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Edvardsson, M., Sund-Levander, M., Milberg, A., Ernerudh, J., Wressle, E., Marcusson, J. & Grodzinsky, E. (2022). Classification of ≥80-year-old individuals into healthy, moderately healthy, and frail based on different frailty scores affects the interpretation of laboratory results. Asian Journal of Medical Sciences, 13(9), 63-71
Open this publication in new window or tab >>Classification of ≥80-year-old individuals into healthy, moderately healthy, and frail based on different frailty scores affects the interpretation of laboratory results
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2022 (English)In: Asian Journal of Medical Sciences, ISSN 2091-0576, E-ISSN 2091-0576, Vol. 13, no 9, p. 63-71Article in journal (Refereed) Published
Abstract [en]

Background: Interpretation laboratory analyses are crucial when assessing the patient’s condition. Reference intervals from apparently healthy and disease-free individuals may cause problems when outcomes from elderly patients with chronic diseases and on medications are being interpreted. Elderly individuals are a heterogeneous group ranging from individuals managing their daily life independently to individuals with diseases and impairment, in need of nursing care around the clock, that is, frail; a term widely used although there is no consensus on the definition.

Aims and Objectives: The aim of the study was to study the effect of classification of elderly into healthy, moderately healthy, and frail, based on activities of daily living (ADL) and Mini-Mental State Examination (MMSE) or frailty index (FI), on the interpretation of outcomes regarding: Albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, and gamma-glutamyltransferase (γ-GT) levels.

Materials and Methods: Individuals ≥80 years (n=568) were classified either on ADL and MMSE or number of deficits, (FI).

Results: Individuals classified as frail based on FI had lower mean levels for ALT, creatinine and γ-GT than individuals classified based on ADL and MMSE (P<0.05).

Conclusion: The model to define health status to some extent affected laboratory analyte levels in ≥80 years old, classified as healthy, moderately healthy, and frail based on ADL and MMSE versus FI.

Place, publisher, year, edition, pages
Nepal Journals Online (NepJOL), 2022
Keywords
Aging; Frail elderly; Analyte; Reference interval; Clinical interpretation
National Category
Geriatrics Clinical Laboratory Medicine
Identifiers
urn:nbn:se:liu:diva-192092 (URN)10.3126/ajms.v13i9.45298 (DOI)
Available from: 2023-03-01 Created: 2023-03-01 Last updated: 2023-03-02
Nord, M., Lyth, J., Marcusson, J. & Alwin, J. (2022). Cost-Effectiveness of Comprehensive Geriatric Assessment Adapted to Primary Care. Journal of the American Medical Directors Association, 23(12), 2003-2009
Open this publication in new window or tab >>Cost-Effectiveness of Comprehensive Geriatric Assessment Adapted to Primary Care
2022 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 23, no 12, p. 2003-2009Article in journal (Refereed) Published
Abstract [en]

Objectives To estimate the cost-effectiveness of a pragmatic trial of comprehensive geriatric assessment adapted to primary care, compared with care as usual. Design Within-trial cost-effectiveness study of a prospective controlled multicenter trial. Setting and Participants Nineteen primary care practices in Sweden. The original trial included 1304 individuals aged ≥75 years at high risk of hospitalization selected using a prediction model. From the original trial, 369 individuals participated in the cost-effectiveness analysis, 185 in the intervention group and 184 in the control group. Mean age was 83.9 years and 57% of the participants were men. Methods We obtained health care costs from administrative registries. Community costs and health-related quality of life data were obtained from a questionnaire sent to participants. Health-related quality of life was measured using EQ-5D-3L and quality-adjusted life years were calculated. We analyzed all outcomes according to intention to treat, and adjusted them to age, gender, and risk score (risk of hospitalization in the next 12 months). The primary outcome was the incremental cost-effectiveness ratio associated with the intervention at follow-up after 24 months. Results The difference in total cost (incremental cost) between intervention and control groups was USD −11,275 (95% CI −407 to −22,142). The incremental effect in quality-adjusted life years was −0.05 (95% CI −0.17 to 0.08). In the cost-effectiveness plane that illustrates the uncertainty of the analysis, 77.9 of the observations were within the south-east quadrant, implying lower cost and greater effect in the intervention group. Conclusions and Implications The results suggests that a primary care comprehensive geriatric assessment intervention delivered to older adults at high risk of hospitalization is cost-effective at follow-up after 24 months. The use of a prediction model to select participants and an intervention with a low cost is promising but requires further study.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Comprehensive geriatric assessment, primary care, frailty, hospitalization, pragmatic clinical trial, cost-effectiveness
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-188232 (URN)10.1016/j.jamda.2022.04.007 (DOI)000899839200028 ()35577011 (PubMedID)
Note

