Browsing by Subject "ELDERLY-PEOPLE"

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  • Inkeri, Niina-Mari; Karjalainen, Merja; Haanpaa, Maija; Kautiainen, Hannu; Saltevo, Juha; Mantyselka, Pekka; Tiihonen, Miia (2019)
    What is known and objective Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self-reported symptoms in older community-dwelling persons with and without diabetes. Methods The basic population was comprised of Finnish community-dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD-10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross-sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire. Results and discussion The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self-reported symptoms. What is new and conclusion There is no difference in anticholinergic drug use in older community-dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully.
  • Liimatta, Heini; Lampela, Pekka; Laitinen-Parkkonen, Pirjo; Pitkälä, Kaisu H. (2019)
    Objective: We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults. Design: A randomised controlled trial. Subjects: Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group. Setting: Hyvinkaa town municipality, Finland. Main outcome measures: We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers. Results: At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was -0.015 (95% CI -0.029 to -0.0016; p = 0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up. Conclusion: Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end.
  • Tanskanen, Maarit; Mäkelä, Mira; Notkola, Irma-Leena; Myllykangas, Liisa; Rastas, Sari; Oinas, Minna; Lindsberg, Perttu J.; Polvikoski, Tuomo; Tienari, Pentti J.; Paetau, Anders (2017)
    Objective: The aim of this study was to analyze brain pathologies which cause dementia in the oldest old population. Methods: All 601 persons aged >= 85 years living in the city of Vantaa (Finland), on April 1st, 1991 formed the study population of the Vantaa85 + study, 300 of whom were autopsied during follow-up (79.5% females, mean age-at-death 92 +/- 3.7 years). Alzheimer's disease (AD) pathology (tau and beta-amyloid [Ab]), cerebral amyloid angiopathy (CAA) and Lewy-related pathologies were analyzed. Brain infarcts were categorized by size (<2 mm, 2-15 mm, > 15 mm) and by location. Brain hemorrhages were classified as microscopic (<2 mm) and macroscopic. Results: 195/300 (65%) were demented. 194/195 (99%) of the demented had at least one neuropathology. Three independent contributors to dementia were identified: AD-type tau-pathology (Braak stage V-VI), neocortical Lewy-related pathology, and cortical anterior 2-15 mm infarcts. These were found in 34%, 21%, and 21% of the demented, respectively, with the multivariate odds ratios (OR) for dementia 5.5, 4.5, and 3.4. Factor analysis investigating the relationships between different pathologies identified three separate factors: (1) AD-spectrum, which included neurofibrillary tau, Ab plaque, and neocortical Lewy-related pathologies and CAA (2) > 2 mm cortical and subcortical infarcts, and (3) <2 mm cortical microinfarcts and microhemorrhages. Multipathology was common and increased the risk of dementia significantly. Interpretation: These results indicate that AD-type neurodegenerative processes play the most prominent role in twilight cognitive decline. The high prevalence of both neurodegenerative and vascular pathologies indicates that multiple preventive and therapeutic approaches are needed to protect the brains of the oldest old.
  • Perttilä, Niko; Ohman, H.; Strandberg, T. E.; Kautiainen, H.; Raivio, M.; Laakkonen, M. -L.; Savikko, N.; Tilvis, R. S.; Pitkala, K. H. (2016)
    Introduction: To investigate how frailty status affects the outcome of exercise intervention among home-dwelling participants with Alzheimer disease (AD). Methods: This is a sub-group analysis of a randomized controlled trial. In this trial, home-dwelling participants with AD received either home-based or group-based exercise twice a week for one year (n = 129); the control group received normal care (n = 65). Both the intervention and control group were subdivided into two groups according to modified Fried criteria: prefrail (0-1 criteria) and advanced frailty (2-5 criteria). The Functional Independence Measure (FIM) and number of falls per person-years served as outcome measures. Results: Whereas there was no significant difference in FIM between the prefrail intervention (PRI) and control (PRC) groups at 3 or 6 months, the PRI group deteriorated significantly slower at 12 months (-6.6 [95% CI -8.6 to -4.5] for PRI and -11.1 [95% CI -13.9 to -8.3] for PRC; P = 0.010). Similarly, there was no significant difference between the advanced frailty intervention (AFI) and control (AFC) groups at 3 months, but the difference became significant at 6 months (-8.1 [95% CI -11.1 to -5.2] for AFI and -15.5 [95% CI -20.0 to -11.1] for AFC; P = 0.007) and at 12 months (-8.9 [95% CI -11.9 to -5.9] for AFI and -15.3 [95% CI -20.2 to -10.3] for AFC; P = 0.031). There was also a significant difference in the number of falls in favor of PRI and AFI groups compared to their respective control groups. Conclusion: A long-term exercise intervention benefited people with AD regardless of their stage of frailty. Trial registration: : ACTRN12608000037303. (C) 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
  • Sauna-Aho, Oili; Bjelogrlic-Laakso, Nina; Siren, Auli; Arvio, Maria (2018)
    BackgroundIntellectual disability (ID) and dementia reflect disturbed cortical function during and after developmental age, respectively. Due to the wide heterogeneity of ID population the decline in cognitive and adaptive skills may be different in distinct genetic subgroups. MethodsUsing the British Present Psychiatric State-learning Disabilities assessment (PPS-LD) questionnaire the dementia signs were screened in 62, 22 and 44 individuals (> 35year of age) with Down (DS, OMIM number 190685), Williams (WS, OMIM number, 194050), and Fragile X syndrome (FXS, OMIM number 309550), respectively. The median age of those with FXS (59years) was higher than of those with DS (50years) and WS (53years). ResultsMost study participants with DS (80%) and FXS (89%) were or had been moderately or severely intellectually disabled while most participants with WS (73%) were or had been mildly or moderately disabled at adolescent age. The adolescent (premorbid) level of ID did not correlate with the dementia score. The median scores were 11/27, 1/27, and 0/27 in DS, WS, and FXS subgroups, respectively. Dementia that was confirmed by brain imaging, manifested as Alzheimer disease and as moya-moya disease associated vascular dementia in DS and as vascular dementia in WS. ConclusionsThis survey suggests that the risk of dementia varies depending on the cause of ID and that the severity of ID in adolescence does not predict the development of dementia at a later age. Consequently, the ID and dementia should be understood as separate clinical entities that need to be taken into account in the health management of intellectually disabled people. This is important for the arrangement of appropriate and timely interventions, which can be expected to delay the need for institutionalization.
  • LIFEPATH Consortium (2018)
    OBJECTIVE To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages. DESIGN Multi-cohort population based study. SETTING 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017. PARTICIPANTS 109 107 men and women aged 45-90 years. MAIN OUTCOME MEASURE Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors. RESULTS According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors. CONCLUSIONS The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.
  • Uusi-Rasi, Kirsti; Kannus, Pekka; Karinkanta, Saija; Pasanen, Matti; Patil, Radhika; Lamberg-Allardt, Christel; Sievanen, Harri (2012)