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  • 1.
    Abbadi, Ahmad
    et al.
    Karolinska Institutet, Sweden;Stockholm University, Sweden.
    Kokoroskos, Emmanouil
    Karolinska Institutet, Sweden;Stockholm University, Sweden;Lideta Mälardalen AB, Sweden.
    Stamets, Matthew
    Karolinska Institutet, Sweden;Stockholm University, Sweden.
    Vetrano, Davide L.
    Karolinska Institutet, Sweden;Stockholm University, Sweden;Stockholm Gerontology Research Center, Sweden.
    Orsini, Nicola
    Karolinska Institutet, Sweden.
    Elmståhl, Sölve
    Lund University, Sweden.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar, Sweden.
    Wimo, Anders
    Karolinska Institutet, Sweden.
    Sköldunger, Anders
    Karolinska Institutet, Sweden.
    Berglund, Johan Sanmartin
    Blekinge Institute of Technology, Sweden.
    Olsson, Christina B.
    Karolinska Institutet, Sweden;Region Stockholm, Sweden.
    Wachtler, Caroline
    Karolinska Institutet, Sweden;Region Stockholm, Sweden.
    Fratiglioni, Laura
    Karolinska Institutet, Sweden;Stockholm University, Sweden;Stockholm Gerontology Research Center, Sweden.
    Calderon-Larranaga, Amaia
    Karolinska Institutet, Sweden;Stockholm University, Sweden;Stockholm Gerontology Research Center, Sweden.
    Validation of the Health Assessment Tool (HAT) based on four aging cohorts from the Swedish National study on Aging and Care2024In: BMC Medicine, E-ISSN 1741-7015, Vol. 22, no 1, article id 236Article in journal (Refereed)
    Abstract [en]

    Background As global aging accelerates, routinely assessing the functional status and morbidity burden of older patients becomes paramount. The aim of this study is to assess the validity of the comprehensive clinical and functional Health Assessment Tool (HAT) based on four cohorts of older adults (60 + years) from the Swedish National study on Aging and Care (SNAC) spanning urban, suburban, and rural areas.Methods The HAT integrates five health indicators (gait speed, global cognition, number of chronic diseases, and basic and instrumental activities of daily living), providing an individual-level score between 0 and 10. The tool was constructed using nominal response models, first separately for each cohort and then in a harmonized dataset. Outcomes included all-cause mortality over a maximum follow-up of 16 years and unplanned hospital admissions over a maximum of 3 years of follow-up. The predictive capacity was assessed through the area under the curve (AUC) using logistic regressions. For time to death, Cox regressions were performed, and Harrell's C-indices were reported. Results from the four cohorts were pooled using individual participant data meta-analysis and compared with those from the harmonized dataset.Results The HAT demonstrated high predictive capacity across all cohorts as well as in the harmonized dataset. In the harmonized dataset, the AUC was 0.84 (95% CI 0.81-0.87) for 1-year mortality, 0.81 (95% CI 0.80-0.83) for 3-year mortality, 0.80 (95% CI 0.79-0.82) for 5-year mortality, 0.69 (95% CI 0.67-0.70) for 1-year unplanned admissions, and 0.69 (95% CI 0.68-0.70) for 3-year unplanned admissions. The Harrell's C for time-to-death throughout 16 years of follow-up was 0.75 (95% CI 0.74-0.75).Conclusions The HAT is a highly predictive, clinically intuitive, and externally valid instrument with potential for better addressing older adults' health needs and optimizing risk stratification at the population level.

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  • 2.
    Abbadi, Ahmad
    et al.
    Karolinska Institutet.
    Kokoroskos, Emmanouil
    Karolinska Institutet.
    Stamets, Matthew
    Karolinska Institutet.
    Vetrano, Davide L.
    Karolinska Institutet.
    Orsini, Nicola
    Karolinska Institutet.
    Elmståhl, Sölve
    Lund University.
    Fagerström, Cecilia
    Linnaeus University.
    Wimo, Anders
    Karolinska Institutet.
    Sköldunger, Anders
    Karolinska Institutet.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Olsson, Christina B.
    Karolinska Institutet.
    Wachtler, Caroline
    Karolinska Institutet.
    Fratiglioni, Laura
    Karolinska Institutet.
    Calderón-Larrañaga, Amaia
    Karolinska Institutet.
    Validation of the Health Assessment Tool (HAT) based on four aging cohorts from the Swedish National study on Aging and Care2024In: BMC Medicine, E-ISSN 1741-7015, Vol. 22, no 1, article id 236Article in journal (Refereed)
    Abstract [en]

    Background: As global aging accelerates, routinely assessing the functional status and morbidity burden of older patients becomes paramount. The aim of this study is to assess the validity of the comprehensive clinical and functional Health Assessment Tool (HAT) based on four cohorts of older adults (60 + years) from the Swedish National study on Aging and Care (SNAC) spanning urban, suburban, and rural areas.

