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Health-related factors associated with hospitalization for old people: Comparisons of elderly aged 85 in a population cohort study
Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
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2012 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 54, no 2, 391-397 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this population-based study was to (1) describe living conditions and actual health care utilization among 85 year olds; (2) determine factors that affect hospital admissions in this age. The study was conducted on 85-year-old residents in Linkoping municipality, Sweden. The data collected included medical records, health care utilization during the preceding 12 months and a postal questionnaire on assistance, assistive technology, functional impairment, feelings of loneliness, worries and health-related quality of life measured by the EQ-5D. Out of 650 eligible individuals, 496 (78% of those alive) participated. Despite the prevalence of multi-morbidity (68%) and mental discomfort, the majority managed self-care (85%), usual activities (74%) and had high (andgt;60/100) self-rated health evaluated by a visual analog scale (VAS). The non-hospitalized group reported a better health status than the hospitalized group in terms of medical aspects, living conditions and subjective estimation. Factors associated with in-patient care were an increased number of general practitioner visits, more assistive technology, community assistance, multimorbidity and/or diagnosed congestive heart failure and arrhythmia.

Place, publisher, year, edition, pages
Elsevier , 2012. Vol. 54, no 2, 391-397 p.
Keyword [en]
Population study, Hospitalization, Health care service, postal questionnaire
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-76812DOI: 10.1016/j.archger.2011.04.023ISI: 000301647400064OAI: diva2:516823

Funding Agencies|Health Research Council of the South-East of Sweden|FORSS-8888FORSS-11636FORSS-31811|County of Ostergotland|LIO-11877LIO-31321LIO-79951|Janne Elgqvist Family Foundation||

Available from: 2012-04-20 Created: 2012-04-20 Last updated: 2014-06-04
In thesis
1. Health Maintenance in Very Old Age: Medical Conditions, Functional Outcome and Nutritional Status
Open this publication in new window or tab >>Health Maintenance in Very Old Age: Medical Conditions, Functional Outcome and Nutritional Status
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to provide better understanding of the underlying factors related to health maintenance in very old people, with a focus on medical conditions, functional outcome and nutritional status. Data were gathered from the ELSA 85 project (Elderly in Linköping Screening Assessment). The ELSA 85 project was started in 2007 with a population-based survey of 85-year-old individuals (n = 650) residing in Linköping municipality, Sweden. During the study period from 2007 to 2010, we conducted surveys by postal questionnaire, home visits, geriatric clinic visits, and reviews of electronic medical records as well as the database of health service consumption. A series of cross-sectional analyses were performed on multimorbidity, health service consumption, activities of daily living (ADLs), physical functioning and nutritional status.

Of 650 eligible individuals, 496 (78% of those alive) completed the questionnaire (Paper I). Despite the prevalence of multimorbidity (68%) and frequent use of assistive technology for mobility (40%), the majority managed self-care (85%), usual activities (74%) and had high self-rated health (>60/100, visual analogue scale). Factors associated with in-patient care were an increased number of general practitioner visits, more use of assistive technology, community assistance, multimorbidity (≥2 chronic diseases) and/or heart failure and arrhythmia.

Cluster analyses (n = 496, Paper II) 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 ageing (one for men and two for women). Heart failure in men (odds ratio [OR], 2.4; 95% confidence interval [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 ageing clusters (OR, 0.5; 95% CI, 0.3–0.8) showed interaction effects on hospitalization.

In Paper III, overweight (body mass index [BMI], 25–29.9 kg/m2) and obese (BMI, ≥30 kg/m2) individuals (n = 333) perceived more difficulty performing instrumental ADL (IADL) and had more comorbidities than their normal weight counterparts (BMI, 18.5–24.9 kg/m2). After controlling for socio-demographic factors, obese but not overweight individuals were more likely to perceive increased difficulty in performing outdoor activities (OR, 2.1; 95% 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 individuals of normal weight and nearly three times as much as in obese individuals (ratio, 2.9; 95% CI, 1.1–8.1).

In Paper IV, 88-year-old obese women (n = 83) had greater absolute waist circumference, fat mass (FM) and fat-free mass (FFM), and lower handgrip strength (HS) corrected for FFM and HS-based ratios (HS/weight (Wt), HS/BMI, HS/FFM and HS/FM) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, the HS-based ratios explained more variance in physical functioning in Short Form-36 (R2, 0.52–0.54) than other single anthropometric or body composition parameters (R2, 0.45–0.51). Waist circumference, HS, and two HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty.

In conclusion, the ELSA 85 population showed a fairly positive image of healthy perception, good functional ability as well as low use of health care among the majority of participants. Patterns of cardiac and pulmonary conditions were better associated than any single morbidity with hospitalization. Heart failure as a single morbidity was better associated than multimorbidity patterns with emergency room visits. For 85-year-olds, being obese, as opposed to overweight, was associated with self-reported activity limitations and comorbidities. Overweight elderly living in their own homes in this population had similar well-being to those of normal weight. In the cohort of 88-year-olds, obese women had high waist circumference, but their HS was relatively low in relation to their Wt and FFM. These parameters were better than BMI for predicting physical function and independent daily living.

