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  • 1.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Dahlberg, Lena
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Dalarna University, Sweden.
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Social integration and alcohol consumption among older people: A four-year follow-up of a Swedish national sample2019In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 196, p. 40-45Article in journal (Refereed)
    Abstract [en]

    Background: Today's older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people's drinking, but the association is complex. This study investigates both high and low levels of social integration and their associations with longitudinal patterns of alcohol consumption among older women and men.

    Methods: Longitudinal nationally representative data of older Swedish women and men aged over 65 - the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) - from 2010/2011 and 2014 (n = 1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses.

    Results: Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.

    Conclusions: Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.

  • 2.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shaw, Benjamin A.
    Smoking and Physical Inactivity as Predictors of Mobility Impairment During Late Life: Exploring Differential Vulnerability Across Education Level in Sweden2018In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 73, no 4, p. 675-683Article in journal (Refereed)
    Abstract [en]

    Objectives: To test whether older adults from high and low educational groups are differentially vulnerable to the impact of smoking and physical inactivity on the progression of mobility impairment during old age.

    Methods: A nationally representative sample of older Swedish adults (n = 1,311), aged 57-76 years at baseline (1991), were followed for up to 23 years (2014). Multilevel regression was used to estimate individual trajectories of mobility impairment over the study period and to test for differences in the progression of mobility impairment on the basis of smoking status, physical activity status, and level of education.

    Results: Compared to nonsmokers, heavy smokers had higher levels and steeper increases in mobility impairment with advancing age. However, there were only small and statistically nonsignificant differences in the impact of heavy smoking on mobility impairment in high versus low education groups. A similar pattern of results was found for physical inactivity.

    Discussion: Differential vulnerability to unhealthy behaviors may vary across populations, age, time-periods, and health outcomes. In this study of older adults in Sweden, low and high education groups did not differ significantly in their associations between heavy smoking or physical inactivity, and the progression of mobility impairment.

  • 3.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kelfve, Susanne
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Linköping University, Sweden.
    Hassing, Linda B.
    Lindwall, Magnus
    Alcohol Consumption Over the Retirement Transition in Sweden: Different Trajectories Based on Education2022In: Work, Aging and Retirement, ISSN 2054-4642, E-ISSN 2054-4650, Vol. 8, no 1, p. 74-81Article in journal (Refereed)
    Abstract [en]

    Retirement is a major life transition that involves changes to everyday routines, roles, and habits. Previous studies suggest that retirement may influence drinking habits. Many natural inhibitors of alcohol consumption disappear with the removal of work constraints. The potential impact depends on both individual and contextual factors. Women in the cohorts undergoing retirement now have been more active on the labor market, including the occupation of higher status jobs, which indicates more financial resources as well as a larger role loss after retirement. Also, the current cohorts who retire have had more liberal drinking habits throughout their lives compared to previous cohorts. We therefore examined changes in alcohol consumption surrounding retirement in different education groups among women and men undergoing retirement using annual data from the Health, Aging and Retirement Transitions in Sweden (HEARTS) study, a longitudinal national study of 60- to 66-year-olds (n = 5,913), from 2015 to 2018. Latent growth curve models were used to estimate trajectories of alcohol consumption. Results showed that those who retired during the follow-up increased their usual weekly alcohol consumption while those who worked or were retired throughout the period had stable drinking habits. Those who were retired reported the highest alcohol consumption. The increase surrounding retirement was driven by people with higher education. Women with tertiary education and men with intermediate or tertiary education increased their weekly alcohol intake after retirement, while those with low education had unchanged drinking habits. Mechanisms and motivations that may fuel increased alcohol intake among people with higher education should be further investigated.

  • 4.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kelfve, Susanne
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Alcohol consumption in very old age and its association with survival: A matter of health and physical function2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 159, p. 240-245Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old. Methods: Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n=863) collected in 2010/2011 were used. Mortality was analyzed unti12014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5-30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed. Results: Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant. Conclusions: The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.

  • 5.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shaw, Benjamin
    Trajectories of social activities from middle age to old age and late-life disability: a 36-year follow-up2013In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 42, no 6, p. 790-793Article in journal (Refereed)
    Abstract [en]

    Objectives: to examine the association between 34-year trajectories of social activity, from middle age to old age and late-life disability.                  

    Methods: data from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of the Oldest Old (SWEOLD) were used. LNU data from 1968, 1981, 1991 and 2000 were merged with SWEOLD data from 1992, 2002 and 2004 to create a longitudinal data set  with five observation periods. Trajectories of social activities covered 1968–2002, and late-life disability was measured  in 2004. The sample consisted of 729 individuals aged 33–61 at baseline (1968), who participated in at least four observation periods and who were free from mobility limitations at baseline. Four trajectories of social activity were identified and used as predictors of late-life disability.                  

    Results: reporting low/medium levels of social activity from mid-life to old age was the most common trajectory group. Persons reporting continuously low/medium or decreasing levels of social activity had higher odds ratios for late-life disability (OR = 2.33 and OR = 2.15, respectively) compared with those having continuously high levels of activity, even when adjusting for age, sex and mobility limitations, and excluding persons with baseline mobility limitations.                  

    Conclusions: results suggest that the disability risk associated with social activities is related to recent levels of activity, but also that risk may accumulate over time, as indicated by the higher disability risk associated with the continuously low/medium level social activity trajectory.

  • 6.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Silverstein, Merril
    Parker, Marti G.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Late-Life and Earlier Participation in Leisure Activities: Their Importance for Survival Among Older Persons2011In: Activities, Adaptation & Aging, ISSN 0192-4788, E-ISSN 1544-4368, Vol. 35, no 3, p. 210-222Article in journal (Refereed)
    Abstract [en]

    Is activity participation in old age important for survival independent of one's earlier history of participation? A nationally representative sample of 457 older persons was followed for 25 years with data from the Level-of-Living Survey and the SWEOLD study. Cox regressions showed that regardless of earlier activities and health, late-life leisure engagement was associated with enhanced survival, especially among men. Among women, earlier activities (study groups) also seem important, perhaps by providing social networks. Results suggest that it is worthwhile to encourage elderly people to participate in leisure activities and to facilitate their participation in the community even at high ages.

  • 7.
    Agerholm, Janne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Burström, Bo
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Liljas, Ann
    How did providers of home care for older adults manage the early phase of the Covid-19 pandemic? A qualitative case study of managers' experiences in Region Stockholm2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, article id 1173Article in journal (Refereed)
    Abstract [en]

    Background In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff.

    Method A descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis.

    Results Three themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions.

    Conclusion Social care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.

  • 8. Agerholm, Janne
    et al.
    Pulkki, Jutta
    Jensen, Natasja K.
    Keskimäki, Ilmo
    Andersen, Ingelise
    Burström, Bo
    Jämsen, Esa
    Tynkkynen, Liina-Kaisa
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Liljas, Ann E. M.
    The organisation and responsibility for care for older people in Denmark, Finland and Sweden: outline and comparison of care systems2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aim: To outline the organisation and responsibility for health and social care provided to older people in Denmark, Finland and Sweden.

    Methods: Non-quantifiable data on the care systems were collated from the literature and expert consultations. The responsibilities for primary healthcare, specialised healthcare, prevention and health promotion, rehabilitation, and social care were presented in relation to policy guidance, funding and organisation.

    Results: In all three countries, the state issues policy and to some extent co-funds the largely decentralised systems; in Denmark and Sweden the regions and municipalities organise the provision of care services – a system that is also about to be implemented in Finland to improve care coordination and make access more equal. Care for older citizens focuses to a large extent on enabling them to live independently in their own homes.

    Conclusions: Decentralised care systems are challenged by considerable local variations, possibly jeopardising care equity. State-level decision and policy makers need to be aware of these challenges and monitor developments to prevent further health and social care disparities in the ageing population.

  • 9. Ahlner, Felicia
    et al.
    Erhag, Hanna Falk
    Johansson, Lena
    Fässberg, Madeleine Mellqvist
    Sterner, Therese Rydberg
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Gothenburg, Sweden.
    Samuelsson, Jessica
    Zettergren, Anna
    Waern, Margda
    Skoog, Ingmar
    Patterns of Alcohol Consumption and Associated Factors in a Population-Based Sample of 70-Year-Olds: Data from the Gothenburg H70 Birth Cohort Study 2014–162022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 14, article id 8248Article in journal (Refereed)
    Abstract [en]

    Older adults of today consume more alcohol, yet knowledge about the factors associated with different consumption levels is limited in this age group. Based on the data from a population-based sample (n = 1156, 539 men and 617 women) in The Gothenburg H70 Birth Cohort Study 2014–16, we examined sociodemographic, social, and health-related factors associated with alcohol consumption levels in 70-year-olds, using logistic regression. Total weekly alcohol intake was calculated based on the self-reported amount of alcohol consumed. Alcohol consumption was categorized as lifetime abstention, former drinking, moderate consumption (≤98 g/week), and at-risk consumption (>98 g/week). At-risk consumption was further categorized into lower at-risk (98–196 g/week), medium at-risk (196–350 g/week), and higher at-risk (≥350 g/week). We found that among the 1156 participants, 3% were lifetime abstainers, 3% were former drinkers, 64% were moderate drinkers, and 30% were at-risk drinkers (20% lower, 8% medium, 2% higher). Among several factors, former drinking was associated with worse general self-rated health (OR 1.65, 95% CI 1.08–2.51) and lower health-related quality of life (measured by physical component score) (OR 0.94, 95% CI 0.91–0.97), higher illness burden (OR 1.16, 95% CI 1.07–1.27), and weaker grip strength (OR 0.96, 95% CI 0.94–0.98). Higher at-risk drinkers more often had liver disease (OR 11.41, 95% CI 3.48–37.37) and minor depression (OR 4.57, 95% CI 1.40–14.95), but less contacts with health care (OR 0.32, 95% CI 0.11–0.92). Our findings demonstrate the importance of classifications beyond abstinence and at-risk consumption, with implications for both the prevention and clinical management of unhealthy consumption patterns in older adults.

