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Gender differences in predictors for survival in elderly nursing-home residents: A 3-year follow-up
Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 1, 18-24 p.Article in journal (Refereed) Published
Abstract [en]

This study focus on predicting factors of survival possible to modify by nursing care, and the incidence and mortality rate of nursing-home-acquired pneumonia, allocated to 1, 2 and 3 years of follow ups. The residents consisted of 156 women and 78 men living in special housing for the elderly. Data on chronic disease and medication were obtained at baseline, and activities of daily living (ADL) status, nutritional status and body temperature were assessed. The incidence of pneumonia was noted prospectively for 1 year and retrospectively for the following 2 years. Predictive factors for survival were explored by Cox hazard regression analysis. The results showed that age, functional and cognitive impairment were predictors of mortality irrespective of gender, while poor nutritional status in women and chronic obstructive pulmonary disease, heart disease and medication with sedatives in men were gender-specific predictors. ADL correlated positively with dementia and negatively with S-albumin irrespective of gender, while malnutrition correlated positively with ADL in women and positively with chronic obstructive pulmonary disease in men. To promote the quality of daily living in elderly individuals, it is of importance to improve the capabilities in daily functions and nutritional status, especially in women with functional impairment, and to prevent anxiety particularly in men. The findings also clarify that pneumonia is as common as cerebral vascular insult and heart failure as cause of death in this population.

Place, publisher, year, edition, pages
2007. Vol. 21, no 1, 18-24 p.
Keyword [en]
activities of daily living, gender, malnutrition, nursing care, pneumonia, survival
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13666DOI: 10.1111/j.1471-6712.2007.00431.xOAI: oai:DiVA.org:liu-13666DiVA: diva2:21131
Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2014-01-10
In thesis
1. Measurement and evaluation of body temperature: Implications for clinical practice
Open this publication in new window or tab >>Measurement and evaluation of body temperature: Implications for clinical practice
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim was to explore factors influencing the normal variation and measurement of body temperature. Additional aims were to study morbidity, mortality and the clinical presentation of pneumonia and predictors for survival in elderly nursing-home residents. Two hundred and thirty seven non-febrile nursing home residents (aged 66-99 years) and 87 healthy adults (aged 19-59 years) were included. In elderly individuals, the morning ear and rectal body temperature was measured at baseline and pneumonia and survival was observed at one- two and three-year. In healthy adults the rectal, ear, oral and axillary temperature were measured simultaneously on one morning and repeated measurements were performed in three subjects.

Overall, the range of normal body temperature was wider then traditionally stated. In elderly nursinghome residents, functional and cognitive impairment and BMI < 20 were related to a lower body temperature and medication with analgesics to a higher. Compared to adults < 60 years elderly persons had a higher average ear and a lower rectal temperature. Men and postmenopausal women < 60 years had lower body temperature than premenopausal women. The repeated measurements showed a wide individual variability irrespective of the site of measurement, and that replicated measurements do not improve accuracy. When comparing the rectal temperature with oral, ear and axillary readings the average difference was > 0.5°C with a wide individual variation.

The yearly incidence of nursing-home acquired pneumonia varied between 6.9% and 13.7%. Functional impairment, chronic obstructive pulmonary disease (COPD) and male sex were related to a higher risk of acquiring pneumonia and presenting non-specific symptoms were common. Age and functional impairment predicted mortality, irrespective of gender, while cerebral vascular insult, a lower body mass index and malnutrition in women and heart disease, COPD, medication with sedatives and mortality rate index in men were gender specific predictors. Surviving women had a higher baseline body temperature than non-surviving, while no such difference was found in men.

When assessing body temperature, it is important to consider the site of measurement, technical design, operator technique, age and gender and, in elderly nursing-home residents, physical and cognitive impairment, body constitution and medication with analgesics. The best approach is to use an unadjusted mode, without adjusting to another site. To prevent a delayed diagnosis of pneumonia, one should be aware of a low baseline body temperature and lack of specific clinical symptoms in elderly nursing-home residents. Preserving and/or improving functional, cognitive, nutritional status and preventing agitation and confusion would improve survival in nursing-home residents.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. 54 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 872
Keyword
Assessment, body temperature measurement, elderly, evaluation, infection, nursing home, pneumonia, survival
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5200 (URN)91-7373-848-4 (ISBN)
Public defence
2004-12-02, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2012-01-25Bibliographically approved

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Sund-Levander, MärthaGrodzinsky, EwaWahren, Lis Karin

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