Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 33
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Clin Rehabil ; 34(4): 533-544, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32070122

RESUMO

OBJECTIVE: To evaluate a group-based music intervention in patients with Parkinson's disease. DESIGN: Parallel group randomized controlled trial with qualitative triangulation. SETTING: Neurorehabilitation in primary care. SUBJECTS: Forty-six patients with Parkinson's disease were randomized into intervention group (n = 26), which received training with the music-based intervention, and control group (n = 20) without training. INTERVENTIONS: The intervention was delivered twice weekly for 12 weeks. MAIN MEASURES: Primary outcome was Timed-Up-and-Go subtracting serial 7's (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. RESULTS: No between-group differences were observed for dual-task ability. Between-group differences were observed for Falls Efficacy Scale (mean difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0, P = 0.001) and for Parkinson Disease Questionnaire-39 items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews: Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. CONCLUSION: Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinson's disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.

2.
Scand J Occup Ther ; 27(3): 231-239, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31088186

RESUMO

Background: Fitness-to-drive assessment is a growing area for occupational therapists. There are few off-road tests specially developed to assess fitness to drive, and several cognitive tests have no age-specific norms.Aims/objectives: The aim was to identify and describe age-related norm values for the Trail Making Test, Nordic Stroke Driver Screening Assessment and Useful Field of View test, and to study inter-correlation between test results.Materials and methods: The sample included 410 volunteers; 149 men and 261 women, mean age 52 ± 16.8 years. Commonly used off-road tests were used: TMT A and B, UFOV and NorSDSA.Results: Normative data for the specific subtests and total score for NorSDSA and UFOV are provided and presented in four age groups. Age correlated with the results for most of the subtests.Conclusions: Off-road cognitive test scores are necessary and valuable for occupational therapists in their contribution to the final decision on continued driving. In clinical practice, it can be difficult to interpret cognitive test results when working with driving assessments. Age-based norm values are suggested to be a way to provide clinicians with a benchmark against which scores can be compared.Significance: Age-based norms can guide occupational therapists working with fitness to drive.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31382824

RESUMO

Normative data for evaluating cognitive function in the oldest old, aged 85 years and above, are currently sparse. The normative values used in clinical practice are often derived from younger old persons, from small sample sizes or from broad age spans (e.g. >75 years) resulting in a risk of misjudgment in assessments of cognitive decline. This longitudinal study presents normative values for the Trail Making Test A (TMT-A), the Symbol Digit Modalities Test (SDMT), the Victoria Stroop Test (VST) and the Parallel Serial Mental Operations (PaSMO) from cognitively intact Swedes aged 85 years and above. 207 participants, born in 1922, were tested at 85, 90 (n = 68) and 93 (n = 35) years of age with a cognitive screening test battery. The participants were originally recruited for participation in the Elderly in Linköping Screening Assessment. Normative values are presented as mean values and standard deviations, with and without adjustment for education. There were no clinically important differences between genders, but education had a significant effect on test results for the 85-year-olds. Age effects emerged in analyses of those participants who completed the entire study and were evident for TMT-A, SDMT, VST1 and PaSMO. When comparisons can be made, our results are in accordance with previous data for TMT-A, SDMT and VST, and we present new normative values for PaSMO.

4.
Int Psychogeriatr ; 31(11): 1569-1579, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31668146

RESUMO

OBJECTIVES: Both morbidity and mortality are elevated for individuals with subsyndromal depression (SSD) compared to non-depression (ND) in those of younger ages, but scientific studies are scarce for very old individuals. The aim of this study was therefore to compare the morbidity and mortality in very old individuals with SSD and ND. DESIGN AND SETTING: An 8-year prospective population-based study was undertaken on 85-year-old individuals in Sweden. MEASUREMENTS: Data were collected from postal questionnaires and clinical assessments at baseline, after 1, 5, and 8 years. Depressive symptoms were measured with Geriatric Depression Scale and the results were classified into ND, SSD, and syndromal depression. Mortality was investigated using multivariable cox regressions, and variables of morbidity were investigated using linear mixed models. RESULTS: Compared to ND, in people with SSD, mortality was elevated in the univariate regression, but this association vanished when controlling for relevant covariates. Morbidity was elevated with regard to basic activities of daily living (ADLs), instrumental ADLs, loneliness, self-perceived health, and depressive symptoms for individuals with SSD compared to ND, whereas cognitive speed, executive functions, and global cognitive function were not significantly impaired when adjusting for covariates. CONCLUSIONS: SSD among very old individuals is longitudinally associated with elevated morbidity but not mortality, when controlling for relevant covariates. Considering the high prevalence of SSD and the demographic development of increasing numbers of very old people, the findings highlight the need to develop clinical and societal strategies to prevent SSD and associated negative outcomes.

