Prediction of the Future Need for Institutional Care in Finnish Older People: A Comparison of Two Birth Cohorts.

BACKGROUND: More recent birth cohorts of older people have better physical and cognitive status than earlier cohorts. As such, this could be expected to diminish the need for institutional care. The prediction of the future need for institutional care provides essential information for the planning and delivery of future care and social services as well as the resources needed. OBJECTIVE: To predict the future need for institutional care among older Finnish people born in 1940. METHODS: Representative samples of home-dwelling 70-year-olds from Turku, Finland were examined with similar methods in 1991 (those born in 1920) (n = 1,032) and in 2011 (those born in 1940) (n = 956). Predictors of institutionalization rates from the earlier 1920 cohort, together with data of sociodemographic factors, health, psychosocial and physical status, the need for help, and health behavior, were used to predict the future institutionalization rate among the 1940 cohort in this study using Cox regression models. RESULTS: Health as well as psychosocial and physical status were significantly better in the 1940 cohort compared to the earlier cohort. In the 1940 cohort, the predicted rates of institutionalization were 1.8, 10.4, and 26.0% at the ages of 80 (year 2020), 85 (year 2025), and 90 years (year 2030), respectively. At every age (80, 85, and 90 years), the predicted rates of institutionalization by Mini-Mental State Examination (MMSE) were about two-fold among those with MMSE scores 18-26 (3.0-38.8%) compared to those with scores 27-30 (1.6-23.7%) and those with a body mass index (BMI) <25 (2.5-34.3%) compared to those with a BMI of 25-29.9 (1.4-20.9%), and about three-fold among participants with several falls (5.3-57.0%) compared to participants with no falls (1.5-23.1%). CONCLUSIONS: The 1940 cohort performed better in health as well as psychosocial and physical status than the 1920 cohort. Nevertheless, the predicted rates of future need for institutional care were high, especially at the ages of 85 and 90 years, among those with a lowered cognitive or physical status.

Predictors of institutionalization among home-dwelling older Finnish people: a 22-year follow-up study.

BACKGROUND: Identification of predictive factors on institutionalization provides the basis for the development and application of preadmission assessment. There is a lack of evidence for predictors of institutionalization for older people. AIMS: To examine the effect of predictive factors on institutionalization in home-dwelling 70-year-old people. METHODS: The data were collected in 1991 by the clinical examinations, a postal questionnaire, and an interview from the residents of Turku, Finland, born in 1920 (n = 1032). Institutionalization was defined as entry into a nursing home or sheltered housing at any time during a 22-year follow-up. RESULTS: A rate of institutionalization was 22.0%. In multivariable Cox regression analysis, impaired cognitive function (MMSE 18-26) (hazard ratio 1.71, confidence interval 1.24-2.36) and low BMI (<25 kg/m2) (compared to both BMI of 25-29.9 and that of ≥30, respectively, 1.88, 1.32-2.67, and 1.66, 1.05-2.60), having several falls during the previous year (2.50, 1.28-4.90). CONCLUSIONS: We conclude that impaired cognitive function, low BMI, and frequent falling predicted institutionalization during the 22-year follow-up. To reduce or postpone institutionalization, interventions should target risk factors, such as frailty, physical limitations, and falling. In addition, community-based services according to the needs and functional ability of the home-dwelling older people should be developed.

Cardiovascular risk profile and use of statins at the age of 70 years: a comparison of two Finnish birth cohorts born 20 years apart.

OBJECTIVE: to compare cardiovascular morbidity and risk factor profiles of two 70-year-old cohorts of Finns examined in 1991 and 2011 and to describe prevalence of statin use according to cardiovascular risk in the later cohort. METHODS: 1920-born cohort of community-dwelling 70-year-old persons (n = 1032) participated in comprehensive health surveys, physical and laboratory examinations in the Turku Elderly Study (TUVA) during 1991-92. In 2011, identical examination pattern was performed, in a 1940-born cohort of 70-year-old persons (n = 956) from the same area. Prevalence of cardiovascular diseases (CVD) and risk factors in the two cohorts was compared. Further, each cohort was divided into three cardiovascular risk groups (high, moderate and low) based on their estimated risk. Prevalence of statin use was calculated among each risk group in the 1940 cohort. RESULTS: coronary heart disease (25 versus 11%) and peripheral artery disease (9 versus 2%) were more common in the 1920 than 1940 cohort, respectively. Lipid profile was worse and blood pressure higher in the earlier cohort, whereas use of statins and antihypertensives was more common in the later cohort. Forty-two per cent of the 1920 cohort and 29% of the 1940 cohort were estimated to have high cardiovascular risk. In the 1940 cohort, a total of 36% used statins. Statin use was most common among high-risk persons. CONCLUSIONS: seventy-year olds examined in 2011 had less CVD morbidity than their counterparts 20 years earlier, and their cardiovascular risk factors were better controlled which is reflected in higher use of preventive medications, such as statins and antihypertensives.