Funding: Region Ostergotland and Linkoping University from the strategic research fund "Healthcare andWelfare" [2016186e14]; Linkoping University

Available from: 2022-09-07 Created: 2022-09-07 Last updated: 2023-03-27Bibliographically approved
Olaison, A., Cedersund, E., Marcusson, J., Nord, M. & Sverker, A. M. (2022). ‘Do you have a future when you are 93?’ Frail older person’s perceptions about the future and end of life – a qualitative interview study in primary care. Scandinavian Journal of Primary Health Care, 40(4), 417-425
Open this publication in new window or tab >>‘Do you have a future when you are 93?’ Frail older person’s perceptions about the future and end of life – a qualitative interview study in primary care
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2022 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 4, p. 417-425Article in journal (Refereed) Published
Abstract [en]

Objective: To explore frail older persons’ perceptions of the future and the end of life.

Design: Qualitative content analysis of individual semi-structured interviews.

Setting: Nine primary health care centres in both small and middle-sized municipalities in Sweden that participated in the intervention project Proactive healthcare for frail elderly persons.

Subjects/Patients: The study includes 20 older persons (eight women and 12 men, aged 76–93 years).

Main outcome measures: Frail older persons’ perceptions of the future and end of life.

Results: The analysis uncovered two main categories: Dealing with the future and Approaching the end of life. Dealing with the future includes two subcategories: Plans and reflections and Distrust and delay. Approaching the end of life includes three subcategories: Practical issues, Worries and realism, and Keeping it away.

Conclusion: This study highlights the diverse ways older people perceive future and the end of life. The results make it possible to further understand the complex phenomenon of frail older persons’ perceptions on the future and the end of life.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
National Category
Social Work
Identifiers
urn:nbn:se:liu:diva-189616 (URN)10.1080/02813432.2022.2139348 (DOI)000876156500001 ()36308755 (PubMedID)2-s2.0-85141153781 (Scopus ID)
Note

Funding: Strategic Research Area Healthcare Welfare, Ostergotland County Council and Linkoping University

Available from: 2022-10-30 Created: 2022-10-30 Last updated: 2023-04-04Bibliographically approved
Olaison, A., Cedersund, E., Marcusson, J., Valtersson, E. & Sverker, A. M. (2021). Maneuvering the care puzzle: Experiences of participation in care by frail older persons with significant care needs living at home. International Journal of Qualitative Studies on Health and Well-being, 16(1), Article ID 1937896.
Open this publication in new window or tab >>Maneuvering the care puzzle: Experiences of participation in care by frail older persons with significant care needs living at home
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2021 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, no 1, article id 1937896Article in journal (Refereed) Published
Abstract [en]

Purpose: Despite evidence that older persons want to be involved in care, little is known about how frail older people with significant care needs living at home experience participation in care provided by different stakeholders. This study investigates the experiences of participation in care by older people following their involvement in an intervention of a health care model called Focused Primary care (FPC).'Methods: Individual semi-structured interviews were conducted with 20 older persons in five municipalities in Sweden.Results: The results show that older persons highlighted opportunities and limitations for participation on a personal level i.e., conditions for being involved in direct care and in relation to independence. Experiences of participation on organizational levels were reported to a lesser degree. This included being able to understand the organizational system underpinning care. The relational dimensions of caregiving were emphasized by the older persons as the most central aspects of caregiving in relation to participation .Conclusions: Primary care should involve older persons more directly in planning and execution of care on all levels. An ongoing connection with one specialized elderly team and a coordinating person in Primary care who safeguards relationships is important fo rproviding participation in care for frail older persons with significant care needs living at home.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Older people; significant care needs; health care; primary care; participation; caregiving; relationship-based care; qualitative research
National Category
Social Work
Identifiers
urn:nbn:se:liu:diva-178019 (URN)10.1080/17482631.2021.1937896 (DOI)000673807500001 ()34261426 (PubMedID)
Funder
Region Östergötland
Note

Funding: County Council of Ostergotland; Linkoping University from the strategic research fund for "Health Care and Welfare" [2016186-14]

Available from: 2021-07-17 Created: 2021-07-17 Last updated: 2023-06-18Bibliographically approved
Fällman, K., Lundgren, L., Wressle, E., Marcusson, J. & Classon, E. (2020). Normative data for the oldest old: Trail Making Test A, Symbol Digit Modalities Test, Victoria Stroop Test and Parallel Serial Mental Operations. Aging, Neuropsychology and Cognition, 27(4), 567-550
Open this publication in new window or tab >>Normative data for the oldest old: Trail Making Test A, Symbol Digit Modalities Test, Victoria Stroop Test and Parallel Serial Mental Operations
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2020 (English)In: Aging, Neuropsychology and Cognition, ISSN 1382-5585, E-ISSN 1744-4128, Vol. 27, no 4, p. 567-550Article in journal (Refereed) Published
Abstract [en]

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. amp;gt;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 Linkoping 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.

Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2020
Keywords
Neuropsychological tests; aged; 80 and over; executive function; attention; normative
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-159866 (URN)10.1080/13825585.2019.1648747 (DOI)000480134100001 ()31382824 (PubMedID)
Note

Funding Agencies|Linkoping University [LIO-696631, LIO 602761, LIO 537591]; Linkopings Universitet [LIO- 696631, LIO- 602761, LIO- 537591]

Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2021-05-08
Segernäs Kvitting, A., Johansson, M. M. & Marcusson, J. (2019). Accuracy of the Cognitive Assessment Battery in a Primary Care Population. Dementia and Geriatric Cognitive Disorders Extra, 9(2), 294-301
Open this publication in new window or tab >>Accuracy of the Cognitive Assessment Battery in a Primary Care Population
2019 (English)In: Dementia and Geriatric Cognitive Disorders Extra, E-ISSN 1664-5464, Vol. 9, no 2, p. 294-301Article in journal (Refereed) Published
Abstract [en]

Background: There are several cognitive assessment tools used in primary care, e.g., the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment. The Cognitive Assessment Battery (CAB) was introduced as a sensitive tool to detect cognitive decline in primary care. However, primary care validation is lacking. Therefore, we investigated the accuracy of the CAB in a primary care population. 

Objective: To investigate the accuracy of the CAB in a primary care population. 

Methods: Data from 46 individuals with cognitive impairment and 33 individuals who visited the primary care with somatic noncognitive symptoms were analyzed. They were investigated with the MMSE, the CAB, and a battery of neuropsychological tests; they also underwent consultation with a geriatric specialist. The accuracy of the CAB was assessed using c-statistics and the area under the receiver operating characteristic curve (AUC) was used to quantify the binary outcomes (“no cognitive impairment” or “cognitive impairment”).

Results: The “cognitive impairment” group was significantly different from the unimpaired group for all the subtests of the CAB. When accuracy was based on binary significant reduction or not in one or several domains of the CAB, the AUC varied between 0.685 and 0.772. However, when a summation or logistic regression of several subcategories was performed, using the numerical values for each subcategory, the AUC was >0.9. For comparison, the AUC for the MMSE was 0.849.

Conclusions: The accuracy of the CAB in a primary care population is poor to good when using binary cutoffs. Accuracy can be improved to high when using a summation or logistic regression of the numerical data of the subcategories. Considering CAB time, lack of adequate age norms, and a good accuracy for the MMSE, implementation of the CAB in primary care is not recommended at present based on the results of this study.

Place, publisher, year, edition, pages
S. Karger, 2019
Keywords
Primary care cognitive tests, Cognitive Assessment Battery, Cognitive assessment tools
National Category
Neurology Geriatrics
Identifiers
urn:nbn:se:liu:diva-160370 (URN)10.1159/000501365 (DOI)000496485700009 ()2-s2.0-85071030454 (Scopus ID)
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2023-03-20Bibliographically approved
Segernäs Kvitting, A., Fällman, K., Wressle, E. & Marcusson, J. (2019). Age-Normative MMSE Data for Older Persons Aged 85 to 93 in a Longitudinal Swedish Cohort. Journal of The American Geriatrics Society, 67(3), 534-538
Open this publication in new window or tab >>Age-Normative MMSE Data for Older Persons Aged 85 to 93 in a Longitudinal Swedish Cohort
2019 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 67, no 3, p. 534-538Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
aged 80 and over, dementia test, mental status
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-160367 (URN)10.1111/jgs.15694 (DOI)000461567700019 ()30536796 (PubMedID)2-s2.0-85058337422 (Scopus ID)
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2020-04-29Bibliographically approved
Westerlind, B., Östgren, C. J., Midlöv, P. & Marcusson, J. (2019). Diagnostic Failure of Cognitive Impairment in Nursing Home Residents May Lead to Impaired Medical Care. Dementia and Geriatric Cognitive Disorders, 47(4-6), 209-218
Open this publication in new window or tab >>Diagnostic Failure of Cognitive Impairment in Nursing Home Residents May Lead to Impaired Medical Care
2019 (English)In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 47, no 4-6, p. 209-218Article in journal (Refereed) Published
Abstract [en]

Background/Objectives: Dementia and cognitive impairment are common in nursing homes. Few studies have studied the impact of unnoted cognitive impairment on medical care. This study aimed to estimate the prevalence of diagnostic failure of cognitive impairment in a sample of Swedish nursing home residents and to analyze whether diagnostic failure was associated with impaired medical care. 

