Creativity, leisure activities, social engagement and cognitive impairment: the AGES-Reykjavík study.

BACKGROUND: Participation in leisure activities and extensive social network have been associated with lower risk of cognitive impairment (CI) and dementia. AIMS: We examined whether leisure activities (cognitive solitary, cognitive group, social, physical, or creative activities) and social involvement are associated with less incidence of CI or dementia. METHODS: Analyses were performed from data of 2933 cognitively intact individuals at baseline included in the AGES-REYKJAVIK study. Odds ratios (OR) were calculated for incident CI and dementia in relation to cognitive individual, cognitive group, social, physical, and creative leisure activities as well as social networks. Models were adjusted for a number of known risk factors for cognitive decline. RESULTS: In 5 years, 12% of the cohort were diagnosed with CI or dementia. All leisure activities were associated with reduced likelihood of cognitive decline in the raw model, but in adjusted models, cognitive solitary [OR 0.49 (Confidence Interval (CI) 0.38-0.64)], cognitive group [OR 0.50 (CI 0.30-0.82)], and creative activities [OR 0.53 (CI 0.35-0.83)] were significantly associated with less cognitive decline. Analyses examining creative leisure activities independently, controlling for all other activities, suggested individuals participating in creative activities exhibited less CI [OR 0.64 (CI 0.41-0.98)]. Among social networks variables, frequency of meeting with friends and relatives was associated with reduced likelihood of CI [OR 0.49 (CI 0.31-0.75)]. DISCUSSION: Cognitive and creative leisure activities and frequent gatherings with friends and relatives are associated with reduced incidence of CI in this older cohort. CONCLUSION: Creative leisure activities might have special benefit for cognitive ability.

[Medication use in nursing homes in Iceland 2002-2004. A descriptive study]. / Lyfjanotkun á hjúkrunarheimilum á Íslandi 2002-2004. Lýsandi rannsókn.

PURPOSE: To describe medication use in nursing homes in Iceland during the years 2002-2004. METHODS: In nursing homes using automated medication delivery, the number of medications used were calculated, from the beginning of 2002 to the end of 2004. Information was obtained from 10 nursing homes; a total of 1409 individuals or approximately 60% of the inhabitants of all nursing homes in Iceland. 65% of the population were women, mean age was 83 years and 43% died during the study periond. The total number of prescribed medications was collected as well as their use for common chronic conditions and symptoms was analysed. RESULT: There were on average 8.9 (±4,0) medications used at the beginning of the study period, increasing to 9.9 (±4,3) by its end. On average, women got one more medication than men (p<0,001). 56.2% of women and 47% of men received >10 kinds of medication by the end of the study. Women got more psychiatric medications than men, but men got more medications for cardiovascular diseases. 82% of the population used psychiatric medications regularly, 65% used sedatives/hypnotics, 50% antidepressants and 20 % antipsychotics. Approximately additional 15% used psychiatric medication temporarily over the study period. The majority of medications were used constantly during the study period, especially cardiovascular medications. Medication for urinary incontinence, non steroidal antiinflammatory medications, medications for osteoporosis and medications against Alzheimers disease were used more often temporarily than constantly. Medications that were in constant use by >40% of the population were sedative/hypnotics, antidepressants, paracetamol, diuretics and vitamin D. CONCLUSION: There is a high number of medications used in nursing homes in Iceland. Most medications were already in use at the start of the study and continued throughout the study period indicating that medication review might be lacking. There are no indications of under-treated of pain or depression. Vitamin D is frequently used but should be used more often not least among men.

[Physician's responsibilities in nursing homes]. / Verksvio laeknis á hjúkrunarheimili.

Medical services for nursing homes have been in discussion in Iceland among primary care physicians, geriatricians and the general public the last few years. Physician responsibility for the care of patients in nursing homes is poorly defined, few quality measures are being used and no regular public quality control in use. In the article the authors describe their view on what constitutes a good medical service in nursing homes. The authors base their views on the nursing home literature, their experience and legal surroundings in Iceland. They recommend the use of RAI instrument as base for health promotion, surveillance of health and function. The article describes what physicians who take care of patients in nursing homes need to master.

