The Gothenburg H70 Birth cohort study 2014-16: design, methods and study population.

To improve health care for older persons, we need to learn more about ageing, e.g. identify protective factors and early markers for diseases. The Gothenburg H70 Birth Cohort Studies (the H70 studies) are multidisciplinary epidemiological studies examining representative birth cohorts of older populations in Gothenburg, Sweden. So far, six birth cohorts of 70-year-olds have been examined over time, and examinations have been virtually identical between studies. This paper describes the study procedures for the baseline examination of the Birth cohort 1944, conducted in 2014-16. In this study, all men and women born 1944 on specific dates, and registered as residents in Gothenburg, were eligible for participation (n = 1839). A total of 1203 (response rate 72.2%; 559 men and 644 women; mean age 70.5 years) agreed to participate in the study. The study comprised sampling of blood and cerebrospinal fluid, psychiatric, cognitive, and physical health examinations, examinations of genetics and family history, use of medications, social factors, functional ability and disability, physical fitness and activity, body composition, lung function, audiological and ophthalmological examinations, diet, brain imaging, as well as a close informant interview, and qualitative studies. As in previous examinations, data collection serves as a basis for future longitudinal follow-up examinations. The research gained from the H70 studies has clinical relevance in relation to prevention, early diagnosis, clinical course, experience of illness, understanding pathogenesis and prognosis. Results will increase our understanding of ageing and inform service development, which may lead to enhanced quality of care for older persons.

Changes in the Lethality of Frailty Over 30 Years: Evidence From Two Cohorts of 70-Year-Olds in Gothenburg Sweden.

BACKGROUND: With aging, health deficits accumulate: people with few deficits for their age are fit, and those with more are frail. Despite recent reports of improved health in old age, how deficit accumulation is changing is not clear. Our objectives were to evaluate changes over 30 years in the degree of deficit accumulation and in the relationship between frailty and mortality in older adults. METHODS: We analyzed data from two population based, prospective longitudinal cohorts, assembled in 1971-1972 and 2000-2001, respectively. Residents of Gothenburg Sweden, systematically drawn from the Swedish population registry. The 1901-1902 cohort (N = 973) had a response rate of 84.8%; the 1930 cohort (N = 500) had a response rate of 65.1%. A frailty index using 36 deficits was calculated using data from physical examinations, assessments of physical activity, daily, sensory and social function, and laboratory tests. We evaluated mortality over 12.5 years in relation to the frailty index. RESULTS: Mean frailty levels were the same (x¯ = 0.20, p = .37) in the 1901-1902 cohort as in the 1930 cohort. Although the frailty index was linked to the risk of death in both cohorts, the hazards ratio decreased from 1.67 per 0.1 increment in the frailty index for the first cohort to 1.32 for the second cohort (interaction term p = .005). DISCUSSION: Although frailty was as common at age 70 as before, its lethality appears to be less. Just why this is so should be explored further.

Differences in Symptom Distress Based on Gender and Palliative Care Designation Among Hospitalized Patients.

PURPOSE: To explore patient-reported symptom distress in relation to documentation of symptoms and palliative care designation in hospital inpatients. DESIGN: This cross-sectional study analyzed data from 710 inpatients at two large hospitals in Sweden using the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Chart reviews focused on nurses' and physicians' symptom documentation and palliative turning point. METHODS: Descriptive statistics were calculated for all variables and provided summaries about the sample. Patients were grouped according to gender, age, palliative care designation, and symptom documentation. The t test and chi-square test were used to calculate whether symptom distress varied between groups. A two-way analysis of variance was conducted for multiple comparisons to explore the impact of gender and age on mean symptom distress. FINDINGS: Females reported higher levels of symptom distress than did males related to pain, fatigue, and nausea. When comparing symptom distress between males and females with documentation pertaining to symptoms, there were significant differences implying that females had to report higher levels of symptom distress than males in order to have their symptoms documented. CONCLUSIONS: Females need to report higher levels of symptom distress than do males for healthcare professionals to identify and document their symptoms. It can be hypothesized that females are not receiving the same attention and symptom alleviation as men. If so, this highlights a serious inequality in care that requires further exploration. CLINICAL RELEVANCE: Considering that common reasons why people seek health care are troublesome symptoms of illness, and that the clinical and demographic characteristics of inpatients are changing towards more advanced ages with serious illnesses, inadequate symptom assessment and management are a serious threat to the care quality.