Abstract [sv]

Att åldras innebär inte bara en utveckling över tid utan också en förändring av människans fysiologi och funktion. Vi har många olika bilder av åldrandet. Ofta överväger de negativa bilderna som betonar sjuklighet och höga samhällskostnader för vård och omsorg. ELSA 85, en förkortning av the Elderly in Linköping Screening Assessment, påbörjades 2007 med avsikt att kartlägga 85-åringars hälsotillstånd och funktion. Syftet med denna avhandling var att fördjupa kunskapen om faktorer med betydelse för bevarande av hälsa hos dessa 85-åringar.

Populationsstudien genomfördes via enkätutskick (bl.a. livssituation, livskvalitet), hembesök (bl.a. aktiviteter i dagliga livet (ADL), kognitiva funktioner) och mottagningsbesök (bl.a. nutritionsstatus, rörelseförmåga, kroppslig undersökning, blodprover, läkemedel) under perioden mars 2007 till mars 2008. Vi kartlade även deltagarnas sjukvårdsbesök samt sjukvårdskostnader. Tre år senare, när individerna var 88 år, analyserades även kroppssammansättningen hos delar av populationen.

Totalt 496 Linköpingsbor födda 1922, deltog i studien. Andelen som svarade på enkäten var 78 % av alla då levande 85-åringar. Resultaten visar att majoriteten av 85-åringarna klarade att sköta sin hygien (85%) samt huvudsakliga aktiviteter (74%). Sextio procent skattade sin hälsorelaterade livskvalitet som hög trots förekomst av flera kroniska sjukdomar och frekvent användning av hjälpmedel för att förbättra rörligheten. Oberoende riskfaktorer för slutenvård var multipla besök hos distriktsläkare, användande av flera hjälpmedel, förekomst av minst två sjukdomar eller förekomst av hjärtsvikt och arytmi.

Multimorbiditet (förekomst av minst två kroniska sjukdomar) var vanligt hos 85-åringarna (68%). Olika kombinationer av sjukdomar hade varierande betydelse för behovet av sjukvård. I clusteranalys, där man försöker gruppera diagnoser med hög sannolikhet att förekomma hos en enskild individ, fann vi några cluster som var starkare relaterade till inläggning i slutenvård än andra. Clustren såg dessutom olika ut mellan män och kvinnor. För män var t.ex. kardiella och för kvinnor t.ex. hjärt-lung-cluster starkare relaterade till slutenvård än enskilda diagnoser.

Personer med fetma (body mass index (BMI) ≥30 kg/m2) hade mer problem med rörlighet och instrumentell ADL (IADL) jämfört med de med normal- eller övervikt. Trots ett klart samband mellan fetma och multimorbiditet hade de normalviktiga individerna nästan tre gånger så höga hälso-sjukvårds kostnader som personer med fetma.

Bland 88-åriga kvinnor, hade personer med fetma högre bukomfång, mer fettmassa (FM) och mer fettfri massa (FFM) men lägre handstyrka (HS) än de normal- eller överviktiga. Relativ HS, handstyrka i form av kvoter (HS/Vikt, HS/BMI, HS/FFM and HS/FM) hade starkare samband med fysisk funktion (Short Form-36, SF-36PF) än andra enskilda parametrar. Två enskilda parametrar (bukomfång och HS) samt HS/Vikt och HS/FFM var associerade med antal aktiviteter utan svårighet i IADL.

Sammanfattningsvis är 85-åringarna inte så skröpliga som de ofta beskrivs. Studien ELSA 85 visar en övervägande positiv bild med bevarad hälsa och funktion för en övervägande del av populationen. De flesta 85-åringarna klarar sig ganska bra trots förekomst av flera sjukdomar. Vissa mönster av multimorbiditet med hjärt- och lungsjukdomar är mer relaterade till slutenvård medan hjärtsvikt hade hög risk för akutmottagningsbesök. Därför är det viktigt att beakta en komplexitet av sjukdomar, inte bara enskilda diagnoser eller antalet diagnoser, i planeringen av den framtida vården. Personer med normal- eller övervikt klarar sin funktion bättre och lever mer självständigt än de som lider av fetma. Den betydande andelen feta med begränsad rörlighet och funktion bland äldre kan komma att påverka behovet av tyngre omsorgsinsatser för den gruppen och är således en varningssignal inför framtiden.