5.
Int J Health Care Qual Assur ; 32(4): 752-764, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31111781

RESUMO

PURPOSE: Comprehensive geriatric assessment (CGA) is a widely used approach in geriatric care and involves multidisciplinary assessments focused on determining a frail elderly person's medical, psychological and functional capability to develop an integrated plan for treatment. The purpose of this paper is to describe and scrutinize the CGA implementation process at six acute geriatric departments in three county councils and to study the outcome by the documentation in the patient medical records, and the staff perceptions using CGA. DESIGN/METHODOLOGY/APPROACH: The paper describes the implementation process stages. Outcome measures were based on patient medical records reviews at baseline and follow-ups at year 1 and year 2. Staff perceptions of using CGA were gathered by a questionnaire at the second follow-up. FINDINGS: The implementation had not yet reached sustainability so the implementation process must continue. Results show that documentation on the different areas increased in year 1, as well as the use of standardized assessment tools. However, results from the reviews for year 2 showed some decrease. Staff considered CGA to have high value for the geriatric patient but pointed out the need for continuing education. ORIGINALITY/VALUE: Successful strategies for this implementation were strong support from the managers, small seminars, CGA rounds, good introduction routines for new staff and the use of reminders such as pocket-sized focus cards. A high staff turnover occurred during the study, which probably had a significant negative impact on the results.


Assuntos
Avaliação Geriátrica/métodos , Implementação de Plano de Saúde/métodos , Avaliação de Processos em Cuidados de Saúde , Idoso , Documentação , Prática Clínica Baseada em Evidências , Humanos , Inquéritos e Questionários , Suécia
6.
J Am Geriatr Soc ; 67(3): 534-538, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30536796

RESUMO

BACKGROUND/OBJECTIVES: Normative Mini-mental state examination (MMSE) reference values in elderly are scarce. Therefore, the aim is to present normative MMSE values for 85-93 year olds. DESIGN: A longitudinal age cohort study. SETTING: A population study of the residents in the municipality of Linköping, Sweden. PARTICIPANTS: Residents (n = 650) born in 1922 during the course of 2007. In total, 374 individuals participated and were tested with MMSE at age 85, 280 of these were willing and able to also participate at age 86, 107 at age 90 and 51 at age 93. MEASUREMENTS: MMSE, from 0-30, with lower scores denoting more impaired cognition. RESULTS: Median MMSE values for the total population over the ages 85, 86, 90 and 93 years was 28 for all ages investigated. The 25th percentile values were 26, 26, 26 and 27, respectively. For a "brain healthy" sub-group median values were 28, 29, 28, and 28. The 25th percentile values were 27, 28, 26 and 27, respectively. Comparisons for age-effects showed no differences when all individuals for each age group were compared. When only the individuals reaching 93 years of age (n = 50) were analyzed, there was a significant lowering of MMSE in that age group. CONCLUSION: The literature is variable and in clinical practice a low (24) MMSE cut off is often used for possible cognitive impairment in old age. The present data indicate that MMSE 26 is a reasonable cut off for possible cognitive decline in older persons up to the age of 93. J Am Geriatr Soc 67:534-538, 2019.