Patients' experience of important factors in the healthcare environment in oncology care.

BACKGROUND AND OBJECTIVE: The aim of this study was to describe what factors of the healthcare environment are perceived as being important to patients in oncology care. DESIGN: A qualitative design was adopted using focus group interviews. SETTING AND PARTICIPANTS: The sample was 11 patients with different cancer diagnoses in an oncology ward at a university hospital in west Sweden. RESULTS: Analysis of the patients' perceptions of the environment indicated a complex entity comprising several aspects. These came together in a structure consisting of three main categories: safety, partnership with the staff, and physical space. The care environment is perceived as a complex entity, made up of several physical and psychosocial aspects, where the physical factors are subordinated by the psychosocial factors. It is clearly demonstrated that the patients' primary desire was a psychosocial environment where they were seen as a unique person; the patients wanted opportunities for good encounters with staff, fellow patients, and family members, supported by a good physical environment; and the patients valued highly a place to withdraw and rest. CONCLUSIONS: This study presents those attributes that are valued by cancer patients as crucial and important for the support of their well-being and functioning. The results show that physical aspects were subordinate to psychosocial factors, which emerged strongly as being the most important in a caring environment.

Secular changes in the relation between social factors and depression: a study of two birth cohorts of Swedish septuagenarians followed for 5 years.

BACKGROUND: Rapid societal changes occurred in the Western world during the 20(th) century. It is not clear whether this has changed the relation between social factors and depression in older people. METHODS: Representative samples of 70-year-olds from Gothenburg, Sweden, were examined with identical psychiatric examinations in 1971-72 (N=392; 226 women and 166 men) and 2000-01 (N=499; 270 women and 229 men). Follow-up studies were conducted after five years. Social factors were obtained by self-report and depression was diagnosed according to DSM-IV-TR. RESULTS: Feelings of loneliness were related to both concurrent depression at baseline and new depression at follow-up in both birth cohorts. Visits with others than children and neighbours once per month or less, compared to having more visits, and the perception of having too little contact with others, were related to both concurrent and new depression in 70-year-olds examined 1971-72, but not in those examined 30 years later. LIMITATIONS: The response rate declined from 85.2% in 1971-72 to 65.8% in 2000-01. Participation bias may have resulted in an underestimation of depression in the later-born cohort. CONCLUSIONS: Social contacts with others were related to depression in 70-year-olds examined in the 1970s, but not in those examined in the 2000s. This may reflect period changes in the ways of socialising, communicating and entertaining, e.g. due to technological development and expansion of mass media. Findings may be useful when developing modern and effective programs for the prevention of mental ill-health in older people.

The effects of refurbishment on residents' quality of life and wellbeing in two Swedish residential care facilities.

This study was conducted to follow a refurbishment aimed at enhancing the supportiveness of the physical environment in two Swedish residential care facilities. Significant differences between intervention and equivalent reference groups were found for quality of life (p=0.007) and wellbeing (p=0.02, 0.01) indicating a deterioration for the intervention group. These results suggest that residential care facilities residents are more frail and sensitive to change than has been assumed. This needs to be considered when facilities accommodating the elderly need refurbishment. It also indicates that interior design features alone have little importance for the care climate in nursing homes.

A psychometric evaluation of a Swedish version of the Quality of Life in Late-Stage Dementia (QUALID) scale.

BACKGROUND: The aim of the present study was to evaluate the validity, reliability and responsiveness of a Swedish translation of the Quality of Life in Late-Stage Dementia (QUALID) Scale. METHOD: A total of 169 elderly residents at 19 dementia special care units in eight long-term care facilities in the Gothenburg city region participated in the study. Assessments were made by 107 proxy informants. RESULTS: Results showed satisfactory levels of internal consistency reliability (Cronbach's alpha coefficients 0.74), acceptable inter-rater reliability between informants (0.69), and high test-retest reliability (0.86). As hypothesized, QUALID scores were also associated with those from other quality-of-life (QoL) indices (criterion validity), as well as with use of psychoactive drugs, and with tests of cognitive impairment (clinical validity). The responsiveness of the questionnaire was also acceptable. CONCLUSIONS: As important clinical decisions may derive from perceived QoL effects, it is vital that the QoL data be reliable, valid and sensitive to change. Our evaluations of the psychometric properties of the Swedish QUALID indicate that it satisfactorily meets the need for an instrument to assess QoL in late-stage dementia in Sweden, in a wide range of settings and applications.