Loneliness of older people aged 70: a comparison of two Finnish cohorts born 20 years apart.

OBJECTIVE: This study aimed to examine loneliness among two birth cohorts, born 20 years apart, when they were 70 years of age, and to identify factors explaining loneliness. METHODS: The cohorts consisted of older home-dwelling residents of Turku, Finland, from the birth cohort 1920 in 1991 (N=1530) and the birth cohort 1940 in 2011 (N=1307). Suffering from loneliness was assessed with the question: 'Do you suffer from loneliness?' Cross-tabulations with chi-square test, general linear model (GLM) and multiple regression analysis were used in statistical testing and modeling. RESULTS: In the 1940 cohort, around one-fifth (18%) of the respondents suffered from loneliness at least sometimes, while the corresponding figure in the 1920 cohort was around one-fourth (26%). Our analyses indicated that the effect of cohort was not a statistically significant explanatory factor of loneliness. Living status, self-rated health and memory compared to age peers were statistically significant explanatory factors for suffering from loneliness. When we controlled the effect of depressiveness on the experience of loneliness, it was shown that the effects of living status and self-rated health remained statistically significant, whereas memory compared to age peers did not. Depressiveness itself was highly important. The combined effect of living status and self-rated health emerged as the most significant explanatory factor for loneliness. Older people with poor self-rated health who lived alone were most likely to suffer from loneliness. CONCLUSION: The findings give healthcare professionals an opportunity to plan for interventions aimed at combating loneliness among home-dwelling older people.

Factors connected with positive life orientation at age 70, 80, 85 and 90 - The Turku Elderly Study.

BACKGROUND: A positive life orientation (PLO) is important for staying healthy physically, mentally and functionally. However, little is known about the factors connected with PLO in home-dwelling older people, even though it is an important topic. AIM: The aim of this study was to identify factors connected with positive life orientation among home-dwelling older people. STUDY DESIGN: An explorative, population-based cross-sectional study of the age cohort of 70-year-olds living at home at the age of 70, 80, 85 and 90. METHODS: The data were collected in 1991 among all residents of Turku, Finland, born in 1920 (N = 1530). Follow-ups were conducted in 2001 (n = 656), 2006 (n = 304) and 2011 (n = 156). A multiple regression analysis was conducted to estimate a model of factors that connected with PLO. RESULTS: Several factors were significantly connected with PLO at ages 70, 80, 85 and 90. For example, if 70-year-old respondents perceived themselves as being in better health than others of the same age, it improved their PLO. We also observed that PLO was improved by good self-rated health during the past 12 months at 80, good self-rated health at 85 and good self-rated health compared to others of the same age at 90. The various explanatory models explained between 24 and 36% of the variance in outcomes. CONCLUSION: Overall, our results showed that the respondents' own subjective views were significant independent factors of PLO in all four analyses (70, 80, 85 and 90 years). These subjective experiences remained significant even when objective indicators such as medication use, the presence of diseases and functional capacity were taken into account.

Aging of the population may not lead to an increase in the numbers of acute coronary events: a community surveillance study and modelled forecast of the future.

OBJECTIVE: To examine the incidence, mortality and case fatality of acute coronary syndrome (ACS) in Finland during 1993-2007 and to create forecasts of the absolute numbers of ACS cases in the future, taking into account the aging of the population. DESIGN: Community surveillance study and modelled forecasts of the future. SETTING AND METHODS: Two sets of population-based coronary event register data from Finland (FINAMI and the National Cardiovascular Disease Register (CVDR)). Bayesian age-period-cohort (APC) modelling. PARTICIPANTS: 24 905 observed ACS events in the FINAMI register and 364 137 in CVDR. MAIN OUTCOME MEASURES: Observed trends of ACS events during 1993-2007, forecasted numbers of ACS cases, and the prevalence of ACS survivors until the year 2050. RESULTS: In the FINAMI register, the average annual declines in age-standardised incidence of ACS were 1.6% (p<0.001) in men and 1.8% (p<0.001) in women. For 28-day case fatality of incident ACS, the average annual declines were 4.1% (p<0.001) in men and 6.7% (p<0.001) in women. Findings in the country-wide CVDR data were consistent with the FINAMI register. The APC model, based on the CVDR data, suggested that both the absolute numbers of ACS events and the prevalence of ACS survivors reached their peak in Finland around 1990, have declined since then, and very likely will continue to decline until 2050. CONCLUSIONS: The ACS event rates and absolute numbers of cases have declined steeply in Finland. The declining trends are likely to continue in the future despite the aging of the population.