    Methods: The HAT integrates five health indicators (gait speed, global cognition, number of chronic diseases, and basic and instrumental activities of daily living), providing an individual-level score between 0 and 10. The tool was constructed using nominal response models, first separately for each cohort and then in a harmonized dataset. Outcomes included all-cause mortality over a maximum follow-up of 16 years and unplanned hospital admissions over a maximum of 3 years of follow-up. The predictive capacity was assessed through the area under the curve (AUC) using logistic regressions. For time to death, Cox regressions were performed, and Harrell’s C-indices were reported. Results from the four cohorts were pooled using individual participant data meta-analysis and compared with those from the harmonized dataset.

    Results: The HAT demonstrated high predictive capacity across all cohorts as well as in the harmonized dataset. In the harmonized dataset, the AUC was 0.84 (95% CI 0.81–0.87) for 1-year mortality, 0.81 (95% CI 0.80–0.83) for 3-year mortality, 0.80 (95% CI 0.79–0.82) for 5-year mortality, 0.69 (95% CI 0.67–0.70) for 1-year unplanned admissions, and 0.69 (95% CI 0.68–0.70) for 3-year unplanned admissions. The Harrell’s C for time-to-death throughout 16 years of follow-up was 0.75 (95% CI 0.74–0.75).

    Conclusions: The HAT is a highly predictive, clinically intuitive, and externally valid instrument with potential for better addressing older adults’ health needs and optimizing risk stratification at the population level. © The Author(s) 2024.

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  • 3.
    Abbasi, Mojdeh
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication. Linköping University, Faculty of Medicine and Health Sciences. Macquarie Univ, Australia.
    Gupta, Vivek
    Macquarie Univ, Australia.
    Chitranshi, Nitin
    Macquarie Univ, Australia.
    Moustardas, Petros
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication. Linköping University, Faculty of Medicine and Health Sciences.
    Ranjbaran, Reza
    Shiraz Univ Med Sci, Iran.
    Graham, Stuart L.
    Macquarie Univ, Australia.
    Molecular Mechanisms of Glaucoma Pathogenesis with Implications to Caveolin Adaptor Protein and Caveolin-Shp2 Axis2023In: Aging and Disease, ISSN 2152-5250Article, review/survey (Refereed)
    Abstract [en]

    Glaucoma is a common retinal disorder characterized by progressive optic nerve damage, resulting in visual impairment and potential blindness. Elevated intraocular pressure (IOP) is a major risk factor, but some patients still experience disease progression despite IOP-lowering treatments. Genome-wide association studies have linked variations in the Caveolin1/2 (CAV-1/2) gene loci to glaucoma risk. Cav-1, a key protein in caveolae membrane invaginations, is involved in signaling pathways and its absence impairs retinal function. Recent research suggests that Cav-1 is implicated in modulating the BDNF/TrkB signaling pathway in retinal ganglion cells, which plays a critical role in retinal ganglion cell (RGC) health and protection against apoptosis. Understanding the interplay between these proteins could shed light on glaucoma pathogenesis and provide potential therapeutic targets.

  • 4.
    Abramsson, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Gustafsson, Maria
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Adherence to Bisphosphonates among People Admitted to an Orthopaedic and Geriatric Ward at a University Hospital in Sweden2018In: Pharmacy, E-ISSN 2226-4787, Vol. 6, no 1, article id 20Article in journal (Refereed)
    Abstract [en]

    Oral bisphosphonates are the first choice of therapy to reduce the risk of osteoporotic fractures. These medications have generally poor oral bioavailability, which may further be reduced by concomitant intake of certain foods and drugs; therefore, it is vital to follow specific instructions. The aim with this study was to assess general adherence to oral bisphosphonates and adherence to specific administration instructions among people admitted to two wards at Umeå University hospital in Sweden. This interview study focuses on elderly patients living at home and prescribed oral bisphosphonates. Invited were 27 patients admitted to an orthopaedic ward and a geriatric ward during the period 28 March 2017 and 5 December 2017. In total, 21 patients were interviewed regarding their adherence to oral bisphosphonates. Out of 21 patients, 13 (62%) were considered non-adherent. The most common reason was calcium intake less than 2 h after oral administration of bisphosphonate (54%). The number of regularly prescribed drugs was significantly higher among patients rated non-adherent to bisphosphonates compared to those rated adherent (p = 0.004). Adherence to bisphosphonates administration instruction among elderly people living at home was limited. More research is needed to confirm these results and to investigate the reasons for non-adherence and how adherence to bisphosphonates can be improved.