Abstract [zh]

【目的】      通过研究高龄老人的医疗情况,躯体功能和营养状态,提高对高龄老人健康维护相关因素的理解。

【方法】      ELSA 85 项目(林雪平老年人普查,Elderly in Linköping Screening Assessment)是一个以瑞典林雪平城市中85岁高龄老人(1922年出生, n = 650)为研究对象的人群研究。(1) 2007/03–2008/03:通过邮寄问卷,家庭访问及门诊检查的三个步骤, 我们搜集的数据包括:个人和家庭的背景信息(居住情况,既往的学历和工作程度,健康相关的生活质量EQ-5D等),身体机能(日常生活活动能力ADL评定,移动性测试等)和营养状态(人体测量等)。我们同时还阅览了所有注册的电子病历和每位老年人的年卫生费用。(2) 2010/06–2010/10: 在3年后的随访中,我们对所有88岁的女性老年人增加了人体组成测定和SF-36健康调查量表之生理功能子量表(SF-36PF)的评估。

ELSA 85 项目还包括了其他医学检查项目以及为期一年的随访(2008–2009), 但这些数据统计并未列入本论文中。

【结果】      论文1:共496人(参与率78%)回寄并参与了问卷调查。总体而言,虽然慢性多病以及日常生活中频繁使用辅助身体移动的器具在85岁高龄老人中非常普遍,多数老年人仍然能够完成个人卫生自理和常规日常活动。他们在健康相关评价问卷中的评估自身健康状态多为良好 (EQ-5D评估)。与住院相关的风险因素包括:全科医生的年就诊次数,有共患疾病(存在两种或两种以上的慢性病征),或者是心力衰竭和心律失常两个单病种。

论文 2:运用聚类分析和性别分层对共患疾病归类,生成男女组各五个集群:血管性类疾病集群,心肺疾病集群,心源性疾病集群(只存于男性组内),躯体-精神心理疾病集群(只存于男性组内),精神心理性疾病集群(只存于女性组内),以及三个和老化过程有关的集群(男性组内1组,女性组内2组)。心力衰竭 (男性组内的比值比 OR = 2.4,95% 的可信区间CI = 1–5.7;女性组内 OR = 3,95% CI = 1.3–6.9) 作为单一病种在预测急诊就诊的模型中比任一共患疾病集群都能解释更多的变量值。男性组内的心源性疾病集群 (OR = 1.6,95% CI = 1–2.7) 和女性组内的心肺疾病集群(OR = 1.7,95% CI = 1.2–2.4)与预测是否住院显著有关。在住院模型中, 心肺疾病集群与男性的心源性疾病集群(OR = 1.6,95% CI = 1–2.4), 或与女性组内的老化相关集群(OR = 0.5,95% CI = 0.3–0.8)具有显著的交互作用。

论文3:超重(体重指数 BMI:25–29.9 kg/m2)和肥胖(BMI ≥30 kg/m2)者在工具性日常生活活动评定(IADL)比正常体重者(BMI: 18.5–24.9 kg/m2)有更多的困难,再者也比正常体重者有更高伴发疾病的风险。但是在控制了混杂变量(社会人口因素)后,对照正常体重组,只有肥胖者而不是超重者的IADL(户外活动:OR= 2.1,95% CI=1.1–4;居室清洁:OR= 2.2,95% CI= 1.2–4.2)存在更大的困难。虽然肥胖与共患疾病相关(OR= 3,95% CI=1.2–8),有共患疾病的正常体重者的卫生服务消费却是共患疾病的肥胖者的近三倍(ratio= 2.9,95% CI= 1.1–8.1)。

论文 4:88岁女性肥胖组相比正常体重和超重组而言,其腰围值、脂肪群值和祛脂肪群值较大。肥胖者的绝对握力值在校正祛脂肪群后以及握力比值(握力/体重,握力/BMI,握力/祛脂肪群,等等)都较其他两组低。在控制个体的体力活动程度和慢性疾病数量后,握力比值对生理功能(SF-36PF)的解释度(R2:0.52–0.54)高于任何单一人体测量指标或人体组成成分的测定值(R2:0.45–0.51)。腰围值、绝对握力值及握力比值(握力/体重和握力/祛脂肪群)与IADL中无困难的活动项目数显著相关。

【结论】      ELSA 85 人群研究显示了一个相对健康的,个体功能良好的,且使用卫生服务较低的高龄老年群体。心源性和肺部疾病的共患与住院风险相关,而心力衰竭作为单一病种与急诊就诊有显著相关。对85岁高龄老人而言,肥胖(但不是超重)与个体的活动限制和伴发疾病有关。居住于自己住所内的超重高龄老人,其健康水平与正常体重者相近。在88岁女性高龄老人中,肥胖者有较大的腰围值和较低的握力比值(握力/体重和握力值/祛脂肪群)。这些指标比体重指数更好地反映了生理功能及高龄老人的日常独立生活能力。

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 56 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1398
very old, multimorbidity, health service use, physical function, activities of daily living, obesity, body composition
National Category
Health Sciences Geriatrics
urn:nbn:se:liu:diva-105087 (URN)10.3384/diss.diva-105087 (DOI)978-91-7519-385-4 (print) (ISBN)
Public defence
2014-04-03, Berzeliussalen, ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Elderly in Linköping Screening Assessment, ELSA 85
Available from: 2014-03-13 Created: 2014-03-07 Last updated: 2014-03-13Bibliographically approved

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Nägga, KatarinaDong, Huan-JiMarcusson, JanWressle, Ewa
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GeriatricFaculty of Health SciencesDepartment of Geriatric Medicine in LinköpingDepartment of Clinical and Experimental Medicine
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