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Biomedical subjects

M Thorslund

Publications and source records attributed to M Thorslund.

At least 19 recordsLinked to original sources
PubMed2001

[Holistic perspective is needed in care of multiimpaired elderly. A proposal for structural change of the organization of care in the county of Stockholm].

Studies in the County of Stockholm reveal a malfunctioning care system for elderly persons with one or more diseases in conjunction with immobility and reduced strength. These multi-impaired elderly consume a substantial proportion of care and rehabilitation services. They would need a health co-ordinator to monitor the entire care process, dealing with all aspects of care, and whose sphere of responsibility is not unduly restricted. The communication of information from inpatient care to the primary care setting is highly problematic. Therefore it is proposed that the transfer of multi-impaired elderly individuals from inpatient care to outpatient primary care be a carefully monitored process. In addition, outside of the hospital an "elderly team" that would be composed of doctors, district nurses, rehabilitation personnel and care assistants is proposed. This team should have a geographically well-defined area of responsibility, in which they would provide care in the homes of these multi-impaired elderly.

Aged↗
PubMed2001

Psychotropic drug use in elderly people with and without dementia.

OBJECTIVE: To determine the prevalence of psychotropic drug use in very old persons with and without dementia in two time periods, and describe the patterns of psychotropic drug use between institutions and non-institutions. METHODS: Descriptive analysis on a sample of subjects aged 81+ from a population-based study in Stockholm, Sweden. Psychotropic drug use data were collected from the 1987-1989 and 1994-1996 periods of the study. The diagnosis of dementia was based on the DSM III-R. RESULTS: About 41% of the subjects used at least one psychotropic drug in both periods. Women and subjects in institutions more commonly used psychotropic drugs. The most commonly reported were, in rank order, hypnotics-sedatives, anxiolytics, antipsychotics and antidepressants. Hypnotics-sedatives and anxiolytics were the most commonly used in both institutions and non-institutions. More persons with dementia used psychotropic drugs in both periods. The use of newer drugs, for example, SSRI, was evident. Multivariate analyses showed increased risk for psychotropic drug use among subjects in institutions. CONCLUSIONS: This study confirms the high rate of psychotropic drug use in the very old, particularly in persons with dementia. Psychotropic drug use was high among subjects living in institutions.

Age Factors↗
PubMed2001

The appropriateness of drug use in an older nondemented and demented population.

OBJECTIVE: To assess the extent of inappropriateness of drug use in an older nondemented and demented population. DESIGN: Descriptive analysis based on data from a sample of older subjects age 81 years and older. Data were collected from the second follow-up conducted in 1994-1996. SETTING: A population-based study of the Kungsholmen project in Stockholm, Sweden. PARTICIPANTS: Drug information was obtained from 681 subjects with a mean age of 86.9 years. The subjects were predominantly women (78%). Thirteen percent resided in institutions and 27.6% were diagnosed with dementia. MEASUREMENTS: Dementia diagnosis based on DSM III-R. Criteria for inappropriateness of drug use: use of drugs with potent anticholinergic properties, drug duplication, potential drug-drug and drug-disease interactions, and inappropriate drug dosage. RESULTS: The mean number of drugs used was 4.6: 4.5 drugs for nondemented and 4.8 for demented subjects. Nondemented subjects more commonly used cardiovascular-system drugs and demented subjects used nervous-system drugs. Demented subjects were more commonly exposed to drug duplication and to drugs with potent anticholinergic properties, both involving the use of psychotropic drugs. Nondemented subjects were more commonly exposed to potential drug-disease interactions, mostly with the use of cardiovascular drugs. The most common drug combination leading to a potential interaction was the use of digoxin with furosemide, occurring more frequently among nondemented subjects. The most common drug-disease interaction was the use of beta-blockers and calcium antagonists in subjects with congestive heart failure. The doses of drugs taken by both nondemented and demented subjects were mostly lower than the defined daily dose. CONCLUSION: There was substantial exposure to presumptive inappropriateness of drug use in this very old nondemented and demented population. The exposure of demented subjects to psychotropic drugs and nondemented subjects to cardiovascular drugs reflect the high frequency of prescribing these drugs in this population.

Age Factors↗
PubMed2000

Mobility limitations in the Swedish population from 1968 to 1992: age, gender and social class differences.

