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  • 1. Ericsson, Malin Christina
    et al.
    Gatz, Margaret
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Parker, Marti G.
    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).
    Validation of abridged mini-mental state examination scales using population-based data from Sweden and USA2017In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 14, no 2, p. 199-205Article in journal (Refereed)
    Abstract [en]

    The objective of this study is to validate two abridged versions of the mini-mental state examination (MMSE): one intended for use in face-to-face interviews, and the other developed for telephonic interviews, using data from Sweden and the US to validate the abridged scales against dementia diagnoses as well as to compare their performance to that of the full MMSE scale. The abridged versions were based on eight domains from the original MMSE scale. The domains included in the MMSE-SF were registration, orientation, delayed recall, attention, and visual spatial ability. In the MMSE-SF-C, the visual spatial ability item was excluded, and instead, one additional orientation item was added. There were 794 participants from the Swedish HARMONY study [mean age 81.8 (4.8); the proportion of cognitively impaired was 51 %] and 576 participants from the US ADAMS study [mean age 83.2 (5.7); the proportion of cognitively impaired was 65 %] where it was possible to compare abridged MMSE scales to dementia diagnoses and to the full MMSE scale. We estimated the sensitivity and specificity levels of the abridged tests, using clinical diagnoses as reference. Analyses with both the HARMONY and the ADAMS data indicated comparable levels of sensitivity and specificity in detecting cognitive impairment for the two abridged scales relative to the full MMSE. Receiver operating characteristic curves indicated that the two abridged scales corresponded well to those of the full MMSE. The two abridged tests have adequate validity and correspond well with the full MMSE. The abridged versions could therefore be alternatives to consider in larger population studies where interview length is restricted, and the respondent burden is high.

  • 2.
    Kelfve, Susanne
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Thorslund, Mats
    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).
    Sampling and non-response bias on health-outcomes in surveys of the oldest old2013In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 10, no 3, p. 237-245Article in journal (Refereed)
    Abstract [en]

    Surveys of the oldest old population are associated with several design issues. Place of residence and possible physical or cognitive impairments make it difficult to maintain a representative study population. Based on a Swedish nationally representative survey among individuals 77+, the present study analyze the potential bias of not using proxy interviews and excluding the institutionalized part of the population in surveys of the oldest old. The results show that compared to directly interviewed people living at home, institutionalized and proxy interviewed individuals were older, less educated and more likely to be female. They had more problems with health, mobility and ADL, and a significantly increased mortality risk. If the study had excluded the institutionalized part of the population and/or failed to use proxy interviews, the result would have been severely biased and resulted in underestimated prevalence rates for ADL, physical mobility and psychologic problems. This could not be compensated for weighting the data by age and sex. The results from this study imply that accurate population estimates require a representative study population, in which all individuals are included regardless of their living conditions, health status, and cognitive ability.

  • 3. Larsson, Kristina
    et al.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Thorslund, Mats
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care2014In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 11, no 4, p. 349-359Article in journal (Refereed)
    Abstract [en]

    The effects of gender and marital status on care utilisation in the last years of life are highly correlated. This study analysed whether gender differences in use of eldercare (home help services or institutional care) or hospital care in the last 5 years of life, and the place of death, could be attributed to differences in marital status and thereby to potential access to informal care. A longitudinal Swedish study provided register data on 567 participants (aged 83 +) who died between 1995 and 2004. A higher proportion of unmarried than married people used home help services; this was true of both men and women. The likelihood of receiving home help was lower for those living with their spouse (OR = 0.38) and for those with children (OR = 0.60). In the 2 years preceding death, the proportion receiving home help services decreased and the proportion in institutional care increased. Women were significantly more likely to die in institutional care (OR = 1.88) than men. Although men were less likely to live in institutional care than women and more likely to be inpatients in the 3 months preceding death, after controlling for residence in institutional care, neither gender nor marital status was statistically significant when included in the same model. In summary, the determining factor for home help utilisation seemed to be access to informal care, whereas gender differences in health status could explain women’s higher probability of dying in institutional care.

  • 4.
    Meinow, Bettina
    et al.
    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). Jönkoping University, Sweden .
    Thorslund, Mats
    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).
    Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter2015In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 12, no 4, p. 285-297Article in journal (Refereed)
    Abstract [en]

    Studies of health trends in older populations usually focus on single health indicators. We include multiple medical and functional indicators, which together indicate the broader impact of health problems experienced by individuals and the need for integrated care from several providers of medical and long-term care. The study identified severe problems in three health domains (diseases/symptoms, mobility, and cognition/communication) in three nationally representative samples of the Swedish population aged 77+ in 1992, 2002, and 2011 (n a parts per thousand 1900; response rate > 85 %). Institutionalized people and proxy interviews were included. People with severe problems in two or three domains were considered to have complex health problems. Results showed a significant increase of older adults with complex health problems from 19 % in 1992 to 26 % in 2002 and no change thereafter. Changes over time remained when controlling for age and sex. When stratified by education, complex health problems increased significantly for people with lower education between 1992 and 2002 and did not change significantly between 2002 and 2011. For higher-educated people, there was no significant change over time. Among the people with severe problems in the symptoms/disease domain, about half had no severe problems in the other domains. People with severe mobility problems, on the other hand, were more likely to also have severe problems in other domains. Even stable rates may imply an increasing number of very old people with complex health problems, resulting in a need for improved coordination between providers of medical care and social services.

  • 5. Rostgaard, Tine
    et al.
    Szebehely, Marta
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Changing policies, changing patterns of care: Danish and Swedish home care at the crossroads2012In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 9, no 2, p. 101-109Article in journal (Refereed)
    Abstract [en]

    Despite pursuing the policy of ageing in place, the two Nordic countries of Denmark and Sweden have taken diverse roads in regard to the provision of formal, public tax-financed home care for older people. Whilst Sweden has cut down home care and targeted services for the most needy, Denmark has continued the generous provision of home care. This article focuses on the implication of such diverse policies for the provision and combination of formal and informal care resources for older people. Using data from Level of Living surveys (based on interviews with a total of 1,158 individuals aged 67-87 in need of practical help), the article investigates the consequences of the two policy approaches for older people of different needs and socio-economic backgrounds and evaluates how the development corresponds with ideals of universalism in the Nordic welfare model. Our findings show that in both countries tax-funded home care is used across social groups but targeting of resources at the most needy in Sweden creates other inequalities: Older people with shorter education are left with no one to resort to but the family, whilst those with higher education purchase help from market providers. Not only does this leave some older people more at risk, it also questions the degree of de-familialisation which is otherwise often proclaimed to be a main characteristic of the Nordic welfare model.

  • 6. Shaw, Benjamin A.
    et al.
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Smoking and physical inactivity patterns during midlife as predictors of all-cause mortality and disability: a 39-year prospective study2014In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 11, no 3, p. 195-204Article in journal (Refereed)
    Abstract [en]

    This study estimated the long-term mortality hazards and disability risks associated with various combinations of smoking and physical inactivity measured over time in a sample of middle-aged adults. Data have been collected from a national sample of Swedish adults, originally interviewed in 1968 and followed until 2007 (N = 1,682). Smoking and physical activity status were measured at baseline and 13 years later (1981). Different patterns of change and stability in smoking and physical inactivity over this 13 year period were used as predictors of mortality through 2007. Also, associations between different patterns of these health behaviors and the odds of disability (measured in 2004) were estimated among survivors (n = 925). Results suggest that mortality rates were elevated among persistent (HR = 1.7; 95 % CI = 1.5-2.0) and new smokers (HR = 2.5; 95 % CI = 1.6-4.1), but not among discontinued smokers. However, mortality rates remained elevated among discontinued smokers who were also persistently inactive (HR = 1.9; 95 % CI = 1.3-2.6). Additional findings suggest that persistent physical inactivity during midlife was associated with increased odds of late life disability (OR = 1.8; 95 % CI = 1.1-2.7), but that smoking had no clear additive or multiplicative effects on disability. As such, these findings indicate that while persistent smoking during midlife primarily impacts subsequent mortality, persistent physical inactivity during midlife appears to counteract the survival benefits of smoking cessation, while also imposing a long-term risk on late life disability among those who do survive to old age.

  • 7.
    Sundling, Catherine
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Nilsson, Mats E.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Hellqvist, Sara
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Pendrill, Leslie R.
    Emardson, Ragne
    Berglund, Birgitta
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Travel behaviour change in old age: the role of critical incidents in public transport2016In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 13, no 1, p. 75-83Article in journal (Refereed)
    Abstract [en]

    Older people’s travel behaviour is affected by negative or positive critical incidents in the public transport environment. With the objective of identifying such inci- dents during whole trips and examining how travel beha- viour had changed, we have conducted in-depth interviews with 30 participants aged 65–91 years in the County of Stockholm, Sweden. Out of 469 incidents identified, 77 were reported to have resulted in travel behaviour change, 67 of them in a negative way. Most critical incidents were encountered in the physical environment on-board vehicles and at stations/stops as well as in pricing/ticketing. The findings show that more personal assistance, better driving behaviour, and swift maintenance of elevators and escala- tors are key facilitators that would improve predictability in travelling and enhance vulnerable older travellers’ feeling of security. The results demonstrate the benefit of involving different groups of end users in future planning and design, such that transport systems would meet the various needs of its end users.

  • 8.
    Thorslund, Mats
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wastesson, Jonas W.
    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).
    Lagergren, Mårten
    Parker, Marti G.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    The rise and fall of women's advantage: a comparison of national trends in life expectancy at age 65 years2013In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 10, no 4, p. 271-277Article in journal (Refereed)
    Abstract [en]

    The female advantage in life expectancy (LE) is found worldwide, despite differences in living conditions, the status of women and other factors. However, this advantage has decreased in recent years in low-mortality countries. Few researchers have looked at the gender gap in LE in old age (age 65) in a longer historical perspective. Have women always had an advantage in LE at old age and do different countries share the same trends? Life expectancy data for 17 countries were assessed from Human Mortality Database from 1751 to 2007. Since most of the changes in LE taking place today are driven by reductions of old age mortality the gender difference in LE was calculated at age 65. Most low-mortality countries show the same historical trend, a rise and fall of women's advantage in LE at age 65. Three phases that all but two countries passed through were discerned. After a long phase with a female advantage in LE at 65 of <1 year, the gender gap increased significantly during the twentieth century. The increase occurred in all countries but at different time points. Some countries such as England and France had an early rise in female advantage (1900-1919), while it occurred 50 years later in Sweden, Norway and in the Netherlands. The rise was followed by a more simultaneous fall in female advantage in the studied countries towards the end of the century, with exceptions of Japan and Spain. The different timing regarding the increase of women's advantage indicates that country-specific factors may have driven the rise in female advantage, while factors shared by all countries may underlie the simultaneous fall. More comprehensive, multi-disciplinary study of the evolution of the gender gap in old age could provide new hypotheses concerning the determinants of gendered differences in mortality.

  • 9.
    Trydegård, Gun-Britt
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Care work in changing welfare states: Nordic care workers' experiences2012In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 9, no 2, p. 119-129Article in journal (Refereed)
    Abstract [en]

    This article focuses on Nordic eldercare workers and their experiences of working conditions in times of change and reorganisation. In recent years New Public Management-inspired ideas have been introduced to increase efficiency and productivity in welfare services. These reforms have also had an impact on day-to-day care work, which has become increasingly standardized and set out in detailed contracts, leading to time-pressure and an undermining of care workers' professional discretion and autonomy. The empirical data comes from a survey of unionised eldercare workers in home care and residential care in Denmark, Finland, Norway and Sweden (N = 2583) and was analysed by bi- and multi-variate methods. The care workers reported that they found their working conditions physically and mentally arduous. They had to a great extent experienced changes for the worse in terms of working conditions and in their opportunity to provide good quality care. In addition, the majority felt they did not receive support from their managers. An alarming finding was that one out of three care workers declared that they had seriously considered quitting their jobs. Care workers with multiple problems at work were much more likely to consider quitting, and the likelihood was increasing with the number of problems reported. Furthermore, care workers lacking support from their managers had double odds of wanting to quit. The Nordic welfare states with growing older populations are facing challenges in retaining care staff in the eldercare services and ensuring they have good working conditions and support in their demanding work.

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