  • 10.
    Akugizibwe, Roselyne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Roso-Llorach, Albert
    Onder, Graziano
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Zucchelli, Alberto
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Centrum, Sweden.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Italy; Università Cattolica del Sacro Cuore, Italy.
    Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults2020In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 9, no 12, article id 4001Article in journal (Refereed)
    Abstract [en]

    The presence of multiple chronic conditions (i.e., multimorbidity) increases the risk of hospitalisation in older adults. We aimed to examine the association between different multimorbidity patterns and unplanned hospitalisations over 5 years. To that end, 2,250 community-dwelling individuals aged 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were studied. Participants were grouped into six multimorbidity patterns using a fuzzy c-means cluster analysis. The associations between patterns and outcomes were tested using Cox models and negative binomial models. After 5 years, 937 (41.6%) participants experienced at least one unplanned hospitalisation. Compared to participants in the unspecific multimorbidity pattern, those in the cardiovascular diseases, anaemia and dementia pattern, the psychiatric disorders pattern and the metabolic and sleep disorders pattern presented with a higher hazard of first unplanned hospitalisation (hazard ratio range: 1.49-2.05; p < 0.05 for all), number of unplanned hospitalisations (incidence rate ratio (IRR) range: 1.89-2.44; p < 0.05 for all), in-hospital days (IRR range: 1.91-3.61; p < 0.05 for all), and 30-day unplanned readmissions (IRR range: 2.94-3.65; p < 0.05 for all). Different multimorbidity patterns displayed a differential association with unplanned hospital care utilisation. These findings call for a careful primary care follow-up of older adults with complex multimorbidity patterns.

  • 11. Aljeaidi, Muhamad S.
    et al.
    Tan, Edwin C. K.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. The University of Sydney, Australia; Monash University, Australia .
    The association between polypharmacy and cognitive ability in older adults: A national cohort study2022In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 18, no 3, p. 2505-2509Article in journal (Refereed)
    Abstract [en]

    Background: Polypharmacy, the use of multiple medications by one individual, may be associated with adverse health outcomes including poor cognition. However, it remains unclear whether a longitudinal relationship exists.

    Objectives: To investigate the association between polypharmacy and 3-year cognitive ability in older adults.

    Methods: A longitudinal cohort study of older adults 65 years and older, residing in the community, who participated in waves 12 (2012), 13 (2013) and 16 (2016) of the Household Income and Labour Dynamics (HILDA) Survey was conducted. Polypharmacy was defined as the regular use of 5 or more prescription medications. Cognitive ability was assessed using backwards digit span test (BDS), 25-item version of the National Adult Reading Test (NART-25) and symbol-digit modalities test (SDM). Linear regression was used to test the longitudinal association between polypharmacy and cognitive test scores at 3 years. All analyses were adjusted for age, sex, education, comorbidities, socioeconomic and lifestyle factors, and baseline cognitive test scores.

    Results: A total of 2141 participants (mean age 72.9 years, 54.4% female) were included in the study sample. Polypharmacy was present in 27.3%. After adjusting for potential confounders, polypharmacy was negatively associated with cognitive ability at 3 years: BDS: −0.067 (95% CI = −0.353 to −0.051), NART-25: −0.071 (95% CI = −1.428 to −0.294), SDM: −0.073 (95% CI = −2.960 to −0.696).

    Conclusion: Polypharmacy was associated with poorer cognitive ability at 3 years, even after adjusting for comorbidities and other confounders. Future research should consider the long-term impact of polypharmacy on cognitive ability, and identify strategies to optimise medication use and cognition in older adults.

  • 12.
    Allers, Katharina
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Carl von Ossietzky University of Oldenburg, Germany.
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Morin, Lucas
    Socioeconomic position and risk of unplanned hospitalization among nursing home residents: a nationwide cohort study2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no 3, p. 467-473Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic inequalities in health and healthcare use in old age have been on the rise during the past two decades. So far, it is unknown whether these inequalities have permeated the nursing home setting. This study aimed to assess whether the socioeconomic position of newly admitted nursing home residents had an influence on their risk of unplanned hospitalization. Methods: We identified older persons (similar to 75 years) who were newly admitted to a nursing home between March 2013 and December 2014 using a set of linked routinely collected administrative and healthcare data in Sweden. The number of unplanned hospitalizations for any cause and the cumulative length of stay were defined as primary outcomes. Unplanned hospitalizations for potentially avoidable causes (i.e. fall-related injuries, urinary tract infections, pneumonia and decubitus ulcers) were considered as our secondary outcome. Results: Among 40 545 newly admitted nursing home residents (mean age 86.8 years), the incidence rate of unplanned hospitalization ranged from 53.9 per 100 person-years among residents with tertiary education up to 55.1 among those with primary education. After adjusting for relevant confounders, we observed no meaningful difference in the risk of unplanned hospitalization according to the education level of nursing home residents (IRR for tertiary vs. primary education: 0.96, 95% CI 0.92-1.00) or to their level of income (IRR for highest vs. lowest quartile of income: 0.98, 0.95-1.02). There were also no differences in the cumulative length of hospital stays or in the risk of experiencing unplanned hospitalizations for potentially avoidable causes. Conclusions: In sum, in this large cohort of newly admitted nursing home residents, we found no evidence of socioeconomic inequalities in the risk of unplanned hospitalization.

  • 13.
    Almkvist, Ove
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Sweden.
    Bosnes, Ole
    Bosnes, Ingunn
    Stordal, Eystein
    Selective impact of disease on short-term and long-term components of self-reported memory: a population-based HUNT study2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 5, article id e013586Article in journal (Refereed)
    Abstract [en]

    Background: Subjective memory is commonly considered to be a unidimensional measure. However, theories of performance-based memory suggest that subjective memory could be divided into more than one dimension. Objective: To divide subjective memory into theoretically related components of memory and explore the relationship to disease. Methods: In this study, various aspects of self-reported memory were studied with respect to demographics and diseases in the third wave of the HUNT epidemiological study in middle Norway. The study included all individuals 55 years of age or older, who responded to a nine-item questionnaire on subjective memory and questionnaires on health (n=18 633). Results: A principle component analysis of the memory items resulted in two memory components; the criterion used was an eigenvalue above 1, which accounted for 54% of the total variance. The components were interpreted as long-term memory (LTM; the first component; 43% of the total variance) and short-term memory (STM; the second component; 11% of the total variance). Memory impairment was significantly related to all diseases (except Bechterew's disease), most strongly to brain infarction, heart failure, diabetes, cancer, chronic obstructive pulmonary disease and whiplash. For most diseases, the STM component was more affected than the LTM component; however, in cancer, the opposite pattern was seen. Conclusions: Subjective memory impairment as measured in HUNT contained two components, which were differentially associated with diseases.

  • 14.
    Almkvist, Ove
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden.
    Graff, Caroline
    Practice effects in cognitive assessments three years later in non-carriers but not in symptom-free mutation carriers of autosomal-dominant Alzheimer's disease: Exemplifying procedural learning and memory?2022In: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 14, article id 905329Article in journal (Refereed)
    Abstract [en]

    Practice effects (PEs) defined as an improvement of performance in cognition due to repeated assessments between sessions are well known in unimpaired individuals, while less is known about impaired cognition and particularly in latent brain disease as autosomal-dominant Alzheimer's disease. The purpose was to evaluate the general (across tests/domains) and domain-specific PE calculated as the annual rate of change (ARC) in relation to years to the estimated disease onset (YECO) and in four groups of AD: asymptomatic mutation carriers (aAD, n = 19), prodromal, i.e., symptomatic mutation carriers, criteria for AD diagnosis not fulfilled (pAD, n = 4) and mutation carriers diagnosed with AD (dAD, n = 6) as well as mutation non-carriers from the AD families serving as a healthy comparison group (HC, n = 35). Cognition was assessed at baseline and follow-up about 3 years later by 12 tests covering six domains. The aAD and HC groups were comparable at baseline in demographic characteristics (age, gender, and education), when they were in their early forties, while the pAD and dAD groups were older and cognitively impaired. The results on mean ARC for the four groups were significantly different, small, positive, and age-insensitive in the HC group, while ARC was negative and declined with time/disease advancement in AD. The differences between HC and aAD groups in mean ARC and domain-specific ARC were not significant, indicating a subtle PE in aAD in the early preclinical stage of AD. In the symptomatic stages of AD, there was no PE probably due to cognitive disease-related progression. PEs were the largest in the verbal domain in both the HC and aAD groups, indicating a relationship with cognitive vulnerability. The group-related difference in mean ARC was predominant in timekeeping tests. To conclude, the practice effect in over 3 years was suggested to be linked to procedural learning and memory.

