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Torgeir Bruun Wyller

Publications and source records attributed to Torgeir Bruun Wyller.

At least 19 recordsLinked to original sources
PubMed2007

The relative stress scale, a useful instrument to identify various aspects of carer burden in dementia?

OBJECTIVE: To identify carer and patient characteristics associated with various aspects of burden of care. METHOD: The burden on 196 carers, each caring for one patient with dementia, was rated by means of the Relative Stress Scale (RSS). Patients were assessed with the Mini Mental State Examination (MMSE), the Disability Assessment for Dementia (DAD) and the Neuropsychiatric Inventory (NPI). RESULTS: Factor analysis of the RSS resulted in three subgroups: 'emotional distress', 'social distress' and 'negative feelings'. The total NPI score contributed to the explanation of the RSS total score and the three RSS subgroup scores with an explanatory power of 37% for total RSS, 34% for emotional distress, 27% for social distress and 20% for negative feelings. In multiple regression analysis, total NPI, DAD%, the carer being a wife and the hours spent caring per week, contributed to the explanation of total RSS with an explanatory power of 48%. Total NPI, the carer being a female and the hours spent caring, explained 38% of the variance in 'emotional distress'. Total NPI, the DAD%-score, contact with the patient on a daily basis and the hours spent caring, explained 'social distress' (49%). 'Negative feelings' were associated with total NPI, younger patients and the carer being a wife (27%). CONCLUSIONS: The RSS offers an opportunity to differentiate between different patterns of distress. This facilitates the creation of tailored intervention to reduce the strain of caring.

Aged↗
PubMed2007

High score on the Relative Stress Scale, a marker of possible psychiatric disorder in family carers of patients with dementia.

OBJECTIVE: To compare the scores on the Relative Stress Scale (RSS) with those on the General Health Questionnaire (GHQ) and the Geriatric Depression Scale (GDS), and to establish a cut-off score for RSS in order to distinguish carers with symptoms of psychiatric disorders from those without. METHODS: One hundred and ninety-four carers of 194 patients suffering from dementia according to ICD-10 were included in the study. Burden of care was assessed by the 15-items RSS, and psychiatric symptoms by means of the GHQ-30 and the 30-items GDS. A case score above 5 on GHQ and above 13 on GDS were used to define carers with probable psychiatric morbidity. Sensitivity (SS), specificity (SP), accuracy and likelihood ratio for a positive test (LR+) were calculated for different cut-points of the RSS. RESULTS: Fifty-six percent of the carers had a GHQ score above 5, and 22% had a GDS score above 13. A two-step cluster analysis using 192 of the 194 carers, identified three groups of carers; a low risk group for psychiatric morbidity (LRG), 82 carers with GHQ < or = 5 and GDS < or = 13; a medium risk group (MRG), 69 carers with GHQ > 5 and GDS < or = 13; and a high-risk group (HRG), 40 carers with GHQ > 5 and GDS > 13. The optimal RSS cut-off to distinguish between the LRG and the others was > 23 (SS 0.72, SP 0.82, accuracy 0.76, LR + 4.0), whereas the optimal cut-off to separate the HRG from the others was >30 (SS 0.74, SP 0.87, accuracy 0.84, LR + 5.7). CONCLUSION: The RSS is a useful instrument to stratify carers according to their risk of psychiatric morbidity.

Aged↗
PubMed2006

[Self-reported walking, balance testing and risk of fall among the elderly].

BACKGROUND: Falls represent an important health problem among the elderly. Balance testing as well as registration of self-reported balance problems may be appropriate in order to predict the risk of future falls. MATERIALS AND METHODS: Self-reported walking was assessed in 307 randomly selected women 75 years or older living at home. The women underwent testing of gait and balance and were followed up for one year with respect to falls and fall-related injuries. RESULTS: 155 of the women fell during the observation period; 308 falls were reported. 13% of the falls resulted in a fracture. Factor analysis identified five anamnestic questions measuring the same latent construct. The sum score of this self-reported walking index correlated highly with simple balance tests. A poor result on the walking index indicated a high risk of falling (odds ratio (OR) 1.83, 95% confidence interval 1.41-2.30) and of fall-related fractures (OR 2.65, 95 % CI 1.27-5.05) the subsequent year. The areas under the ROC curves (receiver-operating characteristics) were, however, only .57 for falls and .61 for fractures. INTERPRETATION: Simple questions give useful information on the risk of falls and fall-related fractures among elderly women.