Assuntos
Disfunção Cognitiva , Demência , Avaliação Geriátrica , Testes de Estado Mental e Demência/estatística & dados numéricos , Fatores Etários , Idoso de 80 Anos ou mais , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Demência/diagnóstico , Demência/epidemiologia , Feminino , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Valores de Referência , Suécia/epidemiologia
7.
Am J Geriatr Psychiatry ; 26(7): 741-751, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29673895

RESUMO

OBJECTIVES: This study aimed to compare, over a 5-year period, the prospective direct healthcare costs and service utilization of persons with subsyndromal depression (SSD) and non-depressive persons (ND), in a population of very old persons. A second aim was to develop a model that predicts direct healthcare costs in very old persons with SSD. DESIGN AND SETTING: A prospective population-based study was undertaken on 85-year-old persons in Sweden. MEASUREMENTS: Depressiveness was screened with the Geriatric Depression Scale at baseline and at 1-year follow-up, and the results were classified into ND, SSD, and syndromal depression. Data on individual healthcare costs and service use from a 5-year period were derived from national database registers. Direct costs were compared between categories using Mann-Whitney U tests, and a prediction model was identified with linear regression. RESULTS: For persons with SSD, the direct healthcare costs per month of survival exceeded those of persons with ND by a ratio 1.45 (€634 versus €436), a difference that was significant even after controlling for somatic multimorbidity. The final regression model consisted of five independent variables predicting direct healthcare costs: male sex, activities of daily living functions, loneliness, presence of SSD, and somatic multimorbidity. CONCLUSIONS: SSD among very old persons is associated with increased direct healthcare costs independently of somatic multimorbidity. The associations between SSD, somatic multimorbidity, and healthcare costs in the very old need to be analyzed further in order to better guide allocation of resources in health policy.


Assuntos
Depressão/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Sintomas Prodrômicos , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Masculino , Modelos Econômicos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Suécia
8.
Clin Chem Lab Med ; 56(3): 471-478, 2018 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-28988219

RESUMO

BACKGROUND: Reference intervals are widely used as decision tools, providing the physician with information about whether the analyte values indicate ongoing disease process. Reference intervals are generally based on individuals without diagnosed diseases or use of medication, which often excludes elderly. The aim of the study was to assess levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine and γ-glutamyl transferase (γ-GT) in frail, moderately healthy and healthy elderly indivuduals. METHODS: Blood samples were collected from individuals >80 years old, nursing home residents, in the Elderly in Linköping Screening Assessment and Nordic Reference Interval Project, a total of 569 individuals. They were divided into three cohorts: frail, moderately healthy and healthy, depending on cognitive and physical function. Albumin, ALT, AST, creatinine and γ-GT were analyzed using routine methods. RESULTS: Linear regression predicted factors for 34% of the variance in albumin were activities of daily living (ADL), gender, stroke and cancer. ADLs, gender and weight explained 15% of changes in ALT. For AST levels, ADLs, cancer and analgesics explained 5% of changes. Kidney disease, gender, Mini Mental State Examination (MMSE) and chronic obstructive pulmonary disease explained 25% of the variation in creatinine levels and MMSE explained three per cent of γ-GT variation. CONCLUSIONS: Because a group of people are at the same age, they should not be assessed the same way. To interpret results of laboratory tests in elderly is a complex task, where reference intervals are one part, but far from the only one, to take into consideration.


Assuntos
Alanina Transaminase/sangue , Albuminas/análise , Aspartato Aminotransferases/sangue , Creatinina/sangue , gama-Glutamiltransferase/sangue , Idoso de 80 Anos ou mais , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Feminino , Idoso Fragilizado , Humanos , Modelos Lineares , Masculino
9.
PLoS One ; 11(8): e0160742, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27551749

RESUMO

Ability to predict and prevent incipient functional decline in older adults may help prolong independence. Cognition is related to everyday function and easily administered, sensitive cognitive tests may help identify at-risk individuals. Factors like depressive symptoms and self-rated health are also associated with functional ability and may be as important as cognition. The purpose of this study was to investigate the relationship between concurrent longitudinal changes in cognition, depression, self-rated health and everyday function in a well-defined cohort of healthy 85 year olds that were followed-up at the age of 90 in the Elderly in Linköping Screening Assessment 85 study. Regression analyses were used to determine if cognitive decline as assessed by global (the Mini-Mental State Examination) and domain specific (the Cognitive Assessment Battery, CAB) cognitive tests predicted functional decline in the context of changes in depressive symptoms and self-rated health. Results showed deterioration in most variables and as many as 83% of these community-dwelling elders experienced functional difficulties at the age of 90. Slowing-down of processing speed as assessed by the Symbol Digits Modality Test (included in the CAB) accounted for 14% of the variance in functional decline. Worsening self-rated health accounted for an additional 6%, but no other variables reached significance. These results are discussed with an eye to possible preventive interventions that may prolong independence for the steadily growing number of normally aging old-old citizens.