  • 15. Andel, Ross
    et al.
    Crowe, Michael
    Feychting, Maria
    Pedersen, Nancy L.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Johansson, Boo
    Gatz, Margaret
    Work-Related Exposure to Extremely Low-Frequency Magnetic Fields and Dementia: Results from the Population-Based Study of Dementia in Swedish Twins2010In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 65A, no 11, p. 1220-1227Article in journal (Refereed)
    Abstract [en]

    Background. We examined the association between extremely low-frequency magnetic fields (EMF) and the risk of dementia and Alzheimer’s disease using all 9,508 individuals from the Study of Dementia in Swedish Twins (HARMONY) with valid occupational and diagnostic data.

    Methods. Dementia diagnoses were based on telephone screening followed by in-person clinical workup. Main lifetime occupation was coded according to an established EMF exposure matrix. Covariates were age, gender, education, vascular risk factors, and complexity of work. Based on previous research, data were also analyzed separately for cases with disease onset by age 75 years versus later, men versus women, and those with manual versus nonmanual main occupation. We used generalized estimating equations with the entire sample (to adjust for the inclusion of complete twin pairs) and conditional logistic regression with complete twin pairs only.

    Results. Level of EMF exposure was not significantly associated with dementia or Alzheimer’s disease. However, in stratified analyses, medium and high levels of EMF exposure were associated with increased dementia risk compared with low level in cases with onset by age 75 years (odds ratio: 1.94, 95% confidence interval: 1.07–3.65 for medium, odds ratio: 2.01, 95% confidence interval: 1.10–3.65 for high) and in participants with manual occupations (odds ratio: 1.81, 95% confidence interval: 1.06–3.09 for medium, odds ratio: 1.75, 95% confidence interval: 1.00–3.05 for high). Results with 42 twin pairs discordant for dementia did not reach statistical significance.

    Conclusions. Occupational EMF exposure appears relevant primarily to dementia with an earlier onset and among former manual workers.

  • 16. Andel, Ross
    et al.
    Crowe, Michael
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wastesson, Jonas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Parker, Marti G.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Indicators of Job Strain at Midlife and Cognitive Functioning in Advanced Old Age2011In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 66B, no 3, p. 287-291Article in journal (Refereed)
    Abstract [en]

    Objectives. We used data from SWEOLD, a Swedish nationally representative study of individuals aged 77 years or older, to examine midlife indicators of job strain in relation to cognitive performance and impairment.

    Methods. In all, 827 participants completed an abridged 11-point version of the Mini-Mental State Examination in-person in 1992 and/or 2002 and had self-reported and/or occupation-based scores for job control and demands from data collected in 1968. Seventeen percent scored below the cutoff for cognitive impairment.

    Results. Controlling for age, sex, education, self-rated health, and year of cognitive screening, low self-reported and occupation-based job control at midlife was associated with poorer cognitive performance later (ps < .001). For the occupation-based measure, low job control was also associated with greater likelihood of impairment, whereas having an active job (high job control/high job demands) was associated with better cognitive performance and lower likelihood of impairment (ps < .01). Childhood environment, midlife depressive symptoms, and social activity had limited influence, whereas the influence of both adulthood socioeconomic position and work complexity on these results was more pronounced.

    Discussion. Job control at midlife, by itself and in combination with job demands, may influence cognitive functioning later above and beyond demographic variables and other occupational characteristics.

  • 17. Andel, Ross
    et al.
    Silverstein, Merril
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    The Role of Midlife Occupational Complexity and Leisure Activity in Late-Life Cognition2015In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 70, no 2, p. 314-321Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine whether occupational complexity of working with data or people, and cognitive or social leisure activity at midlife predicted cognition in advanced old age.

    METHODS: We used 810 eligible participants from Longitudinal Study of Living Conditions of the Oldest Old, a Swedish nationally representative study of individuals aged 77+ with cognitive assessments (an abridged version of the Mini-Mental State Exam) administered in 1992 and 2002 and linked to information about their midlife occupation and leisure activities collected in 1968 and 1981. A bootstrapping technique was applied to examine the direct and interactive associations of occupational complexity and leisure activity with late-life cognition.

    RESULTS: Controlling for demographic and health-related factors from childhood, midlife, and late life, we found that greater work complexity, both with people and with data, and greater participation in cognitive or social leisure activities independently related to better late-life cognitive scores. The complexity-cognition link was moderated by leisure activity such that the cognitive benefit related to the complexity of work-especially complexity of working with people-was rendered insignificant when participation in leisure activities-especially social activities-was above average.

    DISCUSSION: Results are discussed in terms of using work complexity to compensate for lack of leisure activity as well as in terms of promoting leisure engagement to compensate for long-term cognitive disadvantage imposed by working in less challenging occupations.

  • 18.
    Angleman, Sara B.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Santoni, Giola
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Pilotto, Alberto
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Karolinska Institutet.
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Multidimensional Prognostic Index in Association with Future Mortality and Number of Hospital Days in a Population-Based Sample of Older Adults: Results of the EU Funded MPI_AGE Project2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 7, article id e0133789Article in journal (Refereed)
    Abstract [en]

    Background The Multidimensional Prognostic Index (MPI) has been found to predict mortality in patients with a variety of clinical conditions. We aimed to assess the association of the MPI with future mortality and number of in-hospital days for the first time in a population-based cohort. Methods The study population consisted of 2472 persons, aged 66-99 years, from the Swedish National Study on Aging and Care in Kungsholmen, Sweden, who underwent the baseline visit 2001-4, and were followed up >10 years for in-hospital days and >12 years for mortality. The MPI was a modified version of the original and aggregated seven domains (personal and instrumental activities of daily living, cognitive function, illness severity and comorbidity, number of medications, co-habitation status, and nutritional status). The MPI score was divided into risk groups: low, medium and high. Number of in-hospital days (within 1, 3 and 10 years) and mortality data were derived from official registries. All analyses were age-stratified (sexagenarians, septuagenarians, octogenarians, nonagenarians). Results During the follow-up 1331 persons (53.8%) died. Laplace regression models, suggested that median survival in medium risk groups varied by age from 2.2-3.6 years earlier than for those in the corresponding low risk groups (p = 0.002-p<0.001), and median survival in high risk groups varied by age from 3.8-9.0 years earlier than for corresponding low risk groups (p<0.001). For nonagenarians, the median age at death was 3.8 years earlier in the high risk group than for the low risk group (p<0.001). The mean number of in-hospital days increased significantly with higher MPI risk score within 1 and 3 years for people of each age group. Conclusion For the first time, the effectiveness of MPI has been verified in a population-based cohort. Higher MPI risk scores associated with more days in hospital and with fewer years of survival, across a broad and stratified age range.

  • 19.
    Angleman, Sara B.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Santoni, Giola
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Von Strauss, Eva
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). The Swedish Red Cross University College, Sweden.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). The Swedish Red Cross University College, Sweden.
    Temporal Trends of Functional Dependence and Survival Among Older Adults From 1991 to 2010 in Sweden: Toward a Healthier Aging2015In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 70, no 6, p. 746-752Article in journal (Refereed)
    Abstract [en]

    Background. Declines in functional dependence among older adults were observed before the 1990s, but there is uncertainty about subsequent trends. Our study aimed to verify the temporal trends in disability during 1991-2010 in an older Swedish population and to estimate the associated changes in survival. Methods. Functional status in octogenarians and nonagenarians was assessed at seven occasions with intervals of 2-3 years. Sample size varied at each assessment with an average of 646 (range 212-1096). Disability was defined as difficulty in one or more of personal activities of daily living. We compared prevalence and incidence, as well as mortality, and survival associated with disability over the 20-year period. Results. Sex-standardized prevalence of disability remained steady over time with a tendency toward a gradual decline, and a statistically significant decrease was present among nonagenarians. Sex-standardized cumulative incidence also remained steady. The proportion of people with prevalent disability who died <3 years remained stable, as did the survival time of people with incident disability. In contrast, among nondisabled persons, 3-year mortality decreased significantly, and for octogenarians median survival time was 1.3 years longer at the more recent assessment than a decade earlier. Conclusions. Both prevalence and incidence of disability remained stable over the last two decades in this urban Swedish population, with a trend toward a slow decline. Mortality remained steady among disabled persons but decreased among persons without disability, suggesting that increased life expectancy during the last two decades may be essentially driven by longer lives of functionally independent people.

