities of Helsinki and Vantaa, Finland. Plasma total and high density lipoprotein (HDL) cholesterol, plasma triglycerides, blood glucose and plasma insulin were measured after an overnight fast. LDL cholesterol was calculated using the Friedewald equation. Statistical analyses were performed separately in subjects with non-insulin-dependent diabetes mellitus (NIDDM, n = 219) and non-diabetic subjects (n = 969). Comparison of lipid levels by insulin quartile (I < 7.4 IU/1, II 7.4-10.0, III 10.1-15.0, IV > 15.0) showed that total and LDL cholesterol decreased in the highest insulin quartile (P = 0.003). This trend prevailed after adjustments for age, gender, body mass index, blood glucose and serum triglycerides, and it was significant also in normotriglyceridemic (serum triglycerides <2.3 mmol/l) subjects. Furthermore, the association between high insulin and lower cholesterol was seen in normoglycemic (fasting blood glucose <6.7 mmol/l) and diabetic subjects. Lower LDL cholesterol in elderly subjects with higher fasting insulin may reflect poor health or a 'harvesting' effect, but the results may also be due to effects of insulin on LDL catabolism and/or cholesterol absorption.

Aged↗
PubMed1996

Major depression in the elderly: a population study in Helsinki.

The aim of the study was to estimate the prevalence of major depression and to evaluate associated features in random age cohorts of 75, 80, and 85 years (N = 651). A clinical examination was made by experienced health center physicians, and major depression was diagnosed according to DSM-III criteria. The prevalence increased with age and was 1% to 4% in the age groups of 75 and 80 years, but 13% at the age of 85 years. No sex difference was found. The frequency of major depression was fourfold among institutionalized patients (16%) as compared to those living at home (4%). Major depression was strongly associated with objective health, intellectual functioning, and functional capacity. Depression was most common in subjects suffering from poor vision, urinary incontinence, or Parkinson's disease (odd ratios 4.2 to 4.9). Depression was also correlated with musculoskeletal disorders, coronary heart disease, and cerebrovascular diseases (odd ratios 2.5 to 3.4). The survey suggests that major depression is quite rare in healthy elderly people but common in disabled institutionalized patients.

Activities of Daily Living↗
PubMed1996

Postural hypotension and dizziness in a general aged population: a four-year follow-up of the Helsinki Aging Study.

OBJECTIVE: To evaluate the frequency, risk factors, and prognostic significances of postural hypotension (PH) and dizziness on postural testing (DPT). DESIGN: A prospective cohort study. SETTING: General community, The Helsinki (Finland) Aging Study. SUBJECTS: Persons of three age cohorts (75, 80, and 85 years, n = 569) were chosen randomly and followed for 4 years. MEASURES: Postal questionnaires, structured interview, extensive clinical and laboratory examinations, blood pressure (BP) changes in a postural test using different definitions for PH, history of dizziness, dizziness on testing postural blood pressure reactions (DPT), and date of death during a 4-year follow-up. RESULTS: The frequency of a fall in systolic blood pressure greater than 20 mm Hg or a fall in diastolic pressure greater than 10 mm Hg (PH-I) was 30.3%. Both criteria occurred simultaneously (PH-II) in 7.5%, and if dizziness on postural testing (DPT) was an additional symptom (PH-III), the prevalence was 2.6%. The overall prevalence of DPT was 19.7%. PH-I, PH-II, and DPT were also frequent among the healthy aged (26.6%, 6.6%, and 17.3%, respectively). The postural change in BP correlated inversely with the initial supine BP levels (systolic r = -.149, P < .001 and diastolic r = -.218, P < .001), but in persons with isolated systolic hypertension PH was rather less frequent (21.9% and 2.3%). DPT was more common in the subjects with heart failure (26.3%, P < .05), impaired exercise tolerance (NYHA III-IV) (33.7%, P < .05), and PH-II (37.2%, P < .05) compared with the healthy controls (17.3%). The 1-year mortality was higher in subjects with than without DPT (7.1% vs 4.8%, P < .05), but the difference was not significant after controlling for age and gender. PH-I, PH-II, and PH-III were not significantly related to 4-year mortality. CONCLUSIONS: In this study of older people in Helsinki, Finland, asymptomatic hypotensive postural BP reactions and DPT were found frequently among healthy older people, and they tended to be increased in people with some diseases. Neither PH nor DPT were of prognostic significance for mortality in this population.

Aged↗
PubMed1995

Usefulness of the Clinical Dementia Rating scale in screening for dementia.

The Clinical Dementia Rating (CDR) scale is a qualitative staging instrument that has traditionally been used for assessing the severity of dementia. We used it for screening dementia in a population study of 75-, 80-, and 85-year-old people. The modified CDR scale was easy to establish and it proved to be useful in screening dementia. A more thorough examination is needed in the second phase to identify the false positives. The sensitivity of the CDR scale was 95% and the specificity 94%.