Mobility limitations are closely related to disability in old age. The study of mobility limitations in the population may improve the understanding of the development of disability, as well as gender and class patterns in disability in old age. Representative samples of the Swedish population between the ages of 18 and 75 years were interviewed in 1968, 1974, 1981, and 1991. A further sample of people aged 76+ years was interviewed in 1992. The questionnaire included the ability to walk 100 meters, to walk up and down stairs, and to run 100 meters. Mobility limitations begin to appear around age 40 years, and increase with age. In 1992 nearly none in the oldest age group (85+) could run 100 meters, and less than half could walk 100 meters, or go up and down stairs without difficulty. Between 1968 and 1991, the proportion of people with mobility limitations was reduced by one third, with the most prominent reduction among the oldest age groups. Women were more likely to report mobility limitations compared to men at all waves; however, the gender difference decreased between 1968 and 1991. Blue-collar workers had more mobility limitations than white-collar workers, and this discrepancy did not decrease over time. Mobility limitations often begin early in life, and differences between cohorts, men and women, and social classes can be seen well before the age of 50. The results suggest that gender differences in functional limitations among elderly people may decrease in the future, while social class inequalities are likely to persist.

Adolescent↗
PubMed2000

Priorities in care and services for elderly people: a path without guidelines?

The growing gap between demands and resources is putting immense pressure on all government spending in Sweden. The gap is especially apparent in care and services for elderly people in light of the rapid aging of the population. The article considers the decisions and priorities concerning resource allocation in the welfare sector in general and in elderly care in particular. The aim is to describe the political and administrative setting and to provide a conceptual structure that outlines the nature of the problem. Various levels of decision making are identified and discussed in the context of political accountability. Current transitions in elderly care are described with respect to service provision, marketisation, coverage rates, and eligibility standards. Basic principles of distribution are highlighted in order to clarify some central concepts of efficiency and justice, and a number of strategies for actual prioritising are identified. The article concludes with an endorsement of more conscious decisions in resource allocation. Existing knowledge and information concerning the effects of various strategies must be utilised, and the values and assumptions used for setting priorities must be made explicit.

Aged↗
PubMed1998

Mortality in elderly men and women in a Swedish municipality.

AIM: to analyse the relationship between age, self-rated global health, morbidity, mobility, life satisfaction, marital status, social network and 6-year mortality in elderly men and women living at home. METHOD: the study area was a municipality in mid-eastern Sweden with a population of about 21,000. Data from interviews with non-institutionalized people aged 75 years and older in 1986 (n = 421) were linked to an individual-based research registry of prescription drug purchases. The elderly subjects were followed for 6 years. Information on mortality was obtained from the national cause of death register. A combined measure of morbidity captured both self-reported symptoms/diseases and prescription drugs. RESULTS: mortality was higher in men than women (P < 0.001). Multivariate analysis was performed using logistic regression analysis. Among elderly men, morbidity-related factors-self-rated global health, heart problems and diabetes mellitus, for example--were the most important predictors of mortality. Among women, the predictors were spread over more domains (morbidity, mobility, social network).

Aged↗
PubMed1998

Changes in Swedish dental health 1968-91.

Studies of changes in dental health are essential in discussions of national health policy matters. In the Level of Living Survey representative samples of the population aged 18-75 were interviewed in 1968, 1974, 1981, and 1991. In the 1991 survey those aged 76+ were also interviewed. Between all the four waves of the survey edentulousness and partial edentulousness decreased and the proportion of persons with teeth with many fillings, crowns or bridges increased. After 1974 the proportion of persons with teeth in good condition with few or no fillings also increased. The fall in edentulousness indicated a greater improvement in dental health than did the rise of the proportion of people with teeth in good condition. Age-specific comparisons showed that the change affected older people most. The largest fall in edentulousness and partial edentulousness was in ages above 50. This fall led to a nearly equal increase in the same ages of persons that had teeth with many fillings, crowns or bridges. This has meant that dental care needs have risen among older people in particular. The results are discussed in connection with the national dental health insurance scheme which was introduced in 1974.

Adolescent↗
PubMed1997

Drug use by demented and non-demented elderly people.