  • 20. Anstey, Kaarin J.
    et al.
    Cherbuin, Nicolas
    Herath, Pushpani M.
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kuller, Lewis H.
    Lopez, Oscar L.
    Wilson, Robert S.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    A Self-Report Risk Index to Predict Occurrence of Dementia in Three Independent Cohorts of Older Adults: The ANU-ADRI2014In: PLOS ONE, E-ISSN 1932-6203, Vol. 9, no 1, p. e86141-Article in journal (Refereed)
    Abstract [en]

    Background and Aims: The Australian National University AD Risk Index (ANU-ADRI, http://anuadri.anu.edu.au) is a self-report risk index developed using an evidence-based medicine approach to measure risk of Alzheimer's disease (AD). We aimed to evaluate the extent to which the ANU-ADRI can predict the risk of AD in older adults and to compare the ANU-ADRI to the dementia risk index developed from the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study for middle-aged cohorts. Methods: This study included three validation cohorts, i.e., the Rush Memory and Aging Study (MAP) (n = 903, age >= 53 years), the Kungsholmen Project (KP) (n = 905, age >= 75 years), and the Cardiovascular Health Cognition Study (CVHS) (n = 2496, age >= 65 years) that were each followed for dementia. Baseline data were collected on exposure to the 15 risk factors included in the ANU-ADRI of which MAP had 10, KP had 8 and CVHS had 9. Risk scores and C-statistics were computed for individual participants for the ANU-ADRI and the CAIDE index. Results: For the ANU-ADRI using available data, the MAP study c-statistic was 0.637 (95% CI 0.596-0.678), for the KP study it was 0.740 (0.712-0.768) and for the CVHS it was 0.733 (0.691-0.776) for predicting AD. When a common set of risk and protective factors were used c-statistics were 0.689 (95% CI 0.650-0.727), 0.666 (0.628-0.704) and 0.734 (0.707-0.761) for MAP, KP and CVHS respectively. Results for CAIDE ranged from c-statistics of 0.488 (0.427-0.554) to 0.595 (0.565-0.625). Conclusion: A composite risk score derived from the ANU-ADRI weights including 8-10 risk or protective factors is a valid, self-report tool to identify those at risk of AD and dementia. The accuracy can be further improved in studies including more risk factors and younger cohorts with long-term follow-up.

  • 21.
    Augustsson, Erika
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    von Saenger, Isabelle
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Ericsson, Malin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Impact of the COVID-19 pandemic on Swedish adults aged 77 years and older: Age differences in lifestyle changes2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, no 5, p. 764-768Article in journal (Refereed)
    Abstract [en]

    Aims: This study aimed to describe the impact of the COVID-19 pandemic on lifestyle and social activities among older adults in Sweden, with a special focus on differences between the ‘younger old’ (aged 77–84) and ‘older old’ (aged 85–109).

    Methods: This study is based on a nationally representative sample of older adults (aged ⩾77 years) in Sweden (SWEOLD). Data were collected between May 2021 and April 2022, when many recommendations were removed but the virus was still classified as a public health disease. We studied occurrences and differences between the two age groups in several lifestyle factors and social activities.

    Results: The younger old displayed larger changes in lifestyles because of the pandemic than the older old. Most changes were found in social interactions with family.

    Conclusions: Our results highlight the large heterogeneity within the Swedish population aged ⩾77 years, and that the younger old experienced a bigger lifestyle change than the older old. Previous activity levels might be important to consider in order to understand how regulations may affect the older population. Finally, our findings indicate large age differences in Internet use, which require attention to prevent digital exclusion of an already vulnerable group.

  • 22. Badache, Andreea C.
    et al.
    Mäki-Torkko, Elina
    Widen, Stephen
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Centre for Epidemiology and Community Medicine, Sweden.
    Why Are Old-Age Disabilities Decreasing in Sweden and Denmark? Evidence on the Contribution of Cognition, Education, and Sensory Functions2022In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 78, no 3, p. 483-495Article in journal (Refereed)
    Abstract [en]

    Objectives: Improvements in educational attainment, cognitive and sensory functions, and a decline in the prevalence of disabilities have been observed in older adults in Sweden and Denmark. In the present study, it was investigated whether better cognition, higher educational attainment, and improved sensory function among older adults aged 60 and older in these countries have contributed to decreasing rates of old-age disabilities.

    Methods: The analyses were based on repeated cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe for the 2004-2017 period. Descriptive data were used to benchmark the declining prevalence of disabilities, improving cognitive and sensory functions, and increased educational level. The association between time and disabilities was analyzed with logistic regression models, and the contribution of the improved cognitive function, education, and sensory function to the declining prevalence of old-age disabilities was estimated using the Karlson-Holm-Breen method for mediation analysis.

    Results: The analysis suggests that the declining prevalence of old-age disabilities in Sweden and Denmark between 2004 and 2017 can largely be attributed to improved cognitive function and vision and to a lesser extent by education and hearing ability.

    Discussion: These findings raise important questions about the causal mechanisms producing the associations between cognition, education, and sensory functions and disability in older age. Future studies should explore the causal nature of the associations between these mediators and old-age disabilities. In addition, they should explore whether these findings differ across regional and cultural contexts and over different time periods.

  • 23.
    Banerjee, Albert
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    James, Robert
    McGregor, Margaret
    Lexchin, Joel
    Nursing Home Physicians Discuss Caring for Elderly Residents: An Exploratory Study2018In: Canadian Journal on Aging, ISSN 0714-9808, E-ISSN 1710-1107, Vol. 37, no 2, p. 133-144Article in journal (Refereed)
    Abstract [en]

    Despite the increasing complexity of nursing home care, the role of physicians caring for residents is largely unexplored. This international, exploratory study sought to learn about physicians' roles, responsibilities, and tasks as well as investigate the unique qualities of medical practice in nursing homes. We conducted interviews with 18 physicians, who reported making important contributions to the quality of resident care, including clarifying the goals of care, working to reduce unnecessary medication and hospitalization, as well as contributing to staff education. Nursing home practice involved physicians in networks of relations that were instrumental to the quality of medical care and physicians' job satisfaction. The importance of these relationships disrupts the oft-drawn boundary between the medical and the social, suggesting that good medical practice depends on good social practice. Reflecting the exploratory nature of the study, we recommend research to better understand and support the relational dimensions of nursing home medicine.

  • 24. Baumann, Isabel
    et al.
    Eyjólfsdóttir, Harpa Sif
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Darin-Mattsson, Alexander
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Andel, Ross
    Dratva, Julia
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Do cognitively stimulating activities affect the association between retirement timing and cognitive functioning in old age?2022In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 42, no 2, p. 306-330Article in journal (Refereed)
    Abstract [en]

    In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people.

  • 25.
    Becker, Nina
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Max Planck Institute for Human Development, Germany.
    Laukka, Erika J.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kalpouzos, Gregoria
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Naveh-Benjamin, Moshe
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Brehmer, Yvonne
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Max Planck Institute for Human Development, Germany.
    Structural brain correlates of associative memory in older adults2015In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 118, p. 146-153Article in journal (Refereed)
    Abstract [en]

    Associative memory involves binding two or more items into a coherent memory episode. Relative to memory for single items, associative memory declines greatly in aging. However, older individuals vary substantially in their ability to memorize associative information. Although functional studies link associative memory to the medial temporal lobe (MTL) and prefrontal cortex (PFC), little is known about how volumetric differences in MTL and PFC might contribute to individual differences in associative memory. We investigated regional gray-matter volumes related to individual differences in associative memory in a sample of healthy older adults (n = 54; age = 60 years). To differentiate item from associative memory, participants intentionally learned face-scene picture pairs before performing a recognition task that included single faces, scenes, and face-scene pairs. Gray-matter volumes were analyzed using voxel-based morphometry region-of-interest (ROI) analyses. To examine volumetric differences specifically for associative memory, item memory was controlled for in the analyses. Behavioral results revealed large variability in associative memory that mainly originated from differences in false-alarm rates. Moreover, associative memory was independent of individuals' ability to remember single items. Older adults with better associative memory showed larger gray-matter volumes primarily in regions of the left and right lateral PFC. These findings provide evidence for the importance of PFC in intentional learning of associations, likely because of its involvement in organizational and strategic processes that distinguish older adults with good from those with poor associative memory.

  • 26. Belvederi Murri, Martino
    et al.
    Triolo, Federico
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Coni, Alice
    Nerozzi, Erika
    Maietta Latessa, Pasqualino
    Fantozzi, Silvia
    Padula, Nicola
    Escelsior, Andrea
    Assirelli, Barbara
    Ermini, Giuliano
    Bagnoli, Luigi
    Zocchi, Donato
    Cabassi, Aderville
    Tedeschi, Stefano
    Toni, Giulio
    Chattat, Rabih
    Tripi, Ferdinando
    Neviani, Francesca
    Bertolotti, Marco
    Cremonini, Alessandro
    Bertakis, Klea D.
    Amore, Mario
    Chiari, Lorenzo
    Zanetidou, Stamatula
    The body of evidence of late-life depression: the complex relationship between depressive symptoms, movement, dyspnea and cognition2023In: Experimental Aging Research, ISSN 0361-073X, E-ISSN 1096-4657Article in journal (Refereed)
    Abstract [en]

    Background: Physical symptoms play an important role in late-life depression and may contribute to residual symptomatology after antidepressant treatment. In this exploratory study, we examined the role of specific bodily dimensions including movement, respiratory functions, fear of falling, cognition, and physical weakness in older people with depression.

