Biomedical subjects
Publications and source records attributed to M Thorslund.
There are not many reports of Nordic intervention studies on the health and medical care of the elderly. Nevertheless much knowledge about old age is available and should be applied in practice under controlled conditions. In this overview article the authors present some experience from four of the Nordic countries to encourage further intervention studies, and focus some important aspects to be taken into consideration.
Research projects in order to evaluate social and health care programmes are unusual in Sweden. Evaluation studies have had little or no discernible effect on the planning of services for the elderly which is largely the product of convention rather than rational thinking. It is difficult to carry out evaluation studies in a field that is rapidly changing. The variations in elderly care between different areas, between institutions and over time makes it difficult to devise general methods of evaluation. Of five recent and current Swedish studies two are treating innovations inside institutions, two deal with innovations outside institutions and one is a relocation study. One thing common to these studies is that they are administered by university departments. However, evaluation is too important to be a matter just for university disciplines. We should also encourage local initiatives to start more evaluation of 'their' interventions. It will then be a task for more centrally placed researchers to educate and guide the administrators and representatives from other areas in what respects the result of a local study can be generalized.
A sample of elderly persons (75-84 years old) in Sweden was surveyed twice on home conditions, health and medical care. Two data collection methods were used: interviews and a mail survey. It has been shown that it is possible to carry out a mail survey (with low non-response) among the elderly in this group. However, what about other aspects of quality? Is it really possible to use a mail survey instead of the much more expensive and complicated techniques involved in interviewing? The results show that for certain groups of variables there are fairly large differences between how respondents reply in the mail survey and in personal interviews carried out by district nurses. These differences apply both to the degree of inconsistency in answers and to shifts in marginal distributions. Among other things, more ailments are mentioned at interview. The demand for information on the elderly and the differences between the methods in the cost of gathering this information make reliability and validity studies of methods of surveying the elderly increasingly important.
The aim of this study is to investigate predictors for mortality in two age groups, 75-84 years old and 85 years and older. Interviews were carried out on 161 community-based persons aged 75-84 and 260 persons aged 85 and over. Predictors for mortality 4 years later were analyzed using logistic regression. Different models to predict mortality were found for the two age groups. Gender and IADL (Instrumental Activities of Daily Living) were found to be significant for the older group while ADL (Primary Activities of Daily Living), mobility and life satisfaction were significant for the younger group. Eliminating variables based on the nurse's evaluations did not change the model for the 85+ age group; in the 75-84 age group the nurse's assessment of ADL was replaced by a self-reported IADL index. Results confirm the heterogeneity of the elderly population and the importance of ADL and subjective measures for predicting mortality.
In a repeated cross-sectional study, changes in nursing load and changes in care organisation (1978-1996) were studied in Sundsvall, Sweden. A total of 4555 nursing load measurements on elderly people were performed on four occasions (1978, 1988, 1993 and 1996). The nursing load has increased considerably at the nursing homes and at the homes for the aged during the whole period. In home care, the nursing load did not increase between 1978 and 1993, but it increased considerably between 1993 and 1996. The mean age of the residents, the number of persons with dementia, as well as the mean age, also increased. Between 1978 and 1996, the number of institutional resources decreased by 38%, while home care resources increased by 421%. The considerable increase in nursing load presents a worrying scenario when it is combined with the expected increase of the oldest old.
The degree of misplacement in the care organisation was studied in a repeated cross-sectional study (788 persons in 1993 and 1538 in 1988, 65 years and older) in Sundsvall, an industrial city in the middle of Sweden. The overall misplacements were 23% both in 1988 and 1993. Misplacements were most frequent in the homes for the aged (about 50%). At the nursing homes, misplacement decreased from 27 to 12% between 1988 and 1993, while it has increased in home care from 8 to 27%. Almost half of the misplacements in home care needed nursing home or psychogeriatric care. The main conclusion is that the care organisation is not working optimally. The number of misplacements reflects an exhausted care situation. The concept of misplacement is probably valuable, but its usefulness must be evaluated in further studies.
The aim of this study was to examine the prevalence of musculoskeletal pain and use of analgesic drugs in a population of very old people. The investigation is based on data from the Kungsholmen project. Of the 2638 inhabitants aged 75 or more in a parish of central Stockholm 1800 were examined. Of the subjects. 60% reported trouble with pain at musculoskeletal locations, while only 40% of the pain reporting subjects used analgesics, one third of which were non-prescription minor analgesics. Prescription analgesics (non-steroidal antiinflammatory drugs or centrally acting drugs) were used by one fourth of the pain reporting subjects, and taken on a regular basis in only half of the cases. Potent opioids were used by less than 1% of the population. There was no increase in pain with increasing age, but an increase in use of minor analgesics with age >85. Women more often reported pain and had a higher consumption of analgesics. Light opioids were more often used by subjects with multifocal pain. Subjects living in sheltered accommodation used more analgesics, particularly light opioids, than did those living in their own homes or in institutions. Subjects with low or intermediate educational status more often reported pain and used light opioids to a larger extent than did the highly educated. These results indicate that musculoskeletal pain is relatively common among the very old, but does not seem to be a severe problem for the majority, considering the low proportion of subjects using prescription analgesics regularly. However, the very low use of potent opioids indicates that some of the elderly suffering from cancer and other severe pain causing diseases might be undertreated.
In a representative, nationwide sample of non-institutionalized elderly in Sweden the bulk of help with basic and instrumental ADL came from informal sources. Formal services played a complementary role and were primarily associated with advanced age and living alone. The findings also indicated a strong preference among the elderly for informal support,with the preference for formal services being strongest among the elderly with the greatest need of care.
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