Assuntos
Envelhecimento/patologia , Cognição/fisiologia , Disfunção Cognitiva/fisiopatologia , Transtorno Depressivo/fisiopatologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Disfunção Cognitiva/diagnóstico , Transtorno Depressivo/diagnóstico , Feminino , Humanos , Masculino , Análise de Regressão , Fatores de Risco
10.
Scand J Occup Ther ; 23(3): 230-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26853384

RESUMO

BACKGROUND: According to the Swedish National Board of Health and Welfare, structured assessment of function and activity has high priority when evaluating suspected cognitive impairment or dementia. AIM/OBJECTIVES: The aim was to develop and psychometrically test an instrument to measure the ability to perform activities of daily living tasks in patients with suspected cognitive impairment. MATERIAL AND METHODS: The Cognitive Impairment in Daily Life (CID) instrument (for self-reported and informant-based assessments) has been developed in several phases. Content validity was achieved through five expert panels using a Content Validity Index (CVI). The content was tested further in a pilot study of 49 patients and 49 relatives from primary care or a specialist memory clinic. RESULTS: Content validity was good with a CVI index of 0.83. All patients considered that the included activities were relevant to them and reflected the difficulties they were experiencing. Most relatives considered the activities included in the instrument as adequate and captured the patients' difficulties in daily life. Some adjustments of the tasks and scale were suggested and these were implicated after each phase. In general, relatives reported that patients had more difficulties performing the activities than the patients reported themselves. CONCLUSION: The CID instrument seems promising in terms of content validity. Further testing of reliability and construct validity is ongoing.


Assuntos
Atividades Cotidianas , Disfunção Cognitiva/psicologia , Demência/psicologia , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Psicometria , Reprodutibilidade dos Testes , Autorrelato
11.
Int J Geriatr Psychiatry ; 31(6): 619-28, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26489528

RESUMO

OBJECTIVE: To investigate factors associated with subsyndromal depression (SSD) in very old persons, and to develop a model for prediction of SSD among very old persons. METHODS: A cross-sectional, population-based study was undertaken on 85-year-old persons in Sweden. Data were collected from a postal questionnaire, assessments in the participants' homes and at reception visits. Depressiveness was screened with GDS-15 (Geriatric Depression Scale), and the results were classified into three outcome categories: non-depression (ND), SSD and syndromal depression. Data were analysed with binary logistic, ordinal logistic and linear regression. RESULTS: With univariate logistic regression 20 factors associated with SSD were identified in very old persons, and the four hypothesized domains--sociodemographic factors, declining physical functioning, neuropsychiatric factors and existential factors--significantly related to SSD. The multivariate logistic model included seven independent factors that increase the likelihood of SSD instead of ND (lower self-perceived health, life not meaningful, problems with self-care, use of tranquilizing medication, no contact with neighbours, history of affective disorder and history of stroke). The ordinal logistic and the linear regression models resulted in seven partly different factors for predicting SSD and depressiveness, in the very old. CONCLUSIONS: The identified markers may help clinicians with the detection, prevention and treatment of SSD in very old persons. The findings indicate the importance of a comprehensive functional approach to diagnosing and treating depressiveness in this population, and the findings might be interpreted as offering support for the coexistence of a dimensional and a categorical view on depressive disorders.


Assuntos
Transtorno Depressivo/etiologia , Idoso de 80 Anos ou mais , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Avaliação da Deficiência , Feminino , Avaliação Geriátrica , Nível de Saúde , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Análise de Regressão , Fatores de Risco , Autoimagem , Índice de Gravidade de Doença , Fatores Socioeconômicos , Suécia
12.
Int Psychogeriatr ; 27(6): 949-58, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25644289