AIM: to determine the use of drugs by demented and non-demented elderly people in a population, by dementia status and type, age, sex and accommodation type. METHOD: data were obtained from the Kungsholmen project, a longitudinal community study of people over 75 in Stockholm, Sweden. RESULTS: 85% used at least one medicinal drug, and of these 12% were demented. Mean numbers of drugs used were 2.8 for demented and 3.2 for non-demented people. 45% of demented people and 38% of non-demented people used psychotropic agents. Psychotropic use was higher in women and increased with institutionalization. Antipsychotic agents were used more by demented (22%) than by non-demented (3.5%) people: this was largely explained by differences in accommodation type. The odds ratio (OR) for use of antipsychotics by those in institutions compared with those living in their own homes was 9.32. Opioids were commonly prescribed for demented people. The proportions taking opioids in those using analgesics were 42% in demented and 23% in non-demented people (OR 2.07). Laxatives were used by 18% of the demented people in institutions compared with 39% of non-demented people in institutions. CONCLUSION: being in an institution had a stronger association with the use of certain drugs (e.g. psychotropics) than did dementia status. Demented people, especially those in institutions, used a large number of antipsychotics and opioids, but fewer laxatives and minor analgesics. Prescribers and institutional staff should be aware of these factors so they can optimize patient treatment.

Aged↗
PubMed1997

A longitudinal study of pain: reported pain from middle age to old age.

OBJECTIVE: Describe patterns of pain reporting over a span of 24 years. DESIGN: Individuals were interviewed on four occasions (1968, 1974, 1981, 1992). PARTICIPANTS: Representative sample (n = 321) of the Swedish population aged 53-63 at baseline. MEASURES: Self-reported pain in the chest, abdomen, and musculoskeletal system (back or hips, shoulders, hands, elbows, legs, or knees). RESULTS: Less than 1% reported chest or abdominal pain on all four occasions. Whereas 21.8% of the sample reported musculoskeletal pain on all four occasions. More than half of the sample reported some kind of pain on three or four occasions. Women reported more severe and more persistent pain compared with men. There were more people who developed pain during the 24-year period than there were who became pain free. An increase in pain was equally common for chest and musculoskeletal pain, but a decrease in pain was much more common for musculoskeletal pain than chest pain. CONCLUSIONS: Cross-sectional studies have shown differing age patterns in pain. This longitudinal study demonstrates different patterns for men and women and for different pain localities.

Aged↗
PubMed1996

Brief cognitive screening in a field survey of the oldest old.

A nationally representative survey of living conditions among persons aged 77 to 98 years included a short instrument for cognitive impairment consisting of items from the Mini-Mental State Examination (MMSE). Because of the wide range of social, health, and economic domains included in the survey, it was necessary that the instrument could be administered in a short time by interviewers without experience in neuropsychological testing. Because of the age of the subjects, the instrument must be relatively independent of sensory or motor disabilities, and be acceptable to both interviewers and older adults. There were very few problems with the use of the instrument and very little missing data. A cut-off point for cognitive impairment was ascertained for the items included in this instrument using other data sets where diagnostic confirmation was available. Being able to identify subjects who are probably cognitively impaired is helpful in a multipurpose survey study of the oldest old, both in documenting the cognitive status of the sample and in evaluating the quality of other information being collected in the study.

Age Distribution↗
PubMed1996

Use of cardiovascular drugs in an older Swedish population.

OBJECTIVE: To describe the use of cardiovascular drugs in an older population with respect to age, sex, housing type, and creatinine clearance. DESIGN: A cross-sectional survey. PARTICIPANTS: All residents of a district of Stockholm (Kungsholmen), Sweden, aged 75 and older, living in institutions or at home. MEASUREMENTS: Cardiovascular drug use, serum creatinine, electrolytes, height, weight, and symptoms. RESULTS: A total of 43 cardiovascular (CV) drugs were used. The most common drugs were digoxin (used by 18.2%), furosemide (16.4%), and glyceryl trinitrate (12.4%). Drugs with an antihypertensive effect accounted for 61% of all CV drugs. CV drug use increased with age for cardiac glycosides and diuretics, but decreased with age for calcium antagonists and beta-blockers. Drug doses tended to be less than the recommended daily dose except for a few drugs, e.g., furosemide. There was a trend toward decreasing dose with increasing age, but this was not significant. Diuretics were the only CV drugs used more often in women. People living in institutional care used the least amount of CV drugs. The dose of drugs taken did not appear to be related to estimated creatinine clearance. Comparisons between drug use and complaint of symptoms showed a strong correlation between the use of cardiac glycosides and anorexia, calcium antagonists and constipation, and nitrates and vertigo. There were weaker correlations with cardiac glycosides and visual disturbances and with potassium sparing diuretics and a high potassium. CONCLUSIONS: CV drugs are used commonly in older people. We suggest that the symptoms correlating with cardiac glycoside use may be signs of unrecognized toxicity, and this may relate to our finding that drug use is often not tailored to renal function as measured by creatinine clearance.