Accidental Falls↗
PubMed2006

Emotional symptoms in acute ischemic stroke.

BACKGROUND: Anxiety and depressive symptoms encountered in acute stroke influence the patients' neurological outcome and the psychosocial burden of family members. These emotional changes may be caused by the patients' brain damage per se or by psychological reactions. The aims of the present study were to assess the prevalence of anxiety and depressive symptoms in the acute stage of ischemic stroke, and to identify the factors associated with such problems. METHODS: Anxiety and depressive symptoms were evaluated in 178 patients with acute ischemic stroke using the Hospital Anxiety and Depression Scale (HADS) between day 3 and 7 after admittance to the stroke unit. Factors associated with anxiety and depressive symptoms were identified using logistic regression analyses. RESULTS: 26.4% of the patients suffered from anxiety symptoms, 14.0% from depressive symptoms and 7.9% from both. Anxiety symptoms were associated with single marital state (OR 2.53, 95% CI 1.18-5.41) and a low Mini Mental State Examination (MMSE) score (< 26 points) (OR 0.53, 95% CI 0.31-0.87) whereas depressive symptoms were related to a low Barthel Activities of Daily Living index (BI) (score < 90 points) (OR 0.37, 95% CI 0.15-0.88). CONCLUSION: The present study indicates that anxiety symptoms are more frequent than depressive symptoms in the acute stage of ischemic stroke. It is important to focus on both anxiety and depressive symptoms throughout the rehabilitation phase in order to ease the patients' personal anguish and improve neurological outcome after stroke.

Adult↗
PubMed2006

Prognostic significance of micturition disturbances after acute stroke.

OBJECTIVES: To investigate the prevalence, incidence, clinical types, and prognostic effect of micturition disturbances in acute stroke. DESIGN: Prospective observational study. SETTING: Geriatric department (stroke and rehabilitation unit) in a community hospital (acute phase); outpatient clinic, patients' own homes, or nursing homes (3 months follow-up). PARTICIPANTS: Three hundred fifteen patients (mean age 77) with acute first-ever or recurrent stroke consecutively admitted to the hospital stroke unit. MEASUREMENTS: Premorbid basic and instrumental activities of daily living (ADLs) and mental functioning; comorbidity; previous and actual micturition symptoms; stroke syndromes; medication use; and poststroke mobility, ADLs, and cognition. RESULTS: One hundred forty-seven patients (46%) had preexisting micturition disturbances (urinary incontinence (UI), n = 98; urgency/frequency, n = 37; voiding difficulties, n = 12). Seventy-eight developed new symptoms (UI, n = 65; urgency/frequency, n = 4; sustained retention, n = 9). There were two UI types: urge UI (n = 27) and UI with impaired awareness of bladder needs (IA UI, n = 38). In regression analyses, IA UI was the only micturition disturbance predicting mortality and need for nursing home care at 3 months (odds ratio (OR) = 27.5, 95% confidence interval (CI) = 7.0-108.2), together with poor mobility (OR = 8.2, 95% CI = 2.6-26.2), and partial or total anterior circulation stroke type (OR = 3.6, 95% CI = 1.4-9.0). CONCLUSION: New-onset poststroke UI with impaired awareness of bladder needs is a strong and independent risk factor for poor outcome at 3 months. This probably reflects more serious brain damage, affecting sustained attention and information processing. Valid clinical tools to detect such dysfunction in stroke victims are needed. Clinical classification of poststroke UI is likely to improve management.

Activities of Daily Living↗
PubMed2005

Patients' experiences with self-referral to in-patient rehabilitation: a qualitative interview study.