Method: A total of 428 nursing home residents were investigated during 2008–2011. Subjects without dementia diagnosis were grouped by result of the Mini Mental State Examination (MMSE), where subjects with <24 points formed a possible dementia group and the remaining subjects a control group. A third group consisted of subjects with diagnosed dementia. These three groups were compared according to baseline data, laboratory findings, drug use, and mortality. 

Results: Dementia was previously diagnosed in 181 subjects (42%). Among subjects without a dementia diagnosis, 72% were cognitively impaired with possible dementia (MMSE <24). These subjects were significantly older, did not get anti-dementia treatment, and had higher levels of brain natriuretic peptide compared to the diagnosed dementia group, but the risks of malnutrition and pressure ulcers were similar to the dementia group. 

Conclusions: Unnoted cognitive impairment is common in nursing home residents and may conceal other potentially treatable conditions such as heart failure. The results highlight a need to pay increased attention to cognitive impairment among nursing home residents.

Place, publisher, year, edition, pages
S. Karger, 2019
Keywords
Cognitive impairment, Nursing homes, Morbidity, Dementia, Heart failure
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-159107 (URN)10.1159/000499671 (DOI)000491345900003 ()31269489 (PubMedID)2-s2.0-85068515589 (Scopus ID)
Note

Funding agencies:  Medical Research Council of Southeast Sweden (FORSS); Futurum - Academy for Health and Care, Region Jonkoping County

Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2021-10-04Bibliographically approved
Johansson, M. M., Marcusson, J. & Wressle, E. (2019). Maintaining health-related quality of life from 85 to 93 years of age despite decreased functional ability. British Journal of Occupational Therapy, 82(6), 348-356
Open this publication in new window or tab >>Maintaining health-related quality of life from 85 to 93 years of age despite decreased functional ability
2019 (English)In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 82, no 6, p. 348-356Article in journal (Refereed) Published
Abstract [en]

Introduction

The ‘oldest-old’ is the most rapidly growing age group in Sweden and in the western world. This group is known to be at great risk of increased functional dependency and the need for help in their daily lives. The aim of this research was to examine how the oldest-old change over time regarding health-related quality of life, cognition, depression and ability to perform activities of daily living and investigate what factors explain health-related quality of life at age 85 and 93 years.

Methods

In this study, 60 individuals from the Swedish Elderly in Linköping Screening Assessment study were followed from age 85 to 93 years. Measurements used were EQ-5D, Geriatric Depression Scale, Mini Mental State Examination and ability to perform activities of daily living. Nonparametric statistics and regression analyses were used.

Results

Although the individuals had increased mobility problems, decreased ability to manage activities of daily living, and thus had increased need of assistance, they scored their health-related quality of life at age 93 years at almost the same level as at age 85 years. No depression and low dependence in activities of daily living speaks in favour of higher health-related quality of life.

Conclusions

Health-related quality of life can be maintained during ageing despite decreased functional ability and increased need of assistance in daily life.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Health-related quality of life; daily living; elderly; occupational therapy
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-158562 (URN)10.1177/0308022619830261 (DOI)000469876400004 ()2-s2.0-85062771149 (Scopus ID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden [FORSS-8888, FORSS-11636, FORSS-31811]; County Council of Ostergotland [LIO-11877, LIO-31321, LIO-79951]; Janne Elgqvist Family Foundation

Available from: 2019-07-03 Created: 2019-07-03 Last updated: 2019-11-27Bibliographically approved
Johansson, M., Marcusson, J. & Wressle, E. (2016). Development of an instrument for measuring activities of daily living in persons with suspected cognitive impairment. Scandinavian Journal of Occupational Therapy, 23(3), 230-239
Open this publication in new window or tab >>Development of an instrument for measuring activities of daily living in persons with suspected cognitive impairment
2016 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 23, no 3, p. 230-239Article in journal (Refereed) Published
Abstract [en]

Background: According to the Swedish National Board of Health and Welfare, structured assessment of function and activity has high priority when investigating for dementia.

Aim/objectives: The aim was to develop and psychometrically test an instrument to measure self-reported and/or informant-reported ability to perform activities of daily living in persons with suspected cognitive impairment.

Material and methods: The Cognitive Impairment in Daily Life (CID) instrument 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 51 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 relevant activities were included. Most relatives considered that the activities included in the instrument were adequate and captured the patients’ difficulties in daily life. Some adjustments to the items and scale were suggested and these were done after each phase. In general, relatives indicated more difficulties than patients.

Conclusion: The CID instrument seems promising in terms of content validity. Further testing of reliability and construct validity is ongoing.

Keywords
Cognition, dementia investigation, instrument development
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-115306 (URN)10.3109/11038128.2016.1139621 (DOI)000374634100006 ()
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2017-12-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6452-3930

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