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The combination of modern interventional and preventive medicine has led to an epidemic of ageing. While this phenomenon is a positive consequence of an improved lifestyle and achievements in a society, the longer life expectancy is often accompanied by decline in quality of life due to musculoskeletal pain and disability. The Aarhus Regenerative Orthopaedics Symposium (AROS) 2015 was motivated by the need to address regenerative challenges in an ageing population by engaging clinicians, basic scientists, and engineers. In this position paper, we review our contemporary understanding of societal, patient-related, and basic science-related challenges in order to provide a reasoned roadmap for the future to deal with this compelling and urgent healthcare problem. [ABSTRACT FROM AUTHOR]

Extended working lives become important in aging populations. Yet, for a long time, increasing computer use pushed older individuals out of the workforce. Recently, older workers' computer skills have improved. This article investigates how computer use, experience, and training affect workforce participation in old age in countries with widespread computer use. It conducts regression analyses of Danish and Finnish survey data. Findings show that individuals who used computers had a higher chance of remaining in the workforce. Computer experience made older Finns marginally more likely to retire. However, computer training had no influence. Findings suggest that the relevance of computer use for extended working lives depends on a country's computerization level: the higher the level, the less of an obstacle to extended working lives computerization presents. Policymakers should facilitate older workers' computer use especially when computers are first introduced, and explore alternative means for extending working lives afterwards. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this PhD thesis was to analyse: (1) the prevalence and causes of visual impairment and blindness among adult Danes (papers I–III); (2) the 14-year incidence of age-related maculopathy (ARM) (paper IV); (3) the 14-year incidence of visual loss with special attention to ARM (paper IV); (4) the risk factors for development of ARM (papers IV and V); and (5) the association between ARM and survival (paper VI). The studies were based on data from the Copenhagen City Heart Study (CCHS), the baseline eye study conducted by Troels Vinding MD, and the follow-up eye study conducted by Helena Buch MD. The CCHS is a population-based cohort study that included initially a random population sample of almost 20 000 people. This cohort includes the basis population of the Copenhagen City Eye Study, which includes two subsamples: (1) 1000 individuals between the ages of 60–80 years from the second CCHS population who were studied twice with a mean time interval of 14.5 years (range, 12.6–16.1 years) to determine the prevalence (papers I and II) and incidence rates (papers IV–VI) among elderly Danes, based on standardized clinical and grading procedures; and (2) 9980 individuals aged 20–84 years from the third CCHS population who were studied to determine cause-specific prevalence rates of visual loss with a wide age range based on a validated questionnaire-response method (paper III).(1) The prevalence of visual loss rose significantly with age. Using the national criteria, the age-standardized prevalence rates of visual impairment and blindness for people aged 20–64 years were 0.21% and 0.10%, respectively. However, for people aged 65–80 years the age-standardized prevalence rates of visual impairment and blindness were 3.89% and 1.14%, respectively. The distributions of the causes of visual loss varied by age. The most important contributors to poor vision occurring before the age of 65 years were optic neuropathy, diabetic retinopathy, retinitis pigmentosa, excessive myopia and other retinal diseases. After the age of 64 years, late ARM and cataract were the primary causes of the age-related increase in the prevalence of visual loss. Late ARM was the major cause of prevalent blindness. The potential impact of therapeutic intervention is great; when the causes of visual impairment and blindness were grouped for Danish people aged 20–84 years, 29% had the potential for improved vision via surgical intervention, and 15% had potentially preventable eye diseases.(2) The cumulative 14-year incidence of early and late ARM in either eye was 37.8% and 16.9%, respectively. The cumulative incidence of exudative ARM in either eye was 12.0% and that of pure geographic atrophy was 4.9%, and the rates increased with age (P < 0.01).(3) The cumulative 14-year incidences of visual impairment or legal blindness in the better eye were 16.7% and 5.1%, respectively, and those of visual impairment or legal blindness from late ARM were 6.0% and 3.4%, respectively. Late ARM, the leading cause, resulted in 66.7% of all incident blindness.(4) Our findings indicate that severe drusen type, large drusen and pigmentary abnormalities were predictors for progression to late ARM and associated visual loss. Additionally, a direct correlation was found between age, cataract, family history, alcohol consumption and the apolipoproteins A1 and B and the 14-year incidence of ARM.(5) Finally, the association between ARM and survival was analysed, because 60.9% of the participants of the baseline study had died. When adjusting for survival-related factors, ARM was statistically significant, associated with 59% increased mortality in women but not in men.These data may mirror the actual occurrence of vision loss and ARM in the Danish population, and hopefully they may assist health-care planners prepare for the future eye-care needs of the general population. [ABSTRACT FROM AUTHOR]

Objectives: Income poverty is one of the most common problems of old age. It varies among older adults living in different societies. This study aims to investigate the predictors of income poverty in older adults based on the data from Organization for Economic Cooperation and Development (OECD) countries. Methods: The secondary data analysis method was used in the present study. The income poverty rate and its associated variables were extracted from 36 members of OECD countries and entered into the SPSS software, version 22. For data analysis, descriptive and inferential statistics, including the Pearson correlation coefficient test and multiple linear regression analysis were employed. Results: The results showed that in the studied countries, the mean of income poverty among older adults was higher in women (11.48±16.2), and the elderly aged 75 years or above (12.57±16.1). The income poverty of older adults was significantly correlated with older adults' share in the gross domestic product (r=-0.376, P=024), targeted pension coverage (r=-0.505, P=0.003), income sources based on public transfers (r=-0.460, P=0.005), income sources from work (r=0.697, P=0.000), mandatory pension contribution rate (r=-0.343, P=0.040), and net pension replacement rate (r=-0.424, P=0.010). The results of regression analysis also revealed that variables of income sources from work and targeted pension coverage explained 66% of the variance in income poverty among older adults. Discussion: It is important to pay attention to the variables of age and gender of older people to overcome economic vulnerability in social policies. It is also necessary to consider the role of the share of public transfers and basic old-age pensions to reduce older adults' poverty. The lessons to be learned from OECD countries in this research are useful for the social rehabilitation of older adults in Iran. [ABSTRACT FROM AUTHOR]

Background Every month, 6% of Danish nursing home residents are admitted to hospital. However, these admissions might have limited benefits and are associated with an increased risk of complications. We initiated a new mobile service comprising consultants performing emergency care in nursing homes. Objective Describe the new service, the recipients of this service, hospital admission patterns and 90-day mortality. Design A descriptive observational study. Model When an ambulance is requested to a nursing home, the emergency medical dispatch centre simultaneously dispatches a consultant from the emergency department who will provide an emergency evaluation and decisions regarding treatment at the scene in collaboration with municipal acute care nurses. Method We describe the characteristics of all nursing home contacts from 1st November 2020 to 31st December 2021. The outcome measures were hospital admissions and 90-day mortality. Data were extracted from the patients' electronic hospital records and prospectively registered data. Results We identified 638 contacts (495 individuals). The new service had a median of two (interquartile range: 2–3) new contacts per day. The most frequent diagnoses were related to infections, unspecific symptoms, falls, trauma and neurologic disease. Seven out of eight residents remained at home following treatment, 20% had an unplanned hospital admission within 30 days and 90-day mortality was 36.4%. Conclusion Transitioning emergency care from hospitals to nursing homes could present an opportunity for providing optimised care to a vulnerable population and limiting unnecessary transfers and admissions to hospitals. [ABSTRACT FROM AUTHOR]

With the extensive long-term care services