Positive life orientation in old age: a 15-year follow-up.

BACKGROUND: Positive life orientation (PLO) is considered an important dimension of successful aging. AIM: To investigate how self-reported PLO changed among home-dwelling people from age 70 to 80 and 85 years. STUDY DESIGN: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. SUBJECTS AND METHODS: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (N=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. PLO was assessed with the following items: life satisfaction, feeling needed, having plans for the future, having zest for life, feeling depressed, and suffering from loneliness. We created a PLO score from the answers to these questions, where 1 represented the best PLO and 0 the poorest. RESULTS: At baseline, the participants showed rather high levels of positive life orientation (PLO total score 0.83). PLO declined markedly after the 70-year-old participants reached the age of 80 and 85 years (p<.001). However, depressive feelings remained quite stable. The decrease was similar among men and women except for the items suffering from loneliness and feeling needed. At age 70 and 80 years women suffered more from loneliness than men, while men experienced feeling needed more than women. CONCLUSIONS: Positive life orientation declines during old age, especially from age 70 to 80 years. Thereafter the decline is less steep except for changes in future plans and feeling needed.

Depressive symptoms among older people: a 15-year follow-up.

BACKGROUND AND AIMS: Depressive symptoms are common symptoms impairing the quality of life of older people. This population-based birth year cohort study investigated the prevalence of depressive symptoms and factors associated with them among home-dwelling older people. STUDY DESIGN: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. METHODS: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (n=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. All examinations included an identical study protocol; the participants' self-reported health status/habits and depressive symptoms were investigated via a questionnaire. Afterwards, thorough clinical examinations including the Zung depression scale were conducted by a nurse and physician/geriatrician. RESULTS: The mean of the Zung depression scale total score was 34 (SD 7.7) at the age of 70 and a significant increase was found in both re-examinations. At the age of 80 the mean of the Zung score was 35.8 (SD 7.5) while it was 37.6 (SD 8.9) at the age of 85 years. A similar increasing trend was found in the proportion of persons classified into the high Zung score group (≥45 points) indicating more depressive symptoms over the 15 year follow-up. Univariate and multivariate analyses showed that mostly functional and social factors were associated with subjectively reported depressive symptoms, while few associations were evidenced between depressive symptoms and medical conditions or poor health. CONCLUSIONS: Our findings revealed an increase in prevalence of depressive symptoms throughout the course of the investigation. Our findings suggest that even in the absence of a diagnosis of major depression, depressive symptoms assume importance in the evaluation of the health status and need for health care services among older people.

Sex differences in short- and long-term case-fatality of myocardial infarction.

Declining trends in case fatality (CF) of MI events have been generally reported in western countries. It is, however, not clear whether the development has been equally beneficial in both sexes. Data from two large population based registers, FINAMI and the Finnish National Cardiovascular Disease Register (CVDR) were used to determine whether the CF of incident MI events has declined less in women than in men. All patients aged 35 and over were included. CF was calculated for different time periods after the onset of the MI event, the main emphasis was in pre-hospital, 28-day, and 1-year CF. Figures were compared between two study periods: 1994-1996 and 2000-2002. A total of 6,342 incident MI events were recorded in FINAMI and 117,632 events in CVDR during the study periods. Comparison between the two study periods showed that the CF was generally declining. However, a slower decline in short-term CF was seen among young (aged<55 years) women (P for sex by study period interaction in pre-hospital CF=0.028 in FINAMI and 0.003 in CVDR, and for 28-day CF P=0.016 in FINAMI and <0.0001 in CVDR). In conclusion, the short and long-term prognosis of MI events has improved in both sexes. Pre-hospital CF has declined less among younger women than among men and among older women. This slower decline in early CF was responsible for the slower improvement in 28-day and 1-year prognosis in young women.