PURPOSE: To describe objectives, experiences and satisfaction among subjects referring themselves to in-patient rehabilitation. METHOD: Persons suffering from stroke or multiple sclerosis were invited to refer themselves to a specialised rehabilitation department. Ten patients referred themselves within the study period, of whom two were excluded. The remaining eight underwent qualitative semi-structured in-depth interviews, focusing on the decision of self-referral, the personal goals for the rehabilitation, and the satisfaction with the stay. The interviews were tape-recorded and subjected to content analysis. As an underlying theoretical framework, we applied Antonovsky's Sense of Coherence model. RESULTS: Half of the patients had not written the application themselves and did not know which grounds had been put forward in the application. Nevertheless, all the patients were able to formulate their personal goals for the rehabilitation stay. These were distributed in three main categories: those who recently had got a progressive disability wanted education and improved knowledge on their disease; those who had had an acute, traumatic change of health status wanted training in order to improve muscular strength or everyday skills; and those who had been disabled for several years wanted inspiration for further life. CONCLUSIONS: Patients may put forward other reasons to apply for rehabilitation than health personnel. Does the Sense of Coherence Model seems applicable to describe these reasons.

Adult↗
PubMed2004

[Three consecutive operations for chronic subdural haemorrhage in an 87-year-old man].

We describe a man aged 87 with a subdural haemorrhage which needed to be evacuated three times over an eight-week period. After the third operation the patient's physical and cognitive performance increased markedly, even though his performance had been assessed as "normal for his age" during his illness. The case illustrates the impressive regenerative capacity of the aged brain, the challenge in differentiating between disease symptoms and age-associated functional decline, the difficulties in deciding when to operate on an old patient, and the importance of functional assessments in health care for the elderly.

Aged↗
PubMed2004

Well-being and instrumental activities of daily living after stroke.

OBJECTIVE: To explore the relationship between subjective well-being and competence in instrumental activities of daily living after stroke. DESIGN: Cross-sectional with evaluation at six months post stroke. SUBJECTS: Eighty-two patients admitted to an acute stroke unit, of whom 64 were seen at six months. The mean age was 77.5 years, 55% were females and 55% were living alone. MAIN OUTCOME MEASURES: The General Health Questionnaire (GHQ-20 version), a well-being scale, was factor analysed and yielded three dimensions, named 'coping', 'anxiety' and 'satisfaction' that served as main outcomes. RESULTS: Explanatory variables were the four subscales of the Nottingham IADL scale, the Ullevaal Aphasia Screening test, urinary continence and demographics. Structural equation modelling showed that the GHQ dimension 'satisfaction' related significantly to the Nottingham subscale 'leisure activities' (beta = -0.38, p = 0.01), whereas 'coping' was indirectly associated with 'leisure activities' by its correlation with 'satisfaction' (R = 0.26, p = 0.01). None of the outcomes were statistically associated with aphasia, continence or the background variables. CONCLUSION: 'Leisure activities' demonstrated the strongest association to subjective well-being as expressed by the 'satisfaction' dimension. In stroke rehabilitation leisure activities should be addressed when assessing function and planning intervention.

Activities of Daily Living↗
PubMed2003

[Using the internet in continuous medical education].

BACKGROUND: Modern information technology enables alternative strategies for education and communication. This is a description of a project for systematic utilisation of the internet for distant meetings and professional communication within geriatric medicine. METHOD: A net site has been developed and is being used for the distribution of professionally relevant material, as well as visual aids for audio conferences. The hospitals take their turn giving introductions, and active audience participation is a must. The project has been assessed through a questionnaire survey. RESULTS: 88 audio conferences have been carried out since September 1998. The number of participating hospitals has increased from 6 to 28; the audience varies from 40 to 90 per session. On average, 56% are doctors, 19% nurses, 20% physiotherapists or occupational therapists, 4% have other backgrounds. 100 persons returned the questionnaire (response rate 86%). At an ordinal scale from 1 (bad) to 5 (good), respondents' median global assessment of the project was 4 (interquartile range 3-4); they were particularly satisfied with the professional standard of the lectures, and they found it motivating to work in a field in which modern information technology is put to use. Their use of the net site for other purposes than the audio conferences was very limited. INTERPRETATION: Health professionals in the field of geriatrics saw the project as a help in keeping themselves up to date. Audio conferences may supplement intramural educational sessions but cannot substitute for them.

Aged↗
PubMed2003

[Money or life?].

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Cost-Benefit Analysis↗