Raloxifene for older women: a review of the literature.

Raloxifene is a non-steroidal selective estrogen-receptor modulator (SERM) which is used for prevention and treatment of postmenopausal osteoporosis. Raloxifene decreases the incidence of vertebral fractures by 30%-50% in postmenopausal women with osteoporosis but has not been shown to decrease the incidence of hip fractures or other non-vertebral fractures. At the present time, estrogen-replacement therapy and bisphosphonate treatment are the only medical treatments that are proven to prevent hip fractures with the exception of vitamin D and calcium replacement, which has been shown to prevent hip fractures in elderly individuals and nursing home residents. Raloxifene has been shown to have additive effects on bone turnover and bone mineral density (BMD) when used along with alendronate and teriparatide. Raloxifene could have a role in renal failure as it has been shown to increase BMD of the vertebra over 1 year of therapy. Raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer. The increased incidence of venous thromboembolism is the main concern of raloxifene therapy and previous history of venous thromboembolism is a contraindication for use of raloxifene. Raloxifene has a role in treatment of vertebral osteoporosis in older women. The decision to use raloxifene should be based on evaluation of fracture risk and on potential other benefits than fracture reduction along with consideration of side effects.

[Dialogs on death]. / Samtöl um daudann.

OBJECTIVE: This study is done to examine the ideas of elderly individuals on life, death and end-of-life treatment in order to understand how they interact and influence choices of treatment. DESIGN: A phenomenological study. Eight Icelandic individuals 70 years old or more were interviewed in their homes. The interviews were open with two main questions. A special emphasis was on views toward life and death as studies have indicated their importance. RESULTS: All participants had a history of a good life despite experiences of death and loss. Enjoyment of life was evident along with an accepting attitude towards death. Everyone agreed on the necessity to limit life prolongation if there was no hope of recovery, much suffering, mental and physical ability compromised, no possibility of living a good life and being a burden to others. The participants based their attitudes toward end-of-life treatment on the likely outcome; evaluation of their own life; the impact on loved ones and experience of loss, grief and death. DISCUSSION: A model of end-of-life discussion between a physician and a patient is presented: The discussion takes place within an ethical and cultural framework, which is sometimes discussed. Physicians give information on diagnosis, prognosis, treatment options and the likely outcome. The patient evaluates the information in view of his/her own life based on age, health and views on life and death. The patient considers the impact of the decision made on loved ones and evaluates own experiences and that of others. Each factor has a negative and a positive side towards treatment. The decision on treatment is then made collectively. CONCLUSION: Discussion on end of life treatment involves following themes: Ethical, medical, the patients' evaluation of his/her own life, the impact of the decision on loved ones and experiences of loss, grief and death.

The effect of raloxifene on markers of bone turnover in older women living in long-term care facilities.

OBJECTIVES: To examine the effect of raloxifene on bone turnover in elderly women. DESIGN: Clinical intervention. SETTING: Long-term care facilities. PARTICIPANTS: Nineteen women completed the study, mean age 85 (range 76-99). INTERVENTION: Raloxifene 60 mg was given daily for 12 weeks. MEASUREMENTS: Markers of bone turnover were plasma C-telopeptides of type I collagen (CTx), urine cross-linked N-telopeptides of type I collagen (NTx) and serum tartrate-resistant acid phosphatase (TRAP 5b), plasma osteocalcin, and serum bone alkaline phosphatase. Other markers were serum 25-OH vitamin D, parathyroid hormone, ionized calcium, and phosphate. Markers were measured at baseline, after calcium and vitamin D had been taken for 6 weeks, after raloxifene had been taken for 12 weeks, and 6 weeks after raloxifene had been stopped. Paired sample t test was used to examine changes in markers at each time point. RESULTS: Plasma CTx decreased on average by 31%, urinary NTx by 35%, plasma osteocalcin by 25%, serum bone alkaline phosphatase by 15% (P<.01), and serum TRAP 5b by 10% (P<.05) on treatment. CONCLUSION: Raloxifene reduces bone turnover in elderly women living in long-term care facilities. The effect of raloxifene on bone turnover is comparable with that seen in younger postmenopausal women.