Activities of Daily Living↗
PubMed1994

Factors associated with calcific aortic valve degeneration in the elderly.

This study aimed at identifying factors influencing aortic valve calcification in old age. Echocardiographic and Doppler characteristics of the aortic valve were compared with possible clinical and biochemical predictors in 501 people aged 75-86 years and in 76 aged 55-71. Slight calcification was seen in 222 people (40%) and severe calcification in 72 (13%); 21 people had moderate or severe aortic stenosis. Age (P = 0.000) and serum parathyroid hormone (P = 0.015) were higher and body mass index lower (P = 0.002) in the presence of aortic valve calcification. In multivariate analysis, age (P = 0.000), hypertension (P = 0.005) and body mass index (P = 0.005) were independent predictors of aortic valve calcification, and age (P = 0.022) and serum ionized calcium (P = 0.037) of valve stenosis. The odds ratio (95% confidence interval) for valve calcification was 1.89 (1.42-2.50) for a 10-year increase in age, 1.74 (1.19-2.55) in the presence of hypertension, and 1.39 (1.10-1.76) for a 5 kg.m-2 decrease in body mass index. Sex, smoking, diabetes, serum lipids and insulin were unrelated to valvular calcification. These data suggest that leanness and a history of hypertension increase the likelihood of senile aortic valve calcification. Calcium metabolism may also be of significance. The mechanisms of these associations deserve further study.

Aged↗
PubMed1994

Staging the severity of dementia: comparison of clinical (CDR, DSM-III-R), functional (ADL, IADL) and cognitive (MMSE) scales.

The Helsinki Aging Study is based on a random sample of 795 subjects aged 75 years (N = 274), 80 years (N = 266) and 85 years (N = 255). Ninety-three demented patients were found. All were assessed for severity of dementia by Clinical Dementia Rating (CDR) scale by a general practitioner and according to the DSM-III-R criteria by a neurologist. The Mini-Mental State Examination (MMSE) was carried out by a community nurse and the Index of ADL and the IADL-scale by a close informant. The correlation of the severity of dementia between the DSM-III-R criteria and the CDR scale was moderate. The overall agreement was 64.5% and the Kappa index 0.56. The CDR scale tended to put patients in milder categories than the DSM-III-R criteria. The correlation between the clinical scales and categorized MMSE was moderate to fair. The overall agreement between MMSE and DSM-III-R criteria was 64% (Kappa 0.44) and between MMSE and CDR scale 55% (Kappa 0.33%). The dispersion of the functional scales (ADL, IADL) was much greater indicating that there were also other factors influencing the functional capacity than the degree of dementia. Different methods in staging dementia give different results thus influencing for instance the results of epidemiological studies. Functional scales are needed in clinical practice in addition to the assessment of the severity of dementia. The CDR scale is useful in assessing the need for support services.

Activities of Daily Living↗
PubMed1994

Radiographic findings in the jaws of clinically edentulous old people living at home in Helsinki, Finland.

In the present survey the radiographic findings in the jaws of 124 clinically edentulous old people living at home in Helsinki, Finland, were studied, using panoramic radiography supplemented by intraoral radiographs. Only 9% of the subjects had root remains. Impacted teeth were found in 4%, radiolucent lesions in 3%, and radiopaque findings in 13%. Deviations from normal condylar structure were found in 17% and mucosal thickenings in the maxillary sinuses in 7%. The mental foramen was situated at the top of the residual ridge in 42% of the subjects. Topically situated mental foramen and condylar changes were commoner in women. The radiographic oral health status of the population studied was good.

Aged↗
PubMed1994

Dental radiographic findings in the elderly in Helsinki, Finland.

A total of 169 dentate persons, aged 76, 81, and 86 years, living at home in Helsinki, Finland, were examined by means of panoramic radiography supplemented by intraoral radiographs. The older the age group, the fewer teeth remained. Altogether 75% of the subjects had radiographically detectable caries. A high proportion of the carious teeth (62%) was found in a relatively small number (24%) of subjects. The number of carious teeth and their percentage of the total number of teeth were greater in the older age groups. The proportion of endodontically treated teeth was 19% in the 76-year-olds and 26% in the 86-year-olds. Of the subjects 41% had periapical periodontitis, which was commoner in root-filled teeth (18%) than in other teeth (4%). Caries and periapical radiolucent and radiopaque findings were commoner in men. Vertical bone pockets (3 mm or deeper) were found in 51% and furcation lesions in 28% of the subjects. Compared with earlier Finnish studies, the results indicate an improving oral health status among elderly Finns.

Age Factors↗