Aged↗
PubMed1996

Predictors of physical function among the oldest old: a comparison of three outcome variables in a 24-year follow-up.

This study has measured physical function in a nationally representative sample of persons aged 77 to 98 (N = 508) in 1992. Three measures of function are used: activities of daily living (ADL), an index of mobility, and performance tests. These are used as outcomes and analyzed in relation to variables gathered in a survey in 1968. Variables from 1968 include education, mobility, smoking, and an index of circulation problems. All four variables predict some limitations in physical function in old age. However, there are different patterns of predictors found for the three outcome measures. All three outcomes are associated with age, education, and previous circulation problems. ADL limitations are also associated with poor previous mobility and smoking; mobility limitations are also associated with sex and smoking; performance limitations are also associated with sex.

Activities of Daily Living↗
PubMed1995

The use of medicines with anticholinergic effects in older people: a population study in an urban area of Sweden.

OBJECTIVE: To investigate the use of medicines with anticholinergic properties among older people in an urban population in Sweden. DESIGN: A cross-sectional survey. SETTING: Ordinary homes, sheltered accommodations, nursing homes, and geriatric departments. PARTICIPANTS: All residents aged 75 and older in a district of Stockholm, Sweden. MEASUREMENTS: Structured interviews with older persons, their relatives and/or health care personnel; prescription forms; medical records. RESULTS: The overall use of medicines with anticholinergic effects was comparatively low. Doses of these medicines were also generally low. Concurrent use of several such medicines was uncommon. The most prevalent therapeutic/pharmacological group was neuroleptics. In contrast, antidepressants were used by few older people. The prevalence of medicines with anticholinergic effects was highest at institutions, where neuroleptics were frequent and use of low-potency neuroleptics was not uncommon. CONCLUSION: Our results indicate that the risk of anticholinergic side effects may be quite low in the present population as a whole. However, there may be grounds for revising the therapy in institutions, where the use of neuroleptics was shown to be high and low-potency neuroleptics, known to have a higher incidence of anticholinergic side effects, were not avoided.

Age Factors↗
PubMed1994

The validity of survey data on utilization of health and social services among the very old.

Survey responses to questions regarding utilization of health and social services among very old persons were compared to independently registered utilization records. Survey data came from in-person interviews with a sample of noninstitutionalized 75-84-year-olds and all noninstitutionalized individuals over the age of 84 in a Swedish community. Agreement regarding utilization vs no utilization during the past three months was found to be very high for hospitalizations and home help, somewhat lower for home visits by nurses, and lower yet for visits to physicians and to nurses. Except for visits to nurses, aggregate survey estimates of proportion with utilization were not significantly different from those based on records. Reporting patterns were generally in agreement with predictions made on the basis of frequency and saliency of service utilization. Reasons for over- and underreporting were investigated on the basis of register data, and some evidence for telescoping was observed.

Aged↗
PubMed1994

Physical function and social class among Swedish oldest old.

The relationship between physical ability and social class in later life was explored through an interview survey conducted on a nationally representative sample of persons aged 77-98 (N = 537). Physical ability was measured with activities of daily living, an index of mobility, and performance tests. Social class was measured according to previous occupation. Physical function was found to be correlated with social class, that is, former white-collar workers had better function than blue-collar workers. The differences were significant for all three measures of physical function.

Activities of Daily Living↗
PubMed1994

Health and inequalities among the oldest old.

The elderly, and especially the oldest old, have generally been overlooked in research on social class inequalities in health. On the basis of nationally representative data from Sweden for the age group 77 to 98 (N=537), we have been able to demonstrate clear differences in health between social classes. These inequalities were found both for men and women. It should be noticed, however, that the patterns of class differences varied depending on the health indicator used. The often employed global measure of self-rated health showed the smallest class gradient when controlling for age and sex, whereas larger differences were found with more concrete and descriptive measures such as peak flow rate.

Age Factors↗