RESUMO

BACKGROUND: The aim of this study was to explore experiences of cognitive impairment, its consequences in everyday life and need for support in people with mild cognitive impairment (MCI) or mild dementia and their relatives. METHODS: A qualitative approach with an explorative design with interviews was chosen. The participants included five people with MCI and eight people with mild dementia and their relatives. All participants were recruited at a geriatric memory clinic in Sweden. The Grounded Theory method was used. RESULTS: The following categories emerged: noticing cognitive changes; changed activity patterns; coping strategies; uncertainty about own ability and environmental reactions; support in everyday life; support from the healthcare system; consequences in everyday life for relatives; and support for relatives. The main findings were that people with MCI and dementia experienced cognitive changes that could be burdensome and changed activity patterns. Most of them, however, considered themselves capable of coping on their own. The relatives noticed cognitive changes and activity disruptions to a greater extent and tried to be supportive in everyday life. Degree of awareness varied and lack of awareness could lead to many problems in everyday life. CONCLUSIONS: Perceived cognitive impairment and its consequences in everyday life were individual and differed among people with MCI or dementia and their relatives. Thus, healthcare professionals must listen to both people with cognitive impairment and their relatives for optimal individual care planning. Support such as education groups and day care could be more tailored towards the early stages of dementia.


Assuntos
Atividades Cotidianas/psicologia , Disfunção Cognitiva/psicologia , Demência/psicologia , Família/psicologia , Adaptação Psicológica , Idoso , Conscientização , Efeitos Psicossociais da Doença , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa
13.
Gerontologist ; 55(5): 760-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24398652

RESUMO

PURPOSE OF THE STUDY: The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help. DESIGN AND METHODS: Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata. RESULTS: The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression. IMPLICATIONS: The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.


Assuntos
Envelhecimento/fisiologia , Depressão/psicologia , Idoso Fragilizado/psicologia , Adaptação Psicológica , Fatores Etários , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Depressão/diagnóstico , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Índice de Gravidade de Doença
14.
Scand J Occup Ther ; 22(3): 226-34, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25539151

RESUMO

BACKGROUND: Today, healthcare providers and occupational therapists are increasingly required to rely on evidence-based practices. In both outpatient and inpatient settings, the use of research-based practices can be identified using the Research Utilization Measure questionnaire. AIM: This study explores how occupational therapists in Sweden perceive research utilization. METHOD: The Research Utilization Measure was sent to 807 randomly selected occupational therapists in Sweden, and the response rate was 59% (n = 472). RESULTS: The majority of respondents (56%, n = 256) reported use of research-based knowledge in their practice "very or rather often", although 49% (n = 225) of the therapists noted that they "very seldom or never" discussed research findings with their managers. Differences in answers for most items were related to degree of education and length of experience. Occupational therapists with higher education levels more often reported use of research in their clinical practice and therapists with greater experience less often reported use of research in their clinical practice. CONCLUSION: Education seems to influence the degree to which occupational therapists rely on research to inform their practices. A future challenge for managers and occupational therapists is to create strategic discussions on how to implement treatment that is based on current research.


Assuntos
Terapia Ocupacional , Padrões de Prática Médica , Pesquisa de Reabilitação , Adulto , Estudos Transversais , Prática Clínica Baseada em Evidências , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Suécia
15.
Scand J Occup Ther ; 21(6): 421-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25100242

RESUMO

OBJECTIVE: The aim of this study was to identify work-related stress factors that contributed to work-related stress among Swedish occupational therapists and to investigate the association between work-related stress, demographic factors, and perceived overall stress. METHODS: A postal questionnaire and a letter of invitation were sent to 807 Swedish occupational therapists, selected at random and representing 10% of occupational therapists working in Sweden. The response rate was 59%. A stress index presenting 49 stress factors graded on a scale from 1 (indicating no source of stress) to 6 (definitely a source of stress) was included. In addition, the level of perceived overall stress during the last two weeks was scored on a rating scale with the end points 0 (no stress) and 10 (extreme stress). RESULTS: The main findings indicated that lack of resources and lack of time were the main stressors. "Working at a superficial level due to lack of time" was the only variable associated with high overall stress when both work-related and personal factors were included. Professional identity and clarity concerning the role were graded low with regard to stress. CONCLUSIONS: Work-related stress is just one aspect of the overall stress experienced but knowledge about its consequences highlights the importance of further studies.