Myocardial infarction events and cardiovascular risk factor levels in Finnish- and Swedish-speaking populations of Finland.

BACKGROUND. The Swedish-speaking minority of Finland is unique, because it has a higher socioeconomic status (SES) and longer life expectancy than the Finnish-speaking majority. We hypothesized that this minority may have a lower attack rate of coronary events and analysed whether this could be explained by their higher SES. METHODS. The population-based myocardial infarction (MI) registers recorded 4,845 MI events in Turku during 1988-1998. Individual-level indicators of SES were obtained from Statistics Finland. The population-based FINRISK surveys recorded cardiovascular risk factors and native languages of 10,432 people in 1987, 1997, and 2002. RESULTS. The age-standardized attack rate of MI was lower among the 35-64-year-old Swedish-speaking men than among Finnish-speaking men (rate ratio 0.66; 95% confidence interval 0.47-0.85) and the difference remained significant after adjustment for SES. The Swedish-speaking inhabitants had higher age-, sex-, and SES-adjusted high-density lipoprotein cholesterol, and lower triglycerides, body mass index, and diastolic blood pressure. Conclusion. The Swedish-speaking inhabitants of Turku had lower MI morbidity and coronary mortality than the Finnish-speaking inhabitants. After controlling for SES, these differences remained significant among men, suggesting that other factors, such as differences in the risk factor profiles may also play a role.

Stroke morbidity in Swedish- and Finnish-speaking populations of Turku, Finland.

OBJECTIVES: To examine differences in the morbidity and mortality of stroke between the Finnish- and Swedish-speaking populations in Turku, taking into account the socioeconomic differences between these groups. DESIGN: The population-based FINMONICA and FINSTROKE stroke registers recorded 5,135 stroke events among persons aged 25-99 years in Turku during 1988-1998. Events in persons aged > or =75 years were not registered in 1993-1995. Information on these persons' native language and socioeconomic status (SES) (measured by taxable income, profession and years of education) were obtained by record linkage with the files of Statistics Finland. RESULTS: Swedish-speaking men had a lower attack rate of ischaemic stroke than Finnish-speaking men (270, 95% Confidence Interval (CI) 214-326 versus 370, 95% CI 352-389, per 100,000 inhabitants per year) and the difference remained significant after adjustment for SES. Among women, the attack rates of ischaemic stroke were similar in both language groups. CONCLUSIONS: The attack rate of ischaemic stroke was lower among Swedish-speaking than among Finnish-speaking men. This difference was not totally explained by the higher SES of the Swedish-speaking population.

Social functioning and survival: A 10-year follow-up study.

Although otherwise extensively researched, one aspect of social functioning in older people that has received less attention is its association with staying at home for as long as possible. This 10-year follow-up examines factors of social functioning that support older people's independent living in their own homes and that reduce the risk of mortality. The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. Female gender reduced the risk of mortality. In addition, daily outdoor activities, and not needing help (from different sources) were associated with a reduced risk of mortality. No need for help and a more positive attitude towards life reduced the risk of mortality of women. There were found only non-significant trends for men. Having plans for the future also reduced the risk of mortality. The findings of this study offer useful clues for planning the services provided by home health care personnel. In planning these services it is important that home health care workers take into account the differences between women and men customers: men may need and want different things from the home health care service than women do.

Serum lipids and their association with mortality in the elderly: a prospective cohort study.

BACKGROUND AND AIMS: To determine whether high levels of serum total cholesterol and low levels of high-density lipoprotein cholesterol (HDLc) are associated with increased mortality in the elderly. METHODS: Prospective cohort study of 1032 non-institutionalized people aged 70 in the city of Turku, Southern Finland. The cohort population was recruited as part of a larger longitudinal aging study, the Turku Elderly Study. Fasting serum levels of total cholesterol, HDL-c and triglycerides were measured, and the amount of low-density lipoprotein cholesterol was calculated at baseline. The cohort was followed for mortality for 12 years, and the causes of death were recorded and further classified into cardiovascular and other causes of death. The hazard ratios of dying for subjects in various cholesterol quartiles were computed by the Cox proportional hazards model, adjusting for cardiovascular risk factors and pre-existing medical conditions. RESULTS: Low levels of serum total cholesterol and HDL-c were associated with a greater risk of death over a follow-up of 12 years. After adjustment for several cardiovascular risk factors, the association between total cholesterol and survival changed. All-cause mortality seemed to be highest in the highest quartile of total cholesterol and nearly as high in the lowest quartile of total cholesterol, suggesting a U-shaped connection, but the differences were not statistically significant. However, cardiovascular mortality was significantly lowest in the lowest quartile of total cholesterol and significantly highest in the lowest quartile of HDL-c. CONCLUSIONS: High levels of serum total cholesterol and particularly low levels of HDL-c seem to be risk factors for cardiovascular mortality even in the elderly population.

Coronary events in persons aged 75 years or older in Finland from 1995 to 2002: the FINAMI study.

The authors used population-based myocardial infarction (MI) register data to examine trends in incidence, case fatality, treatment strategies of MI, and coronary heart disease (CHD) mortality in persons aged 75 to 99 years in 4 areas of Finland during 1995 through 2002. This age group contributed 53% (n=13,977) of all CHD events, and 65% occurred in women. CHD mortality declined among men annually by 3.5% and 1.0% in the 75- to 84-year-old and 85- to 99-year-old age groups, respectively. Among women, it declined by 2.2% per year in the 75- to 84-year-old age group but increased by 1.3% per year in the 85- to 99-year-old age group. MI attack rate did not change in men but increased significantly in women aged 85 to 99 years. Clinical management of MI in elderly patients was more conservative than in middle-aged patients. In conclusion, one-half of all CHD events occur among persons aged 75 years or older, and elderly patients with CHD represent an increasing burden to the health care system.

Are coronary event rates declining slower in women than in men - evidence from two population-based myocardial infarction registers in Finland?

BACKGROUND: Studies have suggested that the prevention and treatment of coronary heart disease may not have been as effective in women as in men. Therefore, we aimed to examine whether the incidence, attack rate and mortality of myocardial infarction (MI) events have declined less in women than in men. METHODS: Two large population-based MI registers, the FINAMI register and the Finnish Cardiovascular Disease Register (CVDR) were used for comparing the event rates among men and women aged > or =35 years in two time periods, 1994-1996 and 2000-2002. RESULTS: In the FINAMI register a total of 5,252 events were recorded in men and 4,898 in women. Corresponding numbers in the CVDR were 78,709 and 70,464. Both FINAMI and CVDR data suggested smaller declines in incidence and attack rate of MI events in women than in men. In CVDR data the decline in mortality was also smaller in women than in men, while in FINAMI data this difference did not reach statistical significance. In the large CVDR data set, negative binomial regression models revealed smaller declines in incidence (p = 0.006), attack rate (p = 0.008) and mortality (p = 0.04) in women than in men aged <55 years. In persons > or =55 years no difference was observed between women and men. CONCLUSION: The incidence and attack rate of MI events have declined less in women aged <55 than in men of similar age. In older persons no significant differences were observed. Further studies are warranted to find out the reasons why the development has been less favourable for young women than for men.

The validation of the Finnish Hospital Discharge Register and Causes of Death Register data on stroke diagnoses.

BACKGROUND AND PURPOSE: Administrative registers, like hospital discharge registers and causes of death registers are used for the monitoring of disease incidences and in the follow-up studies. Obtaining reliable results requires that the diagnoses in these registers are correct and the coverage of the registers is high. The purpose of this study was to evaluate the validity of the Finnish hospital discharge registers and causes of death registers stroke diagnoses against the population-based FINSTROKE register. METHODS: All first stroke events from the hospital discharge registers and causes of death registers from the areas covered by the FINSTROKE register were obtained for years 1993-1998 and linked to the FINSTROKE register. The sensitivity and positive predictive values were calculated. RESULTS: A total of 3633 stroke events, 767 fatal and 2866 non-fatal strokes, were included in the registers. The sensitivity for all first stroke events was 85%, for fatal strokes 86% and for non-fatal strokes 85%. The positive predictive values for all first strokes was 86%, for fatal strokes 92% and for non-fatal strokes 85%. The sensitivity as well as the positive predictive values for subarachnoid haemorrhage and intracerebral haemorrhage was higher than for cerebral infarctions. There were no marked differences in the sensitivity or positive predictive values between men and women. CONCLUSIONS: The sensitivity and the positive predictive values of the Finnish hospital discharge registers and causes of death registers are fairly good. Finnish administrative registers can be used for the monitoring of stroke incidence, but the number of cerebral infarctions should be interpreted with caution.