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  • 5.
    Abramsson, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Gustafsson, Maria
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Prevalence of drug-related problems using STOPP/START and medication reviews in elderly patients with dementia2020In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 16, no 3, p. 308-314Article in journal (Refereed)
    Abstract [en]

    Background: Drug-related problems (DRPs) are common among elderly patients with dementia. STOPP/START is an explicit tool that has been used to detect DRPs among elderly patients.

    Objectives: The objective of this study was to compare prevalence and type of DRPs identified by STOPP/START with DRPs identified by clinical pharmacists among the same population. Secondary objectives were to investigate factors associated with the use of DRPs using the two methods.

    Method: Extracts from medical records were used to identify DRPs in 212 patients by using STOPP/START. The patients were ≥65 years of age with dementia or cognitive impairment. An earlier study was performed in the same study population in 2012–2014, where DRPs were identified by clinical pharmacists in order to decrease the number of rehospitalizations.

    Results: STOPP/START identified DRPs in 72.2% of the patients compared with 66.0% identified by the clinical pharmacists. The numbers of DRPs identified by the different methods were 326 and 310, respectively. Different types of DRPs were identified with the different tools. STOPP/START mainly identified DRPs in the categories “ineffective/inappropriate drug” and “needs additional drug therapy”, whereas the clinical pharmacists identified DRPs in several categories.

    Conclusion: Even though STOPP/START was able to identify a similar number of DRPs compared with DRPs identified by clinical pharmacists, STOPP/START failed to identify DRPs in several important categories. To cover all DRPs, STOPP/START might be used as a complement to implicit criteria.

  • 6.
    Adedeji, Dickson O.
    et al.
    Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Norrköping. Karolinska Inst, Sweden.
    Holleman, Jasper
    Karolinska Inst, Sweden.
    Juster, Robert-Paul
    Univ Montreal, Canada.
    Udeh-Momoh, Chinedu T.
    Karolinska Inst, Sweden; Imperial Coll London, England.
    Kareholt, Ingemar
    Karolinska Inst, Sweden; Jonkoping Univ, Sweden; Stockholm Univ, Sweden.
    Hagman, Goran
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Aspo, Malin
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Adagunodo, Sofia
    Memory Clin Zentralschweiz, Switzerland.
    Hakansson, Krister
    Karolinska Inst, Sweden.
    Kivipelto, Miia
    Karolinska Inst, Sweden; Imperial Coll London, England; Karolinska Univ Hosp, Sweden; Univ Eastern Finland, Finland.
    Solomon, Alina
    Karolinska Inst, Sweden; Imperial Coll London, England; Karolinska Univ Hosp, Sweden; Univ Eastern Finland, Finland.
    Sindi, Shireen
    Karolinska Inst, Sweden; Imperial Coll London, England; Care Sci & Soc NVS, Sweden.
    Longitudinal study of Alzheimers disease biomarkers, allostatic load, and cognition among memory clinic patients2023In: Brain, Behavior, and Immunity - Health, E-ISSN 2666-3546, Vol. 28, article id 100592Article in journal (Refereed)
    Abstract [en]

    Background: Allostatic load (AL) is defined as the cumulative dysregulation of neuroendocrine, immunological, metabolic, and cardiovascular systems that increases the susceptibility to stress-related health problems. Several dementia and Alzheimers disease (AD) risk factors have been identified, yet little is known about the role of AL and its associations with AD biomarkers (e.g., beta-amyloid (A & beta;) or tau) and cognitive function among memory clinic patients. Hence, this study aims to assess the association between AL and AD biomarkers, cognitive performance, and cognitive decline after 3-years of follow-up.Methods: Data from 188 memory clinic patients were derived from the Cortisol and Stress in AD (Co-STAR) study in Sweden. Participants underwent baseline assessments including blood tests for AL measures (including cortisol, thyroid stimulating hormone, cobalamin, homocysteine, leukocytes, glycated hemoglobin, albumin, high-density and low-density lipoprotein cholesterol, triglycerides, and creatinine), cerebrospinal fluid (CSF) sampling for AD biomarkers and neuropsychological tests including five cognitive domains. Linear regressions were conducted, adjusting for age, sex, and education.Results: Higher AL was associated with lower CSF A & beta;1-42 levels (& beta; =-0.175, p = 0.025), reflecting higher brain levels of A & beta;1-42. Stratified analyses suggested a significant association among women but not men, although the AL-sex interaction was not statistically significant. AL was not significantly associated with T-tau level (& beta; =-0.030, p = 0.682) and P-tau level (& beta; = 0.091, p = 0.980). There were no significant associations between AL and cognition or cognitive decline after 3 years.Conclusion: This study showed that higher AL was associated with increased brain amyloid accumulation. This suggests that AL may play a role in AD/dementia pathophysiology. Potential sex-related differences should be assessed in further larger studies.

  • 7.
    af Geijerstam, Peder
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Harris, Katie
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Johansson, Maria M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Chalmers, John
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Nägga, Katarina
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Orthostatic Hypotension and Cognitive Function in Individuals 85 Years of Age: A Longitudinal Cohort Study in Sweden2024In: Aging and Disease, ISSN 2152-5250Article in journal (Refereed)
    Abstract [en]

    Background: Orthostatic hypotension (OH) is more common in the elderly, and associated with increased mortality. However, its implications in 85-year-olds are not known.

    Methods: In the prospective observational cohort study Elderly in Linköping Screening Assessment (ELSA 85), 496 individuals in Linköping, Sweden, were followed from age 85 years with cognitive assessments. Blood pressure (BP) was measured supine and after 1, 3, 5, and 10 minutes of standing. Participants with a BP fall of ≥20 mmHg systolic or ≥10 mmHg diastolic after 1 or 3 minutes were classified as classical continuous or classical transient OH depending on whether the BP fall was sustained or not, at subsequent measurements. Those with a BP fall of the same magnitude, but only after 5 or 10 minutes were classified as delayed OH.

    Results: Of participants, 329 took part in BP measurements and were included. Of these, 156 (47.4%) had classical OH (113 [34.3%] continuous classical, 38 [11.6%] transient classical), and 15 (4.6%) had delayed OH. Cognitive assessments were not markedly different between groups. After 8.6 years, 195 (59.3%) of the participants had died, and delayed vs no OH was associated with twice the risk of all-cause mortality, HR 2.15 (95% CI 1.12-4.12). Transient classical OH was associated with reduced mortality, HR 0.58 (95% CI 0.33-0.99), but not after multiple adjustments, and continuous classical OH was not associated with mortality.

    Conclusion: OH may have different implications for morbidity and mortality in 85-year-olds compared with younger populations.

  • 8.
    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.

  • 9.
    Ah, Rebecka
    et al.
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    BChir, M. B.
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Geijer, Håkan
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Taha, Kardo
    Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Pourhossein-Sarmeh, Sahar
    Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Talving, Peep
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallinn, Estonia; Department of Surgery, University of Tartu, Estonia.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery.
    Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients2019In: Bulletin of emergency and trauma, ISSN 2322-2522, Vol. 7, no 3, p. 223-231Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy.

    Methods: All geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. Demographics and outcomes were retrospectively collected from medical records. Association between prognostic markers and 30-day mortality was assessed using Poisson and backward stepwise regression models. Prognostic value was assessed using receiver operating characteristic (ROC) curves.

    Results: =0.004) while osteopenia was not. P-POSSUM had poor prognostic value for 30-day mortality with an area under the ROC curve (AUC) of 0.59. The prognostic value of P-POSSUM improved significantly when adjusting for patient covariates (AUC=0.83).

    Conclusion: P-POSSUM and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. P-POSSUM adjusted for other patient covariates improves the prediction.

  • 10. Ahman, Hanna B.
    et al.
    Cedervall, Ylva
    Kilander, Lena
    Giedraitis, Vilmantas
    Berglund, Lars
    McKee, Kevin J.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Ingelsson, Martin
    Aberg, Anna Cristina
    Dual-task tests discriminate between dementia, mild cognitive impairment, subjective cognitive impairment, and healthy controls: a cross-sectional cohort study2020In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 20, no 1, article id 258Article in journal (Refereed)
    Abstract [en]