Assuntos
Terapia Ocupacional/psicologia , Estresse Psicológico/etiologia , Tolerância ao Trabalho Programado , Adulto , Esgotamento Profissional , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Licença Médica , Inquéritos e Questionários , Suécia , Fatores de Tempo
16.
Int J Family Med ; 2014: 649253, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24778877

RESUMO

Background. Diagnostic evaluations of dementia are often performed in primary health care (PHC). Cognitive evaluation requires validated instruments. Objective. To investigate the diagnostic accuracy and clinical utility of Cognistat in a primary care population. Methods. Participants were recruited from 4 PHC centres; 52 had cognitive symptoms and 29 were presumed cognitively healthy. Participants were tested using the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), and Cognistat. Clinical diagnoses, based on independent neuropsychological examination and a medical consensus discussion in secondary care, were used as criteria for diagnostic accuracy analyses. Results. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.85, 0.79, 0.85, and 0.79, respectively, for Cognistat; 0.59, 0.91, 0.90, and 0.61 for MMSE; 0.26, 0.88, 0.75, and 0.46 for CDT; 0.70, 0.79, 0.82, and 0.65 for MMSE and CDT combined. The area under the receiver operating characteristic curve was 0.82 for Cognistat, 0.75 for MMSE, 0.57 for CDT, and 0.74 for MMSE and CDT combined. Conclusions. The diagnostic accuracy and clinical utility of Cognistat was better than the other tests alone or combined. Cognistat is well adapted for cognitive evaluations in PHC and can help the general practitioner to decide which patients should be referred to secondary care.

17.
Disabil Rehabil Assist Technol ; 9(4): 330-4, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23957388

RESUMO

PURPOSE: This study evaluates the effect of electric powered wheelchairs/scooters (PWC/S) on occupational performance, social participation, health and life satisfaction. In addition, this study estimates the costs and benefits of PWC/S and describes users' experiences with the delivery process. METHODS: This prospective study has a before-and-after design. Postal questionnaires were sent to 24 first-time PWC/S users before delivery of the PWC/S and 4 months after delivery. The participants used their PWC/S for outdoor mobility. RESULTS: PWC/S improved the users' daily lives, their ability to engage in mobility-related activities and their social participation. For a majority of the users, estimated independence, feelings of safety and self-esteem increased although overall health and life satisfaction were not significantly affected. All users thought that the therapist had considered their needs during the providing process. Most participants (73%) were satisfied with their device at follow-up. For the 12 users who reported no change in health status between measures, the mean societal savings based on calculated costs for assistance was €6227 per person per year. CONCLUSIONS: PWC/S seems to improve occupational performance, social participation and life satisfaction for users. Moreover, these improvements seem to have an economic advantage for both users and society. IMPLICATIONS FOR REHABILITATION: The use of a PWC/S has been shown to positively affect a person's independence in daily activities which in turn increases the sense of self-esteem and security. Facilitating mobility is cost-effective both from a societal as well as from anindividual perspective and should be a key intervention in rehabilitation.


Assuntos
Atividades Cotidianas , Limitação da Mobilidade , Cadeiras de Rodas/economia , Cadeiras de Rodas/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Autoimagem , Inquéritos e Questionários
18.
Health Soc Care Community ; 22(4): 368-74, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24313868

RESUMO

Few studies have examined health-related quality of life (HRQoL) with respect to daily living and health factors for relatively healthy elderly individuals. To this end, this study examines 85-year-olds' reported HRQoL in relation to social support, perceived health, chronic diseases, healthcare use and instrumental activities of daily living (IADL). Data were collected from 360 participants (55% response rate) between March 2007 and March 2008 using a postal questionnaire and a home visit interview. HRQoL was assessed using the EQ-5D-3L. For the items in the EQ-5D-3L, more problems were related to lower HRQoL. Restricted mobility and occurrence of pain/discomfort was common. Lower HRQoL was associated with increased risk for depression, increased use of medication, increased number of chronic diseases and more problems with IADL. Healthcare use and healthcare costs were correlated with lower HRQoL. HRQoL is of importance to healthcare providers and must be considered together with IADL in the elderly population when planning interventions. These should take into account the specific needs and resources of the older individuals.