    Methods: Clinically stable older patients with major depression within a Psychiatric Consultation-Liaison program for Primary Care underwent comprehensive assessment of depressive symptoms, instrumental movement analysis, dyspnea, weakness, activity limitations, cognitive function, and fear of falling. Network analysis was performed to explore the unique adjusted associations between clinical dimensions.

    Results: Sadness was associated with worse turning and walking ability and movement transitions from walking to sitting, as well as with worse general cognitive abilities. Sadness was also connected with dyspnea, while neurovegetative depressive burden was connected with activity limitations.

    Discussion: Limitations of motor and cognitive function, dyspnea, and weakness may contribute to the persistence of residual symptoms of late-life depression.

  • 27. Bennett, Alexander
    et al.
    Gnjidic, Danijela
    Gillett, Mark
    Carroll, Peter
    Matthews, Slade
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Hilmer, Sarah
    Prevalence and Impact of Fall-Risk-Increasing Drugs, Polypharmacy, and Drug-Drug Interactions in Robust Versus Frail Hospitalised Falls Patients: A Prospective Cohort Study2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 3, p. 225-232Article in journal (Refereed)
    Abstract [en]

    Background Several measures of medication exposure are associated with adverse outcomes in older people. Exposure to and the clinical outcomes of these measures in robust versus frail older inpatients are not known. Objective In older robust and frail patients admitted to hospital after a fall, we investigated the prevalence and clinical impact of fall-risk-increasing drugs (FRIDs), total number of medications, and drug-drug interactions (DDIs). Methods Patients >= 60 years of age admitted with a fall to a tertiary referral teaching hospital in Sydney were recruited and frailty was assessed. Data were collected at admission, discharge, and 2 months after admission. Results A total of 204 patients were recruited (mean age 80.5 +/- 8.3 years), with 101 robust and 103 frail. On admission, compared with the robust, frail participants had significantly higher mean +/- SD number of FRIDs (frail 3.4 +/- 2.2 vs. robust 1.6 +/- 1.5, P < 0.0001), total number of medications (9.8 +/- 4.3 vs. 4.4 +/- 3.3, P < 0.0001), and DDI exposure (35 vs. 5 %, P = 0.001). Number of FRIDs on discharge was significantly associated with recurrent falls [odds ratio (OR) 1.7 (95 % confidence interval [CI] 1.3-2.1)], which were most likely to occur with 1.5 FRIDs in the frail and 2.5 FRIDs in the robust. Number of medications on discharge was also associated with recurrent falls [OR 1.2 (1.0-1.3)], but DDIs were not. Conclusion Exposure to FRIDs and other measures of high-risk medication exposures is common in older people admitted with falls, especially the frail. Number of FRIDs and to a lesser extent total number of medicines at discharge were associated with recurrent falls.

  • 28. Bergman, Ingvar
    et al.
    Almkvist, Ove
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    The effect of age on fluid intelligence is fully mediated by physical health2013In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 57, no 1, p. 100-109Article in journal (Refereed)
    Abstract [en]

    The present study investigated the extent to which the effect of age on cognitive ability is predicted by individual differences in physical health. The sample consisted of 118 volunteer subjects who were healthy and ranging in age from 26 to 91. The examinations included a clinical investigation, magnetic resonance imaging (MRI) brain neuroimaging, and a comprehensive neuropsychological assessment. The effect of age on fluid IQ with and without visual spatial praxis and on crystallized IQ was tested whether being fully-, partially-or non-mediated by physical health. Structural equation analyses showed that the best and most parsimonious fit to the data was provided by models that were fully mediated for fluid IQ without praxis, non-mediated for crystallized IQ and partially mediated for fluid IQ with praxis. The diseases of the circulatory and nervous systems were the major mediators. It was concluded from the pattern of findings that the effect of age on fluid intelligence is fully mediated by physical health, while crystallized intelligence is non-mediated and visual spatial praxis is partially mediated, influenced mainly by direct effects of age. Our findings imply that improving health by acting against the common age-related circulatory-and nervous system diseases and risk factors will oppose the decline in fluid intelligence with age.

  • 29.
    Berndt, Hanna
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Gothenburg University, Sweden.
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Childhood living conditions, education and health among the oldest old in Sweden2016In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 36, no 3, p. 631-648Article in journal (Refereed)
    Abstract [en]

    The objectives were to investigate the associations between social and financial living conditions in childhood, education and morbidity in old age. The study population (N = 591; 76+ years old) was assembled from two nationally representative Swedish surveys, in 1968 and 2011, that together made longitudinal analysis possible. Morbidity in old age comprised self-reported measures of musculoskeletal disorders, cardiovascular disease, self-rated health and impaired mobility. There were no independent associations between adverse childhood living conditions and morbidity. However, adverse childhood living conditions were associated with an increased likelihood of low education. Moreover, low education was associated with a higher probability of health problems in old age. The results did not show any associations between adverse childhood conditions and late-life morbidity. However, adverse childhood conditions were associated with lower levels of education which, in turn, was associated with health problems and attrition from the study. These results suggest that adverse childhood conditions may indeed be associated with health and survival in old age, but mainly through mechanisms acting earlier in the lifecourse.

  • 30. Berner, Jessica
    et al.
    Comijs, Hannie
    Elmståhl, Sölve
    Weimer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Sanmartin Berglund, Johan
    Anderberg, Peter
    Deeg, Dorly
    Maintaining cognitive function with internet use: a two-country, six-year longitudinal study2019In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 31, no 7, p. 929-936Article in journal (Refereed)
    Abstract [en]

    Objectives: Maintaining good cognitive function with aging may be aided by technology such as computers, tablets, and their applications. Little research so far has investigated whether internet use helps to maintain cognitive function over time.

    Design: Two population-based studies with a longitudinal design from 2001/2003 (T1) to 2007/2010 (T2).

    Setting: Sweden and the Netherlands.

    Participants: Older adults aged 66 years and above from the Swedish National Study on Ageing and Care (N = 2,564) and from the Longitudinal Aging Study Amsterdam (N = 683).

    Measurements: Internet use was self-reported. Using the scores from the Mini-Mental State Examination (MMSE) from T1 and T2, both a difference score and a significant change index was calculated. Linear and logistic regression analysis were performed with difference score and significant change index, respectively, as the dependent variable and internet use as the independent variable, and adjusted for sex, education, age, living situation, and functional limitations. Using a meta-analytic approach, summary coefficients were calculated across both studies.

    Results: Internet use at baseline was 26.4% in Sweden and 13.3% in the Netherlands. Significant cognitive decline over six years amounted to 9.2% in Sweden and 17.0% in the Netherlands. Considering the difference score, the summary linear regression coefficient for internet use was -0.32 (95% CI: -0.62, -0.02). Considering the significant change index, the summary odds ratio for internet use was 0.54 (95% CI: 0.37, 0.78).

    Conclusions: The results suggest that internet use might play a role in maintaining cognitive functioning. Further research into the specific activities that older adults are doing on the internet may shine light on this issue.

  • 31. Berner, Jessica
    et al.
    Rennemark, Mikael
    Jogréus, Claes
    Anderberg, Peter
    Sköldunger, Anders
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wahlberg, Maria
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Elmståhl, Sölve
    Berglund, Johan
    Factors influencing Internet usage in older adults (65 years and above) living in rural and urban Sweden2015In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 21, no 3, p. 237-249Article in journal (Refereed)
    Abstract [en]

    Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.

  • 32.
    Bildtgård, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Öberg, Peter
    Time as a structuring condition behind new intimate relationships in later life2015In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 35, no 7, p. 1505-1528Article in journal (Refereed)
    Abstract [en]

    Although mobility in and out of intimate relationships has become more common in later life, it has been a neglected issue in social gerontology. In this article, we ask what characterises the formation of new intimate relationships in later life, and whether there are any specific conditions that separate these from relationships in earlier stages of the lifecourse. On the basis of qualitative interviews with 28 persons aged 63-91 who have established a new intimate heterosexual relationship after the age of 60 or who are dating singles, we argue that time constitutes such a central structuring condition. We discuss and theorise two aspects of time - post-(re) productive free time and remaining time - which have an important formative power on new late-in-life relationships. We argue that together these aspects form a central existential structure of ageing in many Western societies - the paradoxical condition of having lots of available free time but little time left in life - which, besides influencing new late-in-life relationships, might also be relevant to other aspects of and choices in later life.

  • 33. Bjuhr, Marie
    et al.
    Engstrom, Maria
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lindberg, Magnus
    Sjölund, Britt-Marie
    Incentives behind and Experiences of Being Active in Working Life after Age 65 in Sweden2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 23, article id 15490Article in journal (Refereed)
    Abstract [en]

    Since individual and societal expectations regarding the possibility of an extended working life after the expected retirement age are increasing, research on sustainable working life combined with healthy ageing is needed. This study explores the incentives behind and experiences of an extended working life after the expected retirement age of 65 among Swedish people. The inductive qualitative content analyses are based on 18 individual semi-structured interviews among persons 67–90 years old with varying characteristics and varying experiences of extended working lives. The analyses revealed that working contributed to (1) sustained internal resources, i.e., cognitive function, physical ability and increased vigor; (2) sustained external resources, i.e., social enrichment, better daily routines and economic benefits; (3) added meaningfulness to life, i.e., being needed, capability and satisfaction with working tasks. Meanwhile, having flexible working conditions enabled a satisfying balance between work and leisure. Altogether, these different aspects of overall health and working life were interpreted as contributing to increased feelings of vitality, the innermost dimension of health. Conclusions: regardless of biological age, our results indicate that being able to remain active in working life can be beneficial to vitality and could make these results valuable for both health-care personnel and employers.

  • 34. Bokenberger, Kathleen
    et al.
    Ström, Peter
    Dahl Aslan, Anna K.
    Johansson, Anna L. V.
    Gatz, Margaret
    Pedersen, Nancy L.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Association Between Sleep Characteristics and Incident Dementia Accounting for Baseline Cognitive Status: A Prospective Population-Based Study2017In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 72, no 1, p. 134-139Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

    METHODS: Screening Across the Lifespan Twin (SALT) study participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios for dementia.

    RESULTS: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤6 hours) and extended (>9 hours) time in bed (TIB) compared to the middle reference group (hazard ratio = 1.40, 95% confidence interval = 1.06-1.85; hazard ratio = 1.11, 95% confidence interval = 1.00-1.24, respectively) and rising at 8:00 AM or later compared to earlier rising (hazard ratio = 1.12, 95% confidence interval = 1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

    CONCLUSIONS: Short and extended TIB and delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

  • 35. Bosnes, Ingunn
    et al.
    Nordahl, Hans Morten
    Stordal, Eystein
    Bosnes, Ole
    Myklebust, Tor Åge
    Almkvist, Ove
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Sweden.
    Lifestyle predictors of successful aging: A 20-year prospective HUNT study2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 7, article id e0219200Article in journal (Refereed)
    Abstract [en]

    Background Lifestyle factors predicting successful aging as a unified concept or as separate components of successful aging are important for understanding healthy aging, interventions and preventions. The main objective was to investigate the effect of midlife predictors on subsequent successful aging 20 years later. Materials and methods Data were from a population-based health survey, the Nord-Trondelag Health Study (HUNT), with an average follow-up of 22.6 years. Individuals free of major disease at baseline in 1984-86 with complete datasets for the successful aging components in HUNT3 in 2006-08, were included (n = 4497; mean age at baseline 52.7, range 45-59, years). Successful aging was defined either as a unified category or as three components: being free of nine specified diseases and depression, having no physical or cognitive impairment, and being actively engaged with life. The midlife predictors (smoking, physical activity, alcohol consumption, obesity and social support) were analysed both as separate predictors and combined into a lifestyle index controlling for sociodemographic variables, using multivariable regression analysis. Results Successful aging as a unified concept was related to all the lifestyle factors in the unadjusted analyses, and all except alcohol consumption in the adjusted analyses. The individual components of successful aging were differently associated with the lifestyle factors; engagement with life was less associated with the lifestyle factors. Non-smoking and good social support were the most powerful predictors for successful aging as a unified concept. When the lifestyle factors were summed into a lifestyle index, there was a trend for more positive lifestyle to be related to higher odds for successful aging. Conclusions Lifestyle factors predicted an overall measure of SA, as well as the individual components, more than 20 years later. Modifiable risk factors in midlife, exemplified by social support, may be used for interventions to promote overall health and specific aspects of health in aging.

  • 36.
    Boussard, Annika
    et al.
    Stockholm University, Faculty of Science, Department of Zoology.
    Amcoff, Mirjam
    Stockholm University, Faculty of Science, Department of Zoology.
    Buechel, Séverine D.
    Stockholm University, Faculty of Science, Department of Zoology.
    Kotrschal, Alexander
    Stockholm University, Faculty of Science, Department of Zoology. Wageningen University & Research, Netherlands.
    Kolm, Niclas
    Stockholm University, Faculty of Science, Department of Zoology.
    The link between relative brain size and cognitive ageing in female guppies (Poecilia reticulata) artificially selected for variation in brain size2021In: Experimental Gerontology, ISSN 0531-5565, E-ISSN 1873-6815, Vol. 146, article id 111218Article in journal (Refereed)
    Abstract [en]

    Cognitive ageing is the general process when certain mental skills gradually deteriorate with age. Across species, there is a pattern of a slower brain structure degradation rate in large-brained species. Hence, having a larger brain might buffer the impact of cognitive ageing and positively affect survival at older age. However, few studies have investigated the link between relative brain size and cognitive ageing at the intraspecific level. In particular, experimental data on how brain size affects brain function also into higher age is largely missing. We used 288 female guppies (Poecilia reticulata), artificially selected for large and small relative brain size, to investigate variation in colour discrimination and behavioural flexibility, at 4-6, 12 and 24 months of age. These ages are particularly interesting since they cover the life span from sexual maturation until maximal life length under natural conditions. We found no evidence for a slower cognitive ageing rate in large-brained females in neither initial colour discrimination nor reversal learning. Behavioural flexibility was predicted by large relative brain size in the youngest group, but the effect of brain size disappeared with increasing age. This result suggests that cognitive ageing rate is faster in large-brained female guppies, potentially due to the faster ageing and shorter lifespan in the large-brained selection lines. It also means that cognition levels align across different brain sizes with older age. We conclude that there are cognitive consequences of ageing that vary with relative brain size in advanced learning abilities, whereas fundamental aspects of learning can be maintained throughout the ecologically relevant life span.

  • 37.
    Bromseth, Janne
    et al.
    Stockholm University, Faculty of Humanities, Department of Ethnology, History of Religions and Gender Studies.
    Siverskog, Anna
    LHBTQ-personer och åldrande: nordiska perspektiv2013Collection (editor) (Refereed)
    Abstract [sv]

    Lhbtq-personer och åldrande: Nordiska perspektiv samlar kunskap om äldre lhbtq-personers livsvillkor och åldrande utifrån studier som genomförts i Sverige, Danmark, Norge och Finland.Författarna uppmärksammar frågor om vad det innebär att under stora delar av livet behöva smyga med sin sexualitet eller könsidentitet, och vad det i olika tider har inneburit att komma ut med sin sexualitet och könsidentitet. Vilka räknas som familj? Hur är det att som äldre transperson påbörja en utredning för att ändra könsidentitet? Hur är det att som äldre behöva omsorgshjälp men att samtidigt vara rädd för att bli diskriminerad på grund av sin sexualitet eller könsidentitet?

  • 38. Burzynska, Agnieszka Z.
    et al.
    Nagel, Irene E.
    Preuschhof, Claudia
    Gluth, Sebastian
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Max Planck Institute for Human Development, Germany.
    Li, Shu-Chen
    Lindenberger, Ulman
    Heekeren, Hauke R.
    Cortical thickness is linked to executive functioning in adulthood and aging2012In: Human Brain Mapping, ISSN 1065-9471, E-ISSN 1097-0193, Vol. 33, no 7, p. 1607-20Article in journal (Refereed)
    Abstract [en]

    Executive functions that are dependent upon the frontal-parietal network decline considerably during the course of normal aging. To delineate neuroanatomical correlates of age-related executive impairment, we investigated the relation between cortical thickness and executive functioning in 73 younger (20-32 years) and 56 older (60-71 years) healthy adults. Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST). Cortical thickness was measured at each location of the cortical mantle using surface-based segmentation procedures on high-resolution T1-weighted magnetic resonance images. For regions involved in WCST performance, such as the lateral prefrontal and parietal cortices, we found that thicker cortex was related to higher accuracy. Follow-up ROI-based analyses revealed that these associations were stronger in older than in younger adults. Moreover, among older adults, high and low performers differed in cortical thickness within regions generally linked to WCST performance. Our results indicate that the structural cortical correlates of executive functioning largely overlap with previously identified functional patterns. We conclude that structural preservation of relevant brain regions is associated with higher levels of executive performance in old age, and underscore the need to consider the heterogeneity of brain aging in relation to cognitive functioning.

  • 39.
    Calderón-Larrañaga, Amaia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Hu, Xiaonan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Guo, Jie
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Ferrucci, Luigi
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Body mass trajectories and multimorbidity in old age: 12-year results from a population-based study2021In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 40, no 12, p. 5764-5770Article in journal (Refereed)
    Abstract [en]

    Background & aims: Body weight changes reflect and impact several health conditions in older age, but little is known about its relationship with multimorbidity. We aimed to study the association of long-terms trajectories of body mass index (BMI) with contemporaneous changes in multimorbidity −and multimorbidity type− development in a population-based cohort of older adults.

    Methods: Twelve-year BMI trajectories (2001–2013) were identified in subjects aged 60+ years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) using growth mixture models (N = 2189). Information on 60 chronic diseases and multimorbidity was ascertained based on clinical examinations, lab tests, medications, and inpatient and outpatient medical records. Linear mixed models were used to study the association between BMI trajectories and the speed of chronic disease accumulation, in general and by groups of cardiovascular and neuropsychiatric diseases.

    Results: Eighty percent of the study population was included in what we defined a stable BMI trajectory, 18% in a slow-decline trajectory with an accelerated BMI decline from age 78 onwards, and 2% in a fast-decline trajectory that reached underweight values before age 85. A significantly higher yearly rate of chronic disease accumulation was observed in the fast-decline versus stable trajectory (β = 0.221, 95% CI 0.090–0.352) after adjusting the model for age cohort, sex, education and time to death. Subjects in the slow-decline trajectory showed a significantly higher yearly rate of cardiovascular disease accumulation (β = 0.016, 95% CI 0.000–0.031); those in the fast-decline trajectory showed a faster accumulation of both cardiovascular (β = 0.020, 95% CI -0.025, 0.064) and neuropsychiatric diseases (β = 0.102, 95% CI 0.064–0.139), even if the former association did not reach statistical significance.

    Conclusion: Our results provide further evidence of the importance of carefully monitoring older adults with sustained weight loss, which is an early indicator of accelerated health deterioration, reflected in our study by a faster accumulation of chronic −especially neuropsychiatric− diseases.

  • 40.
    Calderón-Larrañaga, Amaia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Santoni, Giola
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wang, Hui Xin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Rome, Italy.
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Rapidly developing multimorbidity and disability in older adults: does social background matter?2018In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, no 5, p. 489-499Article in journal (Refereed)
    Abstract [en]

    Background. Multimorbidity is among the most disabling geriatric conditions. In this study, we explored whether a rapid development of multi morbidity potentiates its impact on the functional independence of older adults, and whether different sociodemographic factors play a role beyond the rate of chronic disease accumulation. Methods. A random sample of persons aged >= 60 years (n = 2387) from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) was followed over 6 years. The speed of multimorbidity development was estimated as the rate of chronic disease accumulation (linear mixed models) and further dichotomized into the upper versus the three lower rate quartiles. Binomial negative mixed models were used to analyse the association between speed of multimorbidity development and disability (impaired basic and instrumental activities of daily living), expressed as the incidence rate ratio (IRR). The effect of sociodemographic factors, including sex, education, occupation and social network, was investigated. Results. The risk of new activity impairment was higher among participants who developed multi morbidity faster (IRR 2.4, 95% Cl 1.9-3.1) compared with those who accumulated diseases more slowly overtime, even after considering the baseline number of chronic conditions. Only female sex (IRR for women vs. men 1.6, 95% Cl 1.2-2.0) and social network (IRR for poor vs. rich social network 1.7, 95% Cl 1.3-2.2) showed an effect on disability beyond the rate of chronic disease accumulation. Conclusions. Rapidly developing multimorbidity is a negative prognostic factor for disability. However, sociodemographic factors such as sex and social network may determine older adults' reserves of functional ability, helping them to live independently despite the rapid accumulation of chronic conditions.

  • 41.
    Calderón-Larrañaga, Amaia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of the Sacred Heart, Italy; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Italy.
    Ferrucci, L.
    Mercer, S. W.
    Marengoni, A.
    Onder, G.
    Eriksdotter, M.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways2019In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 285, no 3, p. 255-271Article, review/survey (Refereed)
    Abstract [en]

    This review discusses the interplay between multimorbidity (i.e. co-occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person's ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people's reduced ability to cope with treatment and care burden and physicians' fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug-drug and drug-disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age-related health deterioration; this review provides an overview of knowledge gaps and future directions.

  • 42.
    Calderón-Larrañaga, Amaia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Aragon Health Sciences Institute (IACS), Spain.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Onder, Graziano
    Gimeno-Feliu, Luis A.
    Coscollar-Santaliestra, Carlos
    Carfí, Angelo
    Pisciotta, Maria S.
    Angleman, Sara
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Melis, René J. F.
    Santoni, Giola
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Mangialasche, Francesca
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Bernabei, Roberto
    Prados-Torres, Alexandra
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Assessing and Measuring Chronic Multimorbidity in the Older Population: A Proposal for Its Operationalization2017In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 72, no 10, p. 1417-1423Article in journal (Refereed)
    Abstract [en]

    Background

    Although the definition of multimorbidity as the simultaneous presence of two or more chronic diseases is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity.

    Methods

    Based on a consensus definition of chronic disease, all four-digit level codes from the International Classification of Diseases, 10th revision (ICD-10) were classified as chronic or not by an international and multidisciplinary team. Chronic ICD-10 codes were subsequently grouped into broader categories according to clinical criteria. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) using also inpatient data from the Swedish National Patient Register.

    Results

    A disease or condition was considered to be chronic if it had a prolonged duration and either (a) left residual disability or worsening quality of life or (b) required a long period of care, treatment, or rehabilitation. After applying this definition in relation to populations of older adults, 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had >= 2 of these 60 disease categories, 73.2% had >= 3, and 55.8% had >= 4.

    Conclusions

    This operational measure of multimorbidity, which can be implemented using either or both clinical and administrative data, may facilitate its monitoring and international comparison. Once validated, it may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care.

  • 43.
    Canevelli, Marco
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Sapienza University, Italy.
    Wallace, Lindsay M. K.
    Bruno, Giuseppe
    Cesari, Matteo
    Rockwood, Kenneth
    Ward, David D.
    Frailty is associated with the clinical expression of neuropsychological deficits in older adults2024In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 31, no 1, article id e16072Article in journal (Refereed)
    Abstract [en]

    Background and purpose: The aim was to determine whether frailty is associated with the relationship between neuropsychological markers and global cognition in older adults.

    Methods: Cross-sectional analyzes were conducted of baseline data from three large cohort studies: National Alzheimer's Coordinating Center (NACC), Rush Memory and Aging Project (MAP) and Alzheimer's Disease Neuroimaging Initiative (ADNI). Studies recruited North American participants along the spectrum of cognitive functioning (44% no cognitive impairment at baseline). A frailty index was computed in each dataset. Frailty indices, neuropsychological tests (including measures of processing speed, episodic, semantic and working memory) and Mini-Mental State Examination (MMSE) scores were the variables of interest, with age, sex, education and apolipoprotein E ε4 evaluated as confounders.

    Results: Across all studies, 23,819 participants aged 55–104 (57% female) were included in analyzes. Frailty index scores were significantly and inversely associated with MMSE scores and significantly moderated relationships between neuropsychological test scores and MMSE scores. In participants with higher frailty index scores, lower neuropsychological test scores were more strongly associated with lower MMSE scores (standardized interaction coefficients ranged from −0.19 to −1.17 in NACC, −0.03 to −2.27 in MAP and −0.04 to −0.38 in ADNI, depending on the neuropsychological test). These associations were consistent across the different databases and were mostly independent of the composition of frailty indices (i.e., after excluding possible symptoms of dementia).

    Conclusions: Amongst older Americans, frailty is associated with the cognitive expression of neuropsychological deficits. Implementation of frailty assessment in routine neurological and neuropsychological practice should be considered to optimize care outcomes for older adults.

  • 44. Carfi, Angelo
    et al.
    Romano, Allegra
    Zaccaria, Giulia
    Villani, Emanuele Rocco
    Manes Gravina, Ester
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Università Cattolica del Sacro Cuore, Italy.
    Bernabei, Roberto
    Onder, Graziano
    The burden of chronic disease, multimorbidity, and polypharmacy in adults with Down syndrome2020In: American Journal of Medical Genetics. Part A, ISSN 1552-4825, E-ISSN 1552-4833, Vol. 182, no 7, p. 1735-1743Article in journal (Refereed)
    Abstract [en]

    Data on clinical characteristics of adults with Down syndrome (DS) are limited and the clinical phenotype of these persons is poorly described. This study aimed to describe the occurrence of chronic diseases and pattern of medication use in a population of adults with DS. Participants were 421 community dwelling adults with DS, aged 18 years or older. Individuals were assessed through a standardized clinical protocol. Multimorbidity was defined as the occurrence of two or more chronic conditions and polypharmacy as the concomitant use of five or more medications. The mean age of study participants was 38.3 +/- 12.8 years and 214 (51%) were women. Three hundred and seventy-four participants (88.8%) presented with multimorbidity. The most prevalent condition was visual impairment (72.9%), followed by thyroid disease (50.1%) and hearing impairment (26.8%). Chronic diseases were more prevalent among participants aged >40 years. The mean number of medications used was 2.09 and polypharmacy was observed in 10.5% of the study sample. Psychotropic medications were used by a mean of 0.7 individuals of the total sample. The high prevalence of multimorbidity and the common use of multiple medications contributes to a high level of clinical complexity, which appears to be similar to the degree of complexity of the older non-trisomic population. A comprehensive and holistic approach, commonly adopted in geriatric medicine, may provide the most appropriate care to persons with DS as they grow into adulthood.

  • 45.
    Cavazzana, Annachiara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. TU Dresden, Germany.
    Röhrborn, Anja
    Garthus-Niegel, Susan
    Larsson, Maria
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Hummel, Thomas
    Croy, Ilona
    Sensory-specific impairment among older people: An investigation using both sensory thresholds and subjective measures across the five senses2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 8, article id e0202969Article in journal (Refereed)
    Abstract [en]

    Age-related sensory impairment is a slow and gradual progress, which affects multiple modalities. Two contradictory hypotheses exist about the age-related decline of sensory thresholds. The common factor theory assumes one underlying factor-which accounts for the loss of several sensory modalities simultaneously-and the specific factor theory predicts that the sensory decline is uncorrelated between different modalities. In this study, we aimed to explore whether (i) there is a common factor of sensory thresholds in older people, (ii) older people assume that sensory decline in one modality also affects other modalities, (iii) there is a relation between sensory threshold and the subjective assessment of sensory function. This was accomplished by collecting both threshold measures and self-reported ratings for smell, hearing, taste, vision, and touch function in a group of 104 older people (mean age: 67.2 years; SD: 9.85; range: 50-100 years). Results indicated that there was no common factor of sensory thresholds, hence an impairment in one modality did not necessarily imply a shortfall in other modalities. In contrast, our results suggested one or two common factor(s) for the participants' ratings. Participants who reported a diminished function in one sense tended to generalize this rating to the other senses as well. The correspondence between subjective ratings and sensory thresholds was relatively good for vision and audition, although no correlations were observed for the other domains. These findings have implications for clinicians, suggesting that subjective measures should be combined with sensory threshold measurements when evaluating sensory dysfunction. Also, these data convey a positive message for older people and their physicians by showing that loss in one sensory modality does not necessarily generalize to losses across all sensory modalities.

  • 46. Cesari, M.
    et al.
    Canevelli, Marco
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Italy.
    Calvani, R.
    Aprahamian, I.
    Inzitari, M.
    Marzetti, E.
    The Management of Frailty: Barking Up the Wrong Tree2022In: Journal of Frailty & Aging, ISSN 2260-1341, E-ISSN 2273-4309, Vol. 11, no 2, p. 127-128Article in journal (Other academic)
  • 47. Chen, Huashuai
    et al.
    Ye, Kaisy Xinhong
    Feng, Qiushi
    Cao, Kai
    Yu, Jintai
    Li, Chunbo
    Zhang, Can
    Yu, Lirong
    Maier, Andrea Britta
    Langa, Kenneth M.
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Zeng, Yi
    Feng, Lei
    Trends in the prevalence of cognitive impairment at old age in China, 2002–20182023In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: China has the world's largest number of older adults with cognitive impairment (CI). We aimed to examine secular trends in the prevalence of CI in China from 2002 to 2018.

    METHODS: Generalized estimating equations (GEE) was used to assess changes in CI trend in 44,154 individuals (72,027 observations) aged 65 to 105 years old.

    RESULTS: The prevalence of CI increased from 2002 to 2008 and then decreased until 2018. The age-standardized prevalence increased from 25.7% in 2002, 26.1% in 2005, to 28.2% in 2008, then decreased to 26.0% in 2011, 25.3% in 2014, and 24.9% in 2018. Females and those ≥ 80 years old had greater CI prevalence.

    DISCUSSION: The prevalence of CI showed an inverted U shape from early 2000s to late 2010s with a peak in 2008. Follow-up studies are needed to confirm the decreasing trend after 2008 and examine the contributing factors and underlying mechanisms of this trend.

  • 48. Chen, Hui
    et al.
    Cao, Yaying
    Ma, Yuan
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    Zong, Geng
    Yuan, Changzheng
    Age- and sex-specific modifiable risk factor profiles of dementia: evidence from the UK Biobank2023In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 38, no 1, p. 83-93Article in journal (Refereed)
    Abstract [en]

    Dementia constitutes a worldwide concern. To characterize the age- and sex-specific modifiable risk factor profiles of dementia, we included 497,401 UK Biobank participants (mean age = 56.5 years) without dementia at baseline (2006–2010) and followed them until March 2021. Cox proportional hazard models were used to estimate the age- and sex-specific hazard ratios (HRs) of incident dementia associated with socioeconomic (less education and high Townsend deprivation index), lifestyle (non-moderate alcohol intake, current smoking, suboptimal diet, physical inactivity, and unhealthy sleep duration), and health condition factors (hypertension, diabetes, cardiovascular diseases, and depressive symptoms). We also calculated the population attributable fractions (PAFs) of these factors. During follow-up (mean = 11.6 years), we identified 6564 dementia cases. HRs for the risk factors were similar between the sexes, while most factors showed stronger associations among younger participants. For example, the HRs of smoking were 1.74 (95% CI: 1.23, 2.47) for individuals aged < 50 years, and 1.18 (1.05, 1.33) for those aged ≥ 65 years. Overall, 46.8% (37.4%, 55.2%) of dementia cases were attributable to the investigated risk factors. The PAFs of the investigated risk factors also decreased with age, but that for health condition risk factors decreased with lower magnitude than socioeconomic and lifestyle risk factors. The stronger associations and greater PAFs of several modifiable risk factors for dementia among younger adults than older participants underscored the importance of dementia prevention from an earlier stage across the adult life course. 

  • 49. Chen, Hui
    et al.
    Dunk, Michelle M.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wang, Binghan
    Zhao, Mengjia
    Shen, Jie
    Zong, Geng
    Pan, Yuesong
    Tong, Lusha
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Yuan, Changzheng
    Associations of the Mediterranean-DASH Intervention for Neurodegenerative Delay diet with brain structural markers and their changes2023In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The associations of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet with brain structural changes are unclear.

    METHODS: Among 26,466 UK Biobank participants, a 15-point MIND score was calculated from 24-hour diet recalls from 2009 to 2012. We assessed its associations with 17 magnetic-resonance-derived brain volumetric markers and their longitudinal changes and explored whether genetic factors modify the associations.

    RESULTS: Higher MIND adherence was associated with larger volumes of thalamus, putamen, pallidum, hippocampus, and accumbens (beta per 3-unit increment ranging from 0.024 to 0.033) and lower white matter hyperintensities (P-trends < 0.05), regardless of genetic predispositions of Alzheimer's disease. MIND score was not associated with their longitudinal changes (P > 0.05) over a median of 2.2 years among participants with repeated imaging assessments (N = 2963), but was associated with slower atrophy in putamen (beta: 0.026, P-trend = 0.044) and pallidum (beta: 0.030, P-trend = 0.033) among APOE ε4 non-carriers (N = 654).

    DISCUSSION: The MIND diet showed beneficial associations with certain brain imaging markers, and its associations with long-term brain structural changes warrants future investigation.

  • 50.
    Chen, Shuyun
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Saadeh, Marguerita
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Dohrn, Ing-Mari
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Correlations of Subjective and Social Well-Being With Sedentary Behavior and Physical Activity in Older Adults—A Population-Based Study 2021In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 76, no 10, p. 1789-1795Article in journal (Refereed)
    Abstract [en]

    Background: Subjective and social well-being, avoiding sedentary behavior (SB), and engaging in physical activity (PA) are important factors for health in older adults, but the extent to which they are related to each other remains unclear. We aimed to investigate these correlations, and whether they differ by age.

    Method: A cross-sectional study was carried out in 595 people aged 66 years and older, from the Swedish National study on Aging and Care in Kungsholmen. Subjective and social well-being (life satisfaction, positive and negative affect, social connections, social support, and social participation) were assessed through validated questionnaires and activPAL3 accelerometers provided information on SB and PA. Data were analyzed using multi-adjusted quantile regression models.

    Results: Higher positive affect was significantly associated with less daily sitting time (β = −27.08, 95% confidence interval [CI]: −47.77, −6.39) and higher levels of light PA (LPA) (β = 40.67, 95% CI: 21.06, 60.28). Higher levels of social support and social participation were associated with less daily sitting time (β = −22.79, 95% CI: −39.97, −5.62; and β = −21.22, 95% CI: −39.99, −2.44) and more time in LPA (β = 23.86, 95% CI: 4.91, 42.81; and β = 25.37, 95% CI: 6.27, 44.47). Stratified analyses suggested that the associations of positive affect and social participation were strongest for individuals aged 80 years and older.

    Conclusions: Our results suggest that older adults with higher levels of subjective and social well-being spend less time sitting and engage more in PA. This was especially evident among the oldest-old individuals. Future research should longitudinally investigate the directionality of these correlations.

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