    BackgroundDiscrimination between early-stage dementia and other cognitive impairment diagnoses is central to enable appropriate interventions. Previous studies indicate that dual-task testing may be useful in such differentiation. The objective of this study was to investigate whether dual-task test outcomes discriminate between groups of individuals with dementia disorder, mild cognitive impairment, subjective cognitive impairment, and healthy controls.MethodsA total of 464 individuals (mean age 71years, 47% women) were included in the study, of which 298 were patients undergoing memory assessment and 166 were cognitively healthy controls. Patients were grouped according to the diagnosis received: dementia disorder, mild cognitive impairment, or subjective cognitive impairment. Data collection included participants' demographic characteristics. The patients' cognitive test results and diagnoses were collected from their medical records. Healthy controls underwent the same cognitive tests as the patients. The mobility test Timed Up-and-Go (TUG single-task) and two dual-task tests including TUG (TUGdt) were carried out: TUGdt naming animals and TUGdt months backwards. The outcomes registered were: time scores for TUG single-task and both TUGdt tests, TUGdt costs (relative time difference between TUG single-task and TUGdt), number of different animals named, number of months recited in correct order, number of animals per 10s, and number of months per 10s. Logistic regression models examined associations between TUG outcomes pairwise between groups.ResultsThe TUGdt outcomes "animals/10s" and "months/10s" discriminated significantly (p <0.001) between individuals with an early-stage dementia diagnosis, mild cognitive impairment, subjective cognitive impairment, and healthy controls. The TUGdt outcome "animals/10s" showed an odds ratio of 3.3 (95% confidence interval 2.0-5.4) for the groups dementia disorders vs. mild cognitive impairment. TUGdt cost outcomes, however, did not discriminate between any of the groups.ConclusionsThe novel TUGdt outcomes "words per time unit", i.e. "animals/10s" and "months/10s", demonstrate high levels of discrimination between all investigated groups. Thus, the TUGdt tests in the current study could be useful as complementary tools in diagnostic assessments. Future studies will be focused on the predictive value of TUGdt outcomes concerning dementia risk for individuals with mild cognitive impairment or subjective cognitive impairment.

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  • 11.
    Ahorsu, Daniel Kwasi
    et al.
    Hong Kong Polytech Univ, Hung Hom, Hong Kong, Peoples R China..
    Lin, Chung-Ying
    Hong Kong Polytech Univ, Hung Hom, Hong Kong, Peoples R China.;Natl Cheng Kung Univ, Tainan, Taiwan..
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Qazvin Univ Med Sci, Qazvin, Iran.;Jonkoping Univ, Jonkoping, Sweden..
    The Association Between Health Status and Insomnia, Mental Health, and Preventive Behaviors: The Mediating Role of Fear of COVID-192020In: Gerontology and geriatric medicine, E-ISSN 2333-7214, Vol. 6, article id 2333721420966081Article in journal (Refereed)
    Abstract [en]

    Objectives: This study examined the mediation role of fear of COVID-19 in the association between perceived health status of older adults and their insomnia, mental health, and COVID-19 preventive behaviors so as to have better understanding of the factors associated with COVID-19 and its preventive measures. Methods: A total of 413 older adults with a mean age of 57.72 (SD = 7.31) were recruited for this study. They responded to the measures on fear of COVID-19, insomnia, mental health, and COVID-19 preventive behaviors. Results: There were small-large significant interrelationships between insomnia, mental health, fear of COVID-19, and preventive behaviors. Fear of COVID-19 significantly mediated the associations between perceived health status and insomnia, mental health, and COVID-19 preventive behaviors. It was also observed that perceived health status directly influenced insomnia and mental health of older adults but not their COVID-19 preventive behaviors. Conclusion: Fear of COVID-19 has an important role to play in the management of the health and preventive behaviors of older adults. Health experts and communicators may capitalize on these findings to educate people on COVID-19. Future studies are needed to perfectly ascertain the extent of fear needed to stimulate or initiate better preventive behaviors and healthcare practices.

  • 12.
    Aidanpää, Oliver
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Varför utförs färre trombektomier på hjärninfarktspatienter från Norrbotten jämfört med riket? - En retrospektiv kvalitetsgranskningsstudie2020Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 13.
    Akner, G.
    et al.
    School of Health and Medical Sciences, Örebro University, 70185 Örebro, Sweden.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Personalized geriatric medicine2014In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 5, no 3, p. 145-146Article in journal (Other academic)
  • 14.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Analys och handläggning av äldres multisjuklighet måste samordnas [Analysis and management of comorbidity among the elderly must be coordinated]: med DBU-metod tillämpad vid äldrevårdscentral kan behandling utvärderas [Treatment can be evaluated with the DBU method implemented at community centers for the aged]2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 10, p. 758-765Article in journal (Refereed)
  • 15.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Analysis of multimorbidity in individual elderly nursing home residents: development of a multimorbidity matrix2009In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 49, no 3, p. 413-419Article in journal (Refereed)
    Abstract [en]

    The chronic multimorbidity in individual elderly people is rarely documented in its entirety in present medical records, neither as cross-sectional overview nor as longitudinal time-course of various health problems. This obviously hampers an integrated clinical analysis. This work was aimed at evaluating the chronic multimorbidity in individual elderly patients and developing a method to map, quantify and grade the prevalence of the multimorbidity. An explorative study in 70 nursing home residents (55 women), mean age 85 was performed. Information on health problems was obtained through history, clinical examination and medical records. A 19-item multimorbidity matrix that maps, quantifies and grades the chronic morbidity in individual patients is presented. The 70 residents exhibited 275 different health problems; the top 3 items being neuropsychiatric, cardiovascular and gastrointestinal ones. The residents had a mean of 17 different chronic health problems and were prescribed a mean of 6.6 continuous medications per day. There was a significant correlation between the number of continuous drug prescriptions and both quantitative and graded multimorbidity-scores. The presented multimorbidity matrix provides a useful taxonomic overview over the health situation in individual multimorbid elderly and constitutes the basis for ongoing work to develop and renew the electronic health record into an "interactive health analysis system".

  • 16.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Arbetsmetod2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, p. 45-50Chapter in book (Other academic)
  • 17.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Background2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, p. 23-42Chapter in book (Other academic)
  • 18.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Bakgrund2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, p. 25-44Chapter in book (Other academic)
  • 19.
    Akner, Gunnar
    Örebro University Hospital.
    Bräcklighet och multisjuklighet: nödvändigt att flytta fokus från handläggning av isolerade sjukdomar till multipla hälsoproblem inom en individualiserad, integrerad och målstyrd process över tid2012In: Svensk Geriatrik, ISSN 2001-2047, Vol. 1, no 1, p. 7-12Article in journal (Other academic)
  • 20.
    Akner, Gunnar
    Geriatriska kliniken, Universitetssjukhuset, Örebro, Sweden.
    Bräcklighet och multisjuklighet: nödvändigt att flytta fokus från handläggning av isolerade sjukdomar till multipla hälsoproblem inom en individualiserad, integrerad och målstyrd process över tid2012In: Svensk Geriatrik, ISSN 2001-2047, Vol. 1, no 1, p. 7-12Article in journal (Other academic)
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    Bräcklighet och multisjuklighet: nödvändigt att flytta fokus från handläggning av isolerade sjukdomar till multipla hälsoproblem inom en individualiserad, integrerad och målstyrd process över tid
  • 21.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Bräckligt åldrande och multisjuklighet drabbar allt fler [Frail aging and multimorbidity affect more and more]: fokus måste flyttas från isolerade sjukdomar till komplexa hälsoproblem : klinisk översikt [Focus must be moved from isolated diseases to complex health problems]2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 44, p. 2707-2711Article in journal (Refereed)
  • 22.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Evidensbaserad behandling behövs inom äldrevården  [Evidence-based treatment is necessary in geriatric health care]: multibehandling av multisjuka äldre ställer stora krav på samordning [Multitreatment of elderly with multiple illness puts great demands on cooperation]2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, no 34, p. 2592-2596Article in journal (Other academic)
  • 23.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget2003Collection (editor) (Other academic)
  • 24.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Frailty and and multimorbidity in Elderly people: a shift in management approach2013In: Clinical Geriatrics, ISSN 1095-1598, no 9Article in journal (Refereed)
    Abstract [en]

    Frailty and multimorbidity may be regarded as a homeostatic failure of a complex system, and these conditions are commonly encountered in elderly people. The concept of “frailty” has been used to describe an individual’s biological age, and the concept of “multimorbidity” is reserved for the simultaneous presence of two or more chronic health problems in one person. As frailty and multimorbidity are being better understood, optimal management of frail, multimorbid elderly patients is being re-evaluated. In this article, the author provides an overview of frailty, chronic disease, and multimorbidity, and describes how their optimal management can serve as a foundation for developing more expedient, organized, and goal-oriented care of elderly people with complex health problems. The author also describes important challenges for future research and development regarding the management of complex health issues in elderly people; these include transitioning from single disease management to multiple disease management, and expanding the conventional organ-based work-up and treatment plan with repeated evaluations of different systems and functional domains using the comprehensive geriatric assessment method. As noted, one particular challenge that must be addressed is the development of medical records that can serve as a much-needed “geroscope,” enabling an overview of the patient’s health situation, disease management, and follow-up care.

  • 25.
    Akner, Gunnar
    Örebro University.
    Frailty and multimorbidity in elderly people: a shift in management approach2013In: Clinical Geriatrics, ISSN 1095-1598, Vol. 21, no 9Article in journal (Refereed)
    Abstract [en]

    Frailty and multimorbidity may be regarded as a homeostatic failure of a complex system, and these conditions are commonly encountered in elderly people. The concept of “frailty” has been used to describe an individual’s biological age, and the concept of “multimorbidity” is reserved for the simultaneous presence of two or more chronic health problems in one person. As frailty and multimorbidity are being better understood, optimal management of frail, multimorbid elderly patients is being re-evaluated. In this article, the author provides an overview of frailty, chronic disease, and multimorbidity, and describes how their optimal management can serve as a foundation for developing more expedient, organized, and goal-oriented care of elderly people with complex health problems. The author also describes important challenges for future research and development regarding the management of complex health issues in elderly people; these include transitioning from single disease management to multiple disease management, and expanding the conventional organ-based work-up and treatment plan with repeated evaluations of different systems and functional domains using the comprehensive geriatric assessment method. As noted, one particular challenge that must be addressed is the development of medical records that can serve as a much-needed “geroscope,” enabling an overview of the patient’s health situation, disease management, and follow-up care.

  • 26.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Geriatric care and treatment: a systematic compilation of existing scientific literature2003Collection (editor) (Other academic)
  • 27.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Geriatric care in Sweden2014In: Current Diagnosis & Treatment: Geriatrics / [ed] Williams B, Chang A, Ahalt C, Conant R, Richie C, Chen H, Landefeld S, Yukawa M, USA: McGraw-Hill, 2014, p. 539-542Chapter in book (Refereed)
  • 28.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Geriatric medicine in Sweden: a study of the organisation, staffing and care production in 2000-20012004In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 33, no 4, p. 338-341Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: the organisation of long-term medicine and geriatric medicine has undergone many changes during the last 15 years. The aim of this study is to gain an overall perspective of the present organisation of geriatric medicine in Sweden.

    DESIGN: questionnaire survey.

    METHODS: The Swedish Society for Geriatric Medicine and Gerontology, in collaboration with the Federation of County Councils and the Swedish Association of Local Authorities, sent out a survey to people in all county councils in Sweden. The subject of the survey was the speciality of geriatric medicine in the Swedish healthcare system, with regard to healthcare organisation, staffing and care production in 2000/2001.

    RESULTS: there were 52 separate geriatric units, 41 independent 'clinics' and 11 'sections' within other departments. There were a total of 3,101 geriatric inpatient beds. On average, there was one geriatric bed for every 799 individuals within the local population aged 65 years and over, with a 10-fold variation between counties. Four counties had no geriatric provision. The 'geriatric clinics' were mainly located in university towns and averaged 85 beds per clinic, again with a 10-fold variation. There were 604 established positions for doctors within geriatrics, of which 63% were at geriatric clinics. On average, the clinics had 16 positions each (of which 75% were filled with geriatric specialists) with 7 beds per doctor. The corresponding averages for nurses and paramedics could not be summarised due to organisational differences between the county councils. In general, there were very few nurses with specialist training in geriatric medicine.

    CONCLUSIONS: the field of geriatric medicine in Sweden is very heterogeneous regarding terminology, designations, structure, staffing and care production. There is no overall structural plan for the role of geriatric medicine in Swedish healthcare, with the desired close connection between content and dimensioning of geriatric specialist training and the practical organisation of the activities. The county councils designate geriatric medicine so differently that it is hardly possible to compare different geriatric facilities today. Considering how many patients at hospitals today are elderly and suffer from multiple illnesses, it is a major quality issue to ensure that these patients have access to geriatric specialists.

  • 29.
    Akner, Gunnar
    Örebro University.
    International Perspectives in Geriatric Care: Geriatric Care in Sweden2014In: Current Diagnosis & Treatment: Geriatrics / [ed] Brie A. Williams, Anna Chang, Cyrus Ahalt, Helen Chen, Rebecca Conant, C. Seth Landefeld, Christine Richie, Michi Yukawa, McGraw-Hill, 2014, p. 539-542Chapter in book (Refereed)
  • 30.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Karolinska Institutet.
    Kvarboendeprincipen2016In: Svensk Geriatrik, ISSN 2001-2047, no 2, p. 6-6Article in journal (Other academic)
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  • 31.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Malnutrition2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, p. 257-264Chapter in book (Other academic)
  • 32.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Methods2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, p. 43-48Chapter in book (Other academic)
  • 33.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Multidomän-analys av multisjuka äldre personer måste baseras på sedvanlig klinisk analys och får inte ersättas av skattningsskalor.2017In: Svensk Geriatrik, ISSN 2001-2047, no 2, p. 6-6Article in journal (Other academic)
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  • 34.
    Akner, Gunnar
    Örebro University.
    Multimorbidity in elderly: analysis, management and proposal of a geriatric care center2011 (ed. 1)Book (Other (popular science, discussion, etc.))
  • 35.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Multisjuklighet hos äldre: analys, handläggning och förslag om äldrevårdscentral2004 (ed. 1)Book (Other (popular science, discussion, etc.))
  • 36.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Multisjuklighet hos äldre personer2012In: Äldres hälsa: ett sjukgymnastiskt perspektiv / [ed] Elisabeth Rydwik, Lund: Studentlitteratur AB, 2012, 1, p. 367-382Chapter in book (Other academic)
  • 37.
    Akner, Gunnar
    Örebro University ; Örebro University Hospital.
    Multisjuklighet hos äldre personer2012In: Äldres hälsa: ett sjukgymnastiskt perspektiv / [ed] Elisabeth Rydwik, Lund: Studentlitteratur AB, 2012, 1, p. 367-382Chapter in book (Other academic)
  • 38.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Mår de allra äldsta verkligen sämre idag? [Is the health of the elderly really worse nowadays?]: medicinsk kommentar2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 17, p. 1470-1471Article in journal (Other academic)
  • 39.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nationella kvalitetsregister – möjligheter och risker.2017In: Svensk Geriatrik, ISSN 2001-2047, no 1, p. 6-6Article in journal (Other academic)
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  • 40.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nutrition hos ”sköra”, äldre personer2017In: Svensk Geriatrik, ISSN 2001-2047, no 3, p. 30-35Article in journal (Other academic)
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  • 41.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nödvändigt att förbättra förbättringsarbetet kring läkemedel: Back to basics2017In: Svensk Geriatrik, ISSN 2001-2047, no 3, p. 6-6Article in journal (Other academic)
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  • 42.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Orsaker till mat- och nutritionsproblem inom äldrevården samt förslag till utveckling och förbättringsarbete2006In: Nordisk Geriatrik, no 4, p. 36-41Article in journal (Other academic)
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  • 43.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Rapport från framtidens geriatrik och äldrevård2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 43-44, p. 1850-1852Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    I denna rapport från framtiden kan vi visa redan nu, hur man i framtiden – utan nämnvärda svårigheter – lyckades utforma ett integrerat, koordinerat och mänskligt vårdsystem, baserat på kunskapsområdet geriatrik och anpassat för äldre personer med multipla, ofta komplexa, hälsoproblem. Det är påtagligt hur smidigt reformeringen kunde ske när man utgick från de enskilda äldre personerna i stället för från organisation, ekonomi och styrning.

  • 44.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Sammanfattning2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, p. 9-24Chapter in book (Other academic)
  • 45.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Skattning av risk för undernäringstillstånd.2017In: Svensk Geriatrik, ISSN 2001-2047, no 2, article id 22-23Article in journal (Other academic)
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  • 46.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Summary2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, p. 9-22Chapter in book (Other academic)
  • 47.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    SWOT-analys av geriatriken i Sverige2006In: Nordisk Geriatrik, no 2, p. 42-43Article in journal (Other academic)
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  • 48.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Undernutritionstillstånd vid KOL2014In: KOL: Kroniskt obstruktiv lungsjukdom / [ed] Kjell Larsson, Stockholm: Studentlitteratur AB, 2014, 3, p. 497-508Chapter in book (Other academic)
  • 49.
    Akner, Gunnar
    Örebro University.
    Undernutritionstillstånd vid KOL2014In: KOL: Kroniskt obstruktiv lungsjukdom / [ed] Kjell Larsson, Stockholm: Studentlitteratur AB, 2014, 3, p. 497-508Chapter in book (Other academic)
  • 50.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Undernäringstillstånd2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, p. 257-264Chapter in book (Other academic)
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