Assuntos
Atividades Cotidianas/psicologia , Idoso de 80 Anos ou mais/psicologia , Qualidade de Vida/psicologia , Doença Crônica/epidemiologia , Doença Crônica/psicologia , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Apoio Social , Inquéritos e Questionários , Suécia/epidemiologia
19.
BMC Geriatr ; 13: 120, 2013 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-24195643

RESUMO

BACKGROUND: As life expectancy continues to rise, more elderly are reaching advanced ages (≥80 years). The increasing prevalence of multimorbidity places additional demands on health-care resources for the elderly. Previous studies noted the impact of multimorbidity on the use of health services, but the effects of multimorbidity patterns on health-service use have not been well studied, especially for very old people. This study determines patterns of multimorbidity associated with emergency-room visits and hospitalization in an 85-year-old population. METHODS: Health and living conditions were reported via postal questionnaire by 496 Linköping residents aged 85 years (189 men and 307 women). Diagnoses of morbidity were reviewed in patients' case reports, and the local health-care register provided information on the use of health services. Hierarchical cluster analysis was applied to evaluate patterns of multimorbidity with gender stratification. Factors associated with emergency-room visits and hospitalization were analyzed using logistic regression models. RESULTS: Cluster analyses revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic-mental (only for men), mental disease (only for women), and three other clusters related to aging (one for men and two for women). Heart failure in men (OR = 2.4, 95% CI = 1-5.7) and women (OR = 3, 95% CI = 1.3-6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency-room visits. Men's cardiac cluster (OR = 1.6; 95% CI = 1-2.7) and women's cardiopulmonary cluster (OR = 1.7, 95% CI = 1.2-2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men's cardiac cluster (OR = 1.6, 95% CI = 1-2.4) and one of the women's aging clusters (OR = 0.5, 95% CI = 0.3-0.8) showed interaction effects on hospitalization. CONCLUSION: In this 85-year-old population, patterns of cardiac and pulmonary conditions were better than a single morbidity in explaining hospitalization. Heart failure was superior to multimorbidity patterns in explaining emergency-room visits. A holistic approach to examining the patterns of multimorbidity and their relationships with the use of health services will contribute to both local health care policy and geriatric practice.


Assuntos
Doenças Cardiovasculares/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Hospitalização/tendências , Pneumopatias/epidemiologia , Inquéritos e Questionários , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Comorbidade , Feminino , Humanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Masculino , Suécia/epidemiologia
20.
J Am Geriatr Soc ; 60(2): 243-50, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22283806

RESUMO

OBJECTIVES: To determine whether being overweight or obese is associated with significant health outcomes in an 85-year-old population. DESIGN: A cross-sectional population-based study. SETTING: Linköping, Sweden. PARTICIPANTS: Three hundred thirty-eight people born in 1922 were identified using the local authority's register. MEASUREMENTS: Data related to sociodemographic characteristics, health-related quality of life (HRQoL), assistance use, and the presence of diseases were collected using a postal questionnaire. Anthropometry and functional status were assessed during home and geriatric clinic visits. Diseases were double-checked in the electronic medical records, and information about health service consumption was obtained from the local healthcare register. RESULTS: Overweight (body mass index (BMI) 25.0-29.9 kg/m(2)) and obese (BMI ≥ 30.0 kg/m(2)) participants perceived more difficulty performing instrumental activities of daily living (IADLs) and had more comorbidity than their normal-weight counterparts (BMI 18.5-24.9 kg/m(2)), but their overall HRQoL and health service costs did not differ from those of normal-weight participants. After controlling for sociodemographic factors, being overweight did not influence IADLs or any comorbidity, but obese participants were more likely to perceive greater difficulty in performing outdoor activities (odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.1-4) and cleaning (OR = 2.2, 95% CI = 1.2-4.2) than their normal-weight counterparts. Although obesity was also associated with multimorbidity (OR = 3, 95% CI = 1.2-8), the health service cost of each case of multimorbidity (n = 251) was highest in normal-weight participants and nearly three times as much as in obese participants (ratio: 2.9, 95% CI = 1.1-8.1). CONCLUSION: For 85-year-olds, being obese, as opposed to overweight, is associated with self-reported activity limitations and comorbidities. Overweight older adults living in their own homes in this population had well-being similar to that of those with normal weight.


Assuntos
Sobrepeso/complicações , Atividades Cotidianas , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Obesidade/complicações , Estudos Prospectivos , Suécia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA