The MEGA study.
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Cardiovascular Diseases↗
Biomedical subjects
Timo E Strandberg
Publications and source records attributed to Timo E Strandberg.
Cardiovascular risk in midlife and psychological well-being among older men.
BACKGROUND: Negative and positive affects influence the prognosis in the elderly, but underlying mechanisms are obscure. We investigated whether cardiovascular disease risk in midlife is related to psychological well-being in older men (aged 69-84 years old). METHODS: A socioeconomically homogeneous volunteer sample of men, born from 1919 through 1934, was followed up for 29 years. At baseline in 1974, they were healthy but considered to be at low (n = 593) or high (n = 610) risk of cardiovascular diseases (repeatedly 1 or more of classic cardiovascular risk factors). From November 1, 2002, through March 31, 2003, a mailed questionnaire was used to assess psychological well-being in older survivors. Mortality up to December 31, 2002, was retrieved from national registers. RESULTS: During the entire follow-up, 303 men died, 127 (21.4%) and 176 (28.9%) in the low- and high-risk groups, respectively (hazard ratio, 1.54; 95% confidence interval, 1.19-2.00; P = .001). From 2002 through 2003, the response rates were 73.7% (336/456) and 71.4% (297/416) in the low- and high-risk groups, respectively (P = .45), and the mean age was 76 years. The variables related to psychological well-being were consistently better in the low-risk than in the high-risk group as they became older. The differences were observed especially in life satisfaction (P = .02), feeling of happiness (P = .001), positive life orientation as a whole (P = .04), and the Zung depression score (P = .007). The difference in the feeling of happiness between the groups prevailed (P = .01) after adjustments, including the feeling of depression. CONCLUSION: Low cardiovascular risk in midlife was associated not only with better survival but also with better psychological well-being in the elderly.
Aged↗
Cholesterol and glucose metabolism and recurrent cardiovascular events among the elderly: a prospective study.
OBJECTIVES: The aim of this research was to evaluate the prognostic value of cholesterol absorption assessed with the serum cholestanol-to-cholesterol concentration ratio (lower level reflects decreased cholesterol absorption) among elderly cardiovascular patients (DEBATE [Drugs and Evidence-Based Medicine in the Elderly] study). BACKGROUND: The components of the metabolic syndrome have been unexpectedly associated with better prognosis among elderly cardiovascular patients. On the other hand, a metabolic syndrome-type state is characterized by high synthesis and decreased absorption of cholesterol. METHODS: This was a prospective cohort study of home-dwelling individuals age 75 years and older with cardiovascular diseases (247 women, 129 men) recruited from the community. Main outcome measure was multivariate-adjusted time to 3.4-year mortality and recurrent major cardiovascular events. RESULTS: Serum total and low-density lipoprotein cholesterol levels did not predict outcome. Instead, the mortality risk (64 deaths) increased with increasing levels of cholestanol-to-cholesterol ratio. Patients in the 2nd, 3rd, and 4th quartiles had a relative hazard ratio (HR) for death of 2.54 (95% confidence interval [CI] 1.05 to 6.12), 2.48 (95% CI 1.03 to 6.00), and 3.53 (95% CI 1.52 to 8.19) compared with the lowest quartile, even though 50% of individuals in the lowest cholestanol quartile had metabolic syndrome or diabetes. In multivariate models, the lowest cholestanol ratio quartile was independently associated with lower mortality (relative HR, 0.37, 95% CI 0.17 to 0.81), and with fewer major cardiovascular events (115 events, relative HR, 0.59, 95% CI 0.35 to 0.98). CONCLUSIONS: Low cholesterol absorption was associated with fewer recurrent cardiovascular events, and with better survival in elderly patients despite frequent abnormalities of glucose metabolism.
Aged↗
Continuity of temperament from infancy to middle childhood.
Continuity of temperament from 6 months (the IBQ) to 5.5 years (the CBQ) was explored in Finnish children (n=231) within the theoretical framework deviced by Rothbart. Activity level, smiling and laughter, distress to limitations and fear showed significant differential homotypic and heterotypic continuity, while soothability and duration of orienting showed significant differential heterotypic continuity. On the level of latent superconstructs, infant positive and negative affectivity accounted for 4.6, 22.3, and 6.0% of the variance in childhood extraversion, effortful control and negative affectivity, respectively. Infant and childhood temperament clustered into profile types named "resilient", "undercontrolled", and "overcontrolled" mirroring ipsative continuity. These findings give empirical credence to Rothbart's theory by replicating and extending previous findings in significant ways.
Child, Preschool↗
Fetal programming of temperamental negative affectivity among children born healthy at term.
The fetal programming hypothesis suggests that an adverse in utero environment, reflected in small body size at birth, has life-long effects on different physiological systems that may affect both health and behavior. We explored whether fetal growth was associated with biologically based temperamental outcomes (negative affectivity scales, the CBQ) among 5(1/2)-year-old children (n = 416) born healthy at term (gestational weeks 37-42). In line with the hypotheses, small body size at birth (thinness measured by ponderal index, kg/m(3)) was related to increased negative affectivity and its subscales: anger-, discomfort-, and sadness-proneness in childhood. Longer length at birth was predictive of higher levels of child anger- and sadness-proneness. Length of gestation moderated the associations of weight and length at birth with negative affectivity. The results suggest that the biological basis of temperament may be subjected to antenatal environmental influences, and that the mechanisms, proposed to be related to fetal glucocorticoid environment, may operate even within the normal range of term birth.
Affect↗
Multifactorial intervention to prevent recurrent cardiovascular events in patients 75 years or older: the Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study: a randomized, controlled trial.
OBJECTIVE: We aimed to examine whether better use of preventive methods and treatments of cardiovascular disease would reduce recurrent events in home-dwelling patients 75 years or older. METHODS: This was a randomized, controlled trial (a practical clinical trial, the DEBATE), conducted in 2000 to 2003 in Helsinki, Finland. We recruited 400 vascular patients with mean age of 80 years from the community, and they were randomly assigned to the intervention group (n = 199) where both nonpharmacological and pharmacological cardiovascular treatments were optimized by a geriatrician according to current guidelines. The control group (n = 201) received the usual care. Main outcome measures were major cardiovascular disease events and total mortality and changes in risk factors and medications. RESULTS: The groups were balanced at baseline. Mean duration of follow-up was 3.4 years. At 3 years, drug treatments had become more evidence-based in the intervention group. Consequently, total and low-density lipoprotein cholesterol levels (P < .0001) and systolic (P = .005) and diastolic (P = .009) blood pressure were significantly improved in the intervention group. However, neither primary end points (52 and 53 events in the intervention and control groups, respectively) nor total mortality (36 and 35 deaths) were significantly different between the two groups. No special adverse effects were encountered. CONCLUSION: It was possible and safe to institute evidence-based cardiovascular treatments and improve risk factors in patients 75 years or older in a pragmatic setting. During 3.4 years, however, this was not converted to clinical benefits.
Aged↗
Depressive vulnerability in parents and their 5-year-old child's temperament: a family system perspective.
The actor-partner interdependence model was used to test whether one parent's depressive vulnerability (self-criticism and dependency) was associated with the same parent's own (an intraparental association) and the other parent's (a cross-parental association) ratings of their 5-year-old child's temperament (536 parents, 268 dyads). The more vulnerable the parents were, the more the children showed negative affectivity and lack of effortful control. Significant interactions with the parent's gender and between the spouses' depressive vulnerabilities were found, highlighting the fact that child outcomes are dependent on family processes. All associations were independent of maternal and paternal depressive symptoms. The influence of personality-based depressive traits on child temperamental outcomes and effective parenting is discussed with reference to between-dyad family dynamics.
Child of Impaired Parents↗
Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial.
BACKGROUND: Delirium is a common syndrome with poor prognosis affecting elderly inpatients. Treatment is mainly based on common sense with wide variations in practice. We investigated whether intensified, multicomponent geriatric treatment could improve the prognosis of delirious patients. METHODS: We performed a randomized, controlled trial of 174 patients with delirium in six general medicine units from an acute hospital in Helsinki, Finland. The intervention group received individually tailored geriatric treatment. The primary endpoint was the sum of those deceased individuals and the patients permanently institutionalized. Secondary endpoints included the number of days in hospitals and other institutions, delirium intensity, and cognition. RESULTS: The mean age of patients was 83 years, and 31% had previous dementia. The intervention group (N = 87) received significantly more acetylcholinesterase inhibitors (58.6% vs 9.2%), atypical antipsychotics (69.8% vs 30.2%), specialist consultations (49.4% vs 28.7%), hip protectors (88.5% vs 3.4%), physiotherapy (87.4% vs 47.1%), and fewer conventional neuroleptics (8.0% vs 23.0%) than did the control group (N = 87). During the 1-year follow-up, 60.9% of the intervention group and 64.4% of controls were either deceased or permanently institutionalized (p =.638). The intervention group spent a mean of 126 days in institutions, and the control group 140 days (p =.688). Delirium was, however, alleviated more rapidly during hospitalization, and cognition improved significantly at 6 months in the intervention group. CONCLUSIONS: Faster alleviation of delirium and improved cognition justify good, comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis.
Aged↗
Social contacts and their relationship to loneliness among aged people - a population-based study.
BACKGROUND: Emotional loneliness and social isolation are major problems in old age. These concepts are interrelated and often used interchangeably, but few studies have investigated them simultaneously thus trying to clarify their relationship. OBJECTIVES: To describe the prevalence of loneliness among aged Finns and to study the relationship of loneliness with the frequency of social contacts, with older people's expectations and satisfaction of their human relationships. Especially, we wanted to clarify whether emotional loneliness is a separate concept from social isolation. METHODS: The data were collected with a postal questionnaire. Background information, feelings of loneliness, number of friends, frequency of contacts with children, grandchildren and friends, the expectations of frequency of contacts as well as satisfaction of the contacts were inquired. The questionnaire was sent to a random sample of 6,786 aged people (>74 years) in various urban and rural areas in Finland. We report here the results of community-dwelling respondents (n = 4,113). MAIN RESULTS: More than one third of the respondents (39.4%) suffered from loneliness. Feeling of loneliness was not associated with the frequency of contacts with children and friends but rather with expectations and satisfaction of these contacts. The most powerful predictors of loneliness were living alone, depression, experienced poor understanding by the nearest, and unfulfilled expectations of contacts with friends. CONCLUSION: Our findings support the view that emotional loneliness is a separate concept from social isolation. This has implications for practice. Interventions aiming at relieving loneliness should be focused on enabling an individual to reflect her own expectations and inner feelings of loneliness.
Aged↗
Use of inappropriate medications and their prognostic significance among in-hospital and nursing home patients with and without dementia in Finland.
BACKGROUND: Although the Beers criteria have been frequently utilised to describe the use of inappropriate medications in various elderly populations, less is known about the use of such medications among patients with dementia, and nor have many studies dealt with their impact on mortality or use of healthcare services. This study examines the use of inappropriate drugs and their impact on mortality and use of health services among Finnish elderly nursing home and hospital patients. Patients with dementia were studied as a special subgroup. METHODS: A total of 425 patients consecutively admitted to seven Finnish nursing homes and two hospitals in 1999-2000 were examined. Details of all medications prescribed and administered were retrieved from medical records and coded according to the Beers 1997 criteria. Mortality data as well as days in acute hospital were obtained from central registers and all area hospitals during 2 years of follow-up. RESULTS: The entire population was old and frail (mean age 86 years, 82% females), 60% had dementia and 36.2% received at least one potentially inappropriate drug (PID). No differences existed in the proportion of users of PIDs among those 60% of patients with dementia compared with those without. The most common PID was temazepam, with 14% of all patients on high doses. Other commonly used PIDs were oxybutynin and dipyridamole. Amitriptyline was more commonly used among patients without dementia (4.7%) compared with those with dementia (0.8%). Nevertheless, in this very old and frail study population, use of inappropriate drugs did not predict mortality or use of health services. CONCLUSION: Use of PIDs is common in nursing homes and hospitals in Finland but has no impact on mortality or hospital admissions. Use of high-dose temazepam as a hypnotic accounted for most of the high use of PIDs.
Aged↗
Do gestational age and weight for gestational age predict concordance in parental perceptions of infant temperament?
OBJECTIVE: To study whether infant weight for gestational age, and gestational age predict mother- and father-rated infant temperament (IBQ) at 6 months. METHODS: The sample comprised of family units with both biological parents and infants born at term (n = 152). Data on weight and gestational age were collected form obstetric database. RESULTS: Infants born small for gestational age (SGA) (weight < 10th percentile for gestational age) were rated by both parents as significantly more fearful and negatively reactive compared to infants born appropriate for gestational age (AGA). Infants born SGA defined by using the lowest 15th or 20th percentile groups did not differ from AGA group in temperament. The weekly continuum of gestational age predicted differences in parental ratings of infant temperamental attentiveness. CONCLUSIONS: The predictive significance of infant weight for gestational age and gestational age for behavioral outcomes appear true also for infants born at term. Concordance in parental perceptions of an infant born SGA emphasizes the clinical significance of the findings.
Adult↗
Secondary prevention of stroke is important: but all hypertensive drugs are not created equal?
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Angiotensin II Type 1 Receptor Blockers↗
Older people's reasoning for resuscitation preferences and their role in the decision-making process.
OBJECTIVES: To investigate older patients' reasoning for their cardiopulmonary resuscitation (CPR) preferences and the related decision-making process (DMP). METHODS AND SUBJECTS: In a descriptive study 220 elderly home-dwelling cardiovascular patients were interviewed and asked to justify their CPR preferences according to the given statements. Questions related to DMP were asked and their physical function, cognition, mood, and quality of life were assessed. RESULTS: Resuscitation preferences were associated with several patient characteristics, such as age, mood and quality of life. Patients preferring CPR (114/220, 52%) estimated their prognosis of CPR to be better than those preferring to forgo CPR. They justified their view: "Life is precious and worth living for me" (92%), "Maintaining life is a value of its own" (92%), "I feel needed by my family and my closest" (81%). Participants preferring to forgo CPR (106/220, 48%) justified: "I have already gained old age and led a full life" (88%), "People cannot decide these things" (72%). Only 9% of patients had discussed, and 38% would like to discuss preferences for life-sustaining treatments (LSTs) with their physician. However, 80% of respondents felt that the patients should take some part in the DMP; either alone (9%), together with a physician (23%), or together with a physician and a close relative (48%). CONCLUSIONS: Older people justify their resuscitation preferences highlighting their experiences of meaningful life or fulfillment of their life, interpersonal relationships with their loved ones and presumed outcome of CPR. Less than a half of the patients wished to discuss CPR and LSTs preferences in their current situation with their physician, but nevertheless wanted to participate in the DMP of end-of-life treatment. Physicians should assess patients' own preferences in-depth.
Aged↗
Interaction of herpesviridae, APOE gene, and education in cognitive impairment.
While high age, low level of education and APOE epsilon4 allele are known to predict dementia, there is recent data suggesting that certain viruses and subtypes of APOE epsilon3 could be involved, too. We investigated these relationships in a home-dwelling cohort of 357 elderly people with various cardiovascular diseases (DEBATE study). MMSE score below 24 was used to define cognitive impairment (n = 58). When adjusted for age and the presence of diabetes, multivariate analysis demonstrated maximally increased risk of cognitive impairment in association with a combination of three factors: seropositivity for herpesviridae, presence of APOE epsilon4, and low education (risk ratio 6.1, 95% CI 2.4-15.2). In the subcohort of APOE3/3 individuals (n = 216) homozygosity for the -219G epsilon3 haplotype showed a similar association (risk ratio 8.8, 95% CI 2.6-29.8). These results demonstrate an interaction of specific genetic (APOE) and environmental (education and herpesviridae) risk factors in the development of cognitive impairment and indicate that not only the epsilon4 allele of APOE but also the epsilon3 haplotype is a risk factor for dementia.
Aged↗
Physical and cognitive functioning and resuscitation preferences of aged patients.
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Aged↗
Psychotropic medication and stroke outcome.
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Age Factors↗
Prognostic significance of delirium in frail older people.
Our aim was to investigate the long-term prognosis of delirium in the frailest elderly, and to clarify whether delirium is just a marker of the underlying severe disease. We used logistic regression analysis to determine the independent prognostic significance of delirium. A representative sample of 425 patients (> or = 70 years) in acute geriatric wards and nursing homes were assessed at baseline and followed up for 2 years. DSM-IV was used for classification. The prevalence of delirium at baseline was 24.9% (106/425). The prognosis of delirium was poor: mortality at 1 year was 34.9 vs. 21.6% in nondelirious subjects (p = 0.006), and at 2 years 58.5 vs. 42.6% (p = 0.005). Among home-dwelling people at baseline, 54.4% of the delirious vs. 27.9% of others were permanently institutionalized within 2 years (p < 0.001). In logistic regression analysis, delirium was an independent predictor for mortality at 1 year (OR 1.86, 95% CI 1.1-3.1), at 2 years (OR 1.76, 95% CI 1.1-2.8), and for permanent institutionalization (OR 2.45, 95% CI 1.2-4.9). Delirious patients with prior dementia tended to have a better prognosis than those without.
Activities of Daily Living↗
Low cholesterol, mortality, and quality of life in old age during a 39-year follow-up.
OBJECTIVES: We assessed the impact of serum cholesterol level in early midlife on total mortality during up to 39 years of follow-up and on the quality of life (QoL) in old age. BACKGROUND: Total effects of low serum cholesterol on health have been in dispute, especially in elderly persons, and there are few data on the long-term effects of low cholesterol on QoL. METHODS: The cohort consisted of 3,277 healthy businessmen age 30 to 45 years at baseline (1960s). In addition to baseline, serum cholesterol values were available for part of the cohort in 1974, 1986, and 2000. The QoL was assessed in 80.9% of survivors (n = 1,820, mean age 73 years) with a RAND-36 (SF-36) QoL questionnaire in 2000. Mortality up to 2002 (n = 1,173) was retrieved from national registers. RESULTS: Cholesterol was clearly reduced in survivors during follow-up, except in the lowest baseline serum cholesterol group. Baseline cholesterol predicted 39-year total mortality in a graded manner (p < 0.0001), and a value < or =5.0 mmol/l was associated with a 25% reduction in total mortality. In old age, the physical component summary score of RAND-36 was significantly (p = 0.02) higher (better) in the lowest baseline cholesterol group; no difference was found in the mental component summary score (p = 0.51). CONCLUSIONS: Low serum cholesterol level in midlife predicted not only better survival but also better physical function and QoL in old age, without adversely affecting mental QoL.
Adult↗