[Class and morbidity among the oldest old. A study shows a general connection].
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Activities of Daily Living↗
Biomedical subjects
M Thorslund
Publications and source records attributed to M Thorslund.
[Surveys of standard of living among the oldest old. Important to choose the right test and the right interviewer].
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Activities of Daily Living↗
'Bed-blockers': delayed discharge of hospital patients in a nationwide perspective in Sweden.
Between 1989 and 1992 the number of 'bed-blocking' patients in Sweden decreased from 15 to 7% according to national registers containing approx. 4000 patients. Part of this reduction can be explained by the 1992 Elderly Reform, which placed economic responsibility for bed-blockers on municipalities. However, the decrease began before the economic reform, implying that other factors are also involved, such as access to alternative institutional beds and other forms of care. An in-depth study of one district has provided a description of these often elderly patients, their heavy hospital utilization both before and after the bed-blocking period and their mortality. Nearly half the patients were dead within a year. Bed-blocking is a poorly defined concept requiring urgent discussion. Other related topics to which attention should be drawn are the administrative costs of economic control systems and efficient utilization of public resources as a whole.
Aftercare↗
Prescription drug use among ambulatory elderly in a Swedish municipality.
OBJECTIVE: To analyze prescription drug use among the elderly in a Swedish municipality. METHODS: The municipality of Tierp, located in mideastern Sweden, is a well-defined geographic area that includes both rural areas and a few small, industrial towns. All people aged 65 years and older (n = 4769) as of 1986 in a total population of 21,000 inhabitants were included in the study. Their drug use was studied by registering all prescriptions filled by the pharmacies in the area. RESULTS: Most of the elderly (> 70 percent) obtained at least one prescription during the year studied. Drug use was more common among women than men. However, the difference between men and women was much smaller among those aged 85 years or more. The drugs most commonly prescribed were cardiovascular, psychotropic, and analgesic agents. Furthermore, the study showed that simultaneous use of several drugs was quite common. One-fourth of all people aged 65 years and older used drugs from at least four different pharmacologic groups. CONCLUSIONS: Our results revealed widespread use of prescription drugs among the elderly. An important finding was extensive drug use among men aged 85 years or more. This age group is increasing and there is need for further studies of its medication use.
Aged↗
Delayed discharge of elderly hospital patients--a study of bed-blockers in a health care district in Sweden.
With an ageing population an increased pressure on health care resources will be seen in most countries. Patients with delayed discharge from short-term hospitals, sometimes called "bed-blockers", are of special interest in Sweden, especially as liability for payments for these patients has been placed on the municipal authorities by a new reform in 1992. A retrospective study was made of 428 bed-blockers above the age of 64 years from one health district in Uppsala during the two-year period 1987-1988. The median age was 81.6 years, and the majority were women. The patients had a median number of diagnoses of 4.1. Additional medical events/symptoms were noted in half of the patients after they had been classified as medically ready for discharge. Even though they were classified "medically ready" for discharge, they still needed care. One-third needed further rehabilitation and another 1/3 further medical attention. Only 1/10 were independent in daily activities of living. At the final discharge 1/3 actually returned home and 16% died on the acute ward. The results clearly demonstrate that these patients often still had further medical needs after the application for transfer. One crucial question, that needs discussion, is the vague definition of a "bed-blocker". Related questions are when and where should these patients be transferred, as well as the relevance of the term "bed-blocker" from ethical perspectives.
Activities of Daily Living↗
Scandinavian home care for the elderly.
Scandinavian countries provide an example of proactive social policies that aid in the health care of the elderly. Systems in both Norway and Sweden emphasize decentralization of services; with their strong social systems, these countries' home care services for the elderly could be applied with good results elsewhere.
Aged↗
The increasing number of very old people will change the Swedish model of the welfare state.
In Sweden as well as many other welfare states, society has assumed--or been given--a number of functions formerly performed by the family. Child care and care of the elderly are here two significant examples. Since 1960 the number of institutional beds for the care of the elderly has doubled. The number of personnel working within the home-help and home-care systems has increased sharply. In spite of this, the demand for service and care is today increasing faster than the input of new resources. Many have been worried that the increasing number of very old people will create (too) heavy a strain on the Swedish economy. But the main problem will be not the economy but rather the scarcity of personnel. Even the most optimistic prognosis indicates that within the next 10 years, the number of personnel employed in the care of the elderly will no longer be sufficient. Heavy burdens will be placed on families and on women. The potential labour force of the newly retired will be needed, the private sector will expand, etc. Sweden will still be a welfare state, but the fundamental concept of a society where services and care are provided for all citizens on equal terms will change.
Family↗
The structure of IADL and ADL measures: some findings from a Swedish study.
The purpose of this paper is to uncover the dimensional structure of a set of disability items. The analysis is based on a sample of 421 persons aged 75 years and older. Firstly, a factor analysis of the items reveals two distinct dimensions: IADL and ADL. The items with large loadings on the IADL-factor are next submitted to a Guttman analysis. An index is derived which strictly meets the requirements of a Guttman scale, but it is doubtful whether there is a true hierarchical structure among the items. The criterion validity of the index (in different versions) appears to be satisfactory when assessed in terms of the correlation with an outcome variable (home help).
Activities of Daily Living↗
The utilization of home help in Sweden: a multivariate analysis.
We estimated the effect of a variety of factors on the utilization of home help among the elderly in Sweden using a sample (N = 421) of people 75 years and older. A regression analysis singled out two factors as the most important: physical functioning (instrumental activities of daily living) and living alone. Calculations of attributable fractions substantiated this result. Implications for planning and allocating home help are discussed.
Aged↗
The quality of retrospective questions about occupational history--a comparison between survey and census data.
The main purpose of the present study was to assess the quality of information about occupational history obtained via retrospective interview questions. This assessment is achieved by linking interview data from the Swedish survey of Living Conditions (ULF) with occupational information about the same individuals obtained from a number of censuses. This has been done for the census years 1960, 1970, 1975 and 1980. In both ULF and the census, occupations have been classified according to the Nordic Occupational Classification (NYK). Both data sources contain errors. There are also differences in definitions and measurement procedures. Still, the survey question on occupational history gives results of good quality in terms of agreement with census data. This is especially the case for coarse levels of the classification scheme (NYK 1-digit level). The agreement is somewhat lower for the comparisons farthest back in time.
Adult↗
The use of technical aids among community-based elderly.
The growing elderly population will increase the need for assistive technology in the form of technical aids and housing adaptations to facilitate independence in activities of daily living. In this study, which was undertaken to facilitate a better understanding of the life-styles of the disabled elderly and the role of technical aids, 57 disabled persons over 74 years of age were studied. All of the subjects were residents of a rural Swedish community. The subjects had a total of 422 aids, an average of 7.4 per person. Seventy-five percent of the aids were being used, and 42 persons had at least one aid that granted autonomy. This finding illustrates the importance of technical aids in home care. It is recommended, therefore, that information about assistive technology be disseminated to personnel at all levels of community-based care.
Activities of Daily Living↗
Smoking behaviour among pregnant women prior to antenatal care registration.
Changes in smoking behaviour during early pregnancy and factors influencing such changes were studied in an unselected, area-based population. During 1987, all women registered at the antenatal care clinics in Uppsala county. Sweden, received a self-administered questionnaire regarding past and present smoking habits. Thirty-two per cent (n = 1160) were daily smokers at the time of conception. Almost one-fourth of the smokers (n = 263) had quit smoking at the first visit to antenatal care 6-10 weeks later. Using logistic regression analyses, we found that low education, not living with infants's father and whether others smoked at home or at work were factors that were independently associated with increased risks of smoking at time of conception as well as continued smoking in early pregnancy. Continued smoking was also significantly more common among women with previous births, women who started smoking at an early age and women who smoked heavily.
Age Factors↗
The validity of a pain questionnaire for postal surveys.
A postal survey aimed at studying the prevalence of chronic pain and the need for care because of pain was carried out in a representative sample of a Swedish population. A random sample of the study population has been interviewed and assessed clinically to determine whether a questionnaire method gives the same results as clinical assessment. The agreement between estimates based on the questionnaire and those based on the clinical assessments varied depending on the questions used. By creating questions more independent of language habits and values, it was shown that it is possible to get better agreement between different descriptions. The best agreement was shown when answers to questions regarding different dimensions of pain were combined in a model for selecting individuals with more serious pain problems.
Adolescent↗
[Experiences from Medelpad I: To cut down the number of beds in institutions while the number of elderly people is increasing].
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Aged↗
[Questionnaire by post. 40 per cent of the population in the county of Gävleborg suffer from chronic pain].
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Adolescent↗
The use of common pain experiences in designing a pain intensity scale for epidemiological purposes.
The planning of services for the treatment of chronic pain does not seem to be based on adequate information. Although some epidemiological studies exist already, there is a need for more epidemiological knowledge. We have tried to develop a mail questionnaire which may, to some extent, separate pain sensory intensity from pain affect and behaviour. In this paper we refer to the development and testing of a pain sensory intensity scale based on common pain experience. 155 subjects classified the intensity of 15 common pain states. The classifications were then compared. The results indicate that there are pain states which many people have experienced and which they are able to rank according to pain intensity. The pain sensory intensity scale we based on five of these pain experiences or groups of pain experience.
Adult↗
The de-institutionalization of care of the elderly: some notes about implementation and outcome of a Swedish case-study.
During the 1980s the number of institutional beds in Sweden has decreased in relation to the number of elderly in the population. In some communities this development has been drastic. The present paper describes how the implementation of this process in one of these communities was based on action research design. Initially most people regarded the development as a success: more elderly people were able to stay in their homes and institutional places were used more effectively. The situation today is more complicated. Elderly patients finally ending up in institutions are in greater need of care than before. Over-occupation of beds is again common, making the situation more "heavy-going" for the staff. Staff outside the institutions are also experiencing a heavier workload. In view of this, the wisdom of further de-institutionalization is now questioned.
Aged↗
Problems with cross-sectional data in research on working environment and health.
Occupational turnover due to health related selection might introduce a bias in cross-sectional studies that tends to mask real occupational health effects. People could have changed occupation so that they, when disease occurs and/or the data collection is accomplished, are working in an environment that is irrelevant for the disease in question. The aim of this study was to determine whether there is any difference in morbidity between 'stable' workers and 'changers'. Occurrence of long-term illness was studied on four exposure levels, defined according to the physical demands at work. The study populations comprised 10,487 men and 10,058 women between 25 to 74 years of age, who were interviewed within the scope of the Statistics Sweden Survey of Living Conditions in the years 1977 and 1979-81. Considerable differences in health outcomes were found between stable workers and changers, especially when considering the degree of physical strain at work. Thus, the findings indicate the necessity of detailed recording of occupational histories within the framework of cross-sectional studies, especially when the aim of the investigation is to study and compare health outcomes for workers in occupations with different turnover rates.
Adult↗