End-of-life care in the oldest old.

Objective: The aim of this study was to describe the last year of life of a sample of the oldest old, focusing on care trajectories, health, social networks, and function in daily life activities.

Method: Data originated from the NONA study, a longitudinal study of 193 individuals among the oldest old living in a Swedish municipality. During this longitudinal study, 109 participants died.

Discharged after stroke - important factors for health-related quality of life.

Aims: This study examines different correlates to health-related quality (HRQoL) of life after discharge in patients with stroke.

Background: HRQoL is an important aspect of life after suffering a stroke. Previous research has revealed several variables associated with poststroke quality of life, including age, gender, depression, fatigue, length of hospital stay, functional status and amount of social participation.

The nature and cross-domain correlates of subjective age in the oldest old: Evidence from the OCTO Study.

Self-reflections of age and aging are predictors for key outcomes such as mortality, but little is known about the nature and potential antecedents of subjective age in very old age. We used cross-sectional data from the Swedish OCTO study (N = 267; B. Johansson & S.

Serum lipid levels and cognitive change in late life.

Objectives: To assess the effect of lipids and lipoproteins on longitudinal cognitive performance and cognitive health in late life and to consider moderating factors such as age and sex that may clarify conflicting prior evidence.

Design: Prospective cohort study.

Setting: A 16-year longitudinal study of health and cognitive aging.

Analysis of lipid pathway genes indicates association of sequence variation near SREBF1/TOM1L2/ATPAF2 with dementia risk.

We conducted dense linkage disequilibrium (LD) mapping of a series of 25 genes putatively involved in lipid metabolism in 1567 dementia cases [including 1270 with Alzheimer disease (AD)] and 2203 Swedish controls. Across a total of 448 tested genetic markers, the strongest evidence of association was as anticipated for APOE (rs429358 at P approximately 10(-72)) followed by a previously reported association of ABCA1 (rs2230805 at P approximately 10(-8)). In the present study, we report two additional markers near the SREBF1 locus on chromosome 17p that were also significant after multiple testing correction (best P = 3.

Sooner or later? A study of institutionalization in late life.

Background And Aims: Existing information about institutionalization of elderly individuals is mainly based on cross-sectional data and does not address the cumulative risk of institutionalization. The purpose of the present study was to analyze longitudinal data prospectively and estimate the risk of placement in an elder care institution for individuals aged 70 years or older.

Methods: The study was based on a longitudinal investigation (the H70 study) of a random sample of 70- year-olds living in Gothenburg, Sweden, in 1971.

Stability of genetic influences on pulmonary function in a longitudinal study of octogenarian twins.

Using data from the first four waves of the OCTO-Twin study (twins 80 + years), the present study investigated the stability and change of genetic and environmental contributions to pulmonary function. Using a genetic simplex model, variance in peak expiratory flow (PEF) at each wave was decomposed into additive genetic and nonshared (specific) environmental factors. Additionally, this analysis distinguished the source of these influences, either from previous waves (transmissions) or from novel influences at each wave (innovations).

Sequence variation in SORL1 and dementia risk in Swedes.

The gene encoding the neuronal sortilin-related receptor SORL1 has been claimed to be associated with Alzheimer's disease (AD) by independent groups and across various human populations. We evaluated six genetic markers in SORL1 in a sample of 1,558 Swedish dementia cases (including 1,270 AD cases) and 2,179 controls. For both single-marker-based and haplotype-based analyses, we found no strong support for SORL1 as a dementia or AD risk-modifying gene in our sample in isolation nor did we observe association with AD/dementia-related traits, including cerebrospinal fluid beta-amyloid(1-42), tau levels, or age at onset.

A survey of ABCA1 sequence variation confirms association with dementia.

We and others have conducted targeted genetic association analyses of ABCA1 in relation to Alzheimer disease risk with a resultant mixture of both support and refutation, but all previous studies have been based upon only a few markers. Here, a detailed survey of genetic variation in the ABCA1 region has been performed in a total of 1,567 Swedish dementia cases (including 1,275 with Alzheimer disease) and 2,203 controls, providing evidence of association with maximum significance at marker rs2230805 (odds ratio [OR]=1.39; 95% confidence interval [CI] 1.

The pattern of cognitive symptoms predicts time to dementia onset.

Background: Few studies have examined whether cognitive symptom patterns differ by age and length of time before dementia onset. Our objective was to investigate whether different patterns of cognitive symptoms at ages 70, 75, and 79 years predict short-term (< or =5 years) and long-term (>5 years) dementia onset.

Methods: A representative sample of 382 nondemented 70-year-olds from Gothenburg, Sweden was examined periodically up to age 90 years.

Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life.

Background: Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time.

Methods: Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample.

Heritabilities for fifteen routine biochemical values: findings in 215 Swedish twin pairs 82 years of age or older.

Objective: The aim of the present study was to calculate the overall heritability of some routine biochemical analyses. Furthermore, as genetic and environmental influences might differ across various segments, genetic impact in the highest and lowest thirds of the distributions was estimated.

Methods: Ninety-six monozygotic and 120 dizygotic same-sex twin pairs aged 82 and older were tested.

Discharge planning of stroke patients: the relatives' perceptions of participation.

Aims: To describe relatives' perceived participation in discharge planning for patients with stroke and identify correlates to perceived participation.

Background: Stroke affects both patients and their relatives and previous research shows that relatives were often dissatisfied with their perceived involvement in discharge planning and the information they get.

Design: Prospective cross-sectional study.

Older people's "voices"--on paper: obstacles to influence in welfare states--a case study of Sweden.

The official rhetoric of welfare states unconditionally pays tribute to older people's right to express dissatisfaction. In practice, users of older services in welfare states may be deprived of their "exit" options and face considerable constraints when it comes to raising their "voices." For example, when older people in nursing homes would like to lodge a complaint, they may well be referred to the very staff members they depend on in their everyday lives.

Quality of life among Swedish patients after stroke: psychometric evaluation of SF-36.

Objective: Few studies have evaluated the scale assumptions of the Medical Outcomes Study 36-item Short-Form (SF-36) with stroke survivors. The aims of this study were to evaluate the scale assumptions of SF-36 using Swedish patients after stroke and to compare patients' quality of life with that of a healthy population.

Design: Cross-sectional study.

Overweight and obesity in old age are not associated with greater dementia risk.

Objectives: To describe the association between body mass index (BMI) and dementia risk in older persons.

Design: Prospective population-based study, with 8 years of follow-up.

Setting: The municipality of Lieto, Finland, 1990/91 and 1998/99.

Patients' perceptions of their participation in discharge planning after acute stroke.

Aims And Objectives: To describe stroke patients' perceptions of their participation in the discharge planning process and identify correlates of perceived participation.

Background: Patients have the right to participate in discharge planning, but earlier research has shown that they are often dissatisfied with the information they receive and their involvement in goal-setting during discharge planning.

Design: Cross-sectional study.

Identification of dementia in epidemiological research: a study on the usefulness of various data sources.

Background And Aims: Prevalence and incidence ratios of dementia in epidemiological studies vary according to the data source used. Medical records, cognitive tests, and registry information are sources frequently used to differentiate dementia from normal aging. The aim of the present study was to compare the identification of dementia from these different sources with that from consensus diagnosis.

Accounting for the relationship between low education and dementia: a twin study.

We evaluated whether the association between low education and greater risk of dementia is explained by genetic influences, using three different types of analyses. The HARMONY study (Swedish for "health" (Hälsa), "genes" (ARv), "environment" (Miljö), "and" (Och), and "new" (NY)) includes members of the Swedish Twin Registry who were aged 65 and older and alive in 1998, and who were screened and clinically assessed for dementia. There were 394 cases with dementia and 7786 unrelated controls.

Genotype-environment interactions: cognitive aging and social factors.

The possibility of genotype-environment interaction for memory performance and change was examined in 150 monozygotic (MZ) twin pairs from the Swedish Adoption Twin Study of Aging (SATSA). We used an MZ twin pair difference approach to examine the possibility that genotype was associated with intrapair variability and thus suggestive of genotype-nonshared environment interactions. Multiple 'variability genes' were found for longitudinal change in a semantic memory task including candidates coding for apolipoprotein E (APOE) and estrogen receptor alpha (ESR1) as well as serotonin candidates (HTR2A and 5HTT).

Health, functional capacity, formal care, and survival in the oldest old: a longitudinal study.

There are surprisingly few longitudinal studies of the oldest old, but these studies are of high importance because the number of oldest old continues to increase in most countries and because of the uniqueness in this population. The aims of this study were to investigate how health, activities of daily living (ADL), and use of care change over time in the oldest old and to seek how differences in health and ADL affect survival of the oldest old. The study was longitudinal in design, and the participants were interviewed by trained nurses.

Low systolic blood pressure is associated with impaired cognitive function in the oldest old: longitudinal observations in a population-based sample 80 years and older.

Background And Aims: The primary aim of the present study was to examine whether there is an association between blood pressure and the risk of subsequent cognitive decline in the oldest old. Various factors associated with blood pressure and cognitive function were considered.

Methods: The study comprised 599 individuals of a population-based sample, 199 men (mean age at baseline 82.

Longitudinal changes in physical functional performance among the oldest old: insight from a study of Swedish twins.

Aims And Methods: The primary purpose was to characterize mean and individual-level patterns of change in physical functional performance over eight years (2 year intervals) in a community dwelling sample of Swedish twins (579 men and women aged 79-96 years at baseline).

Results: Mixed linear models revealed linear rates of decline for handgrip strength (grip) and time to complete five chair stands, and accelerating decline for peak expiratory flow rate (PEFR) for both sexes. Significant random effects were found for intercept and time for grip and PEFR tests, indicating differences between participants initially and over time.

Effects of repeated testing in a longitudinal age-homogeneous study of cognitive aging.

Estimates of gains related to repeated test exposure (retest effects) and within-person cognitive changes are confounded in most longitudinal studies because of the nonindependent time structures underlying both processes. Recently developed statistical approaches rely on between-person age differences to estimate effects of repeated testing. This study, however, demonstrates how retest effects can be evaluated at the group level in an age-homogeneous population-based study by use of a sampling-based design approach in which level and change of cognitive performance of previous participants, measured at ages 70, 75, 79, 81, 85, 88, 90, 92, 95, 97, and 99 years, were compared with performances of survivors of a representative sample identified and drawn from the same original population cohort but invited for the first time at age 85 with subsequent measurements at ages 88, 90, 92, 95, 97, and 99.

Satisfaction with present life predicts survival in octogenarians.

We examined the effect of life satisfaction on survival over 10 years among 80-year-old and older same-sex twins of whom 320 individuals responded to the Life Satisfaction Index Z questionnaire in connection with the OCTO-Twin study. We treated participants as individuals in semiparametric Cox regression mixed-effects models (frailty) by adjusting the similarity of mortality risk within twin pairs by modeling it as a random variable. An exploratory factor analysis yielded three factors: Zest and Mood represented satisfaction with present life and Congruence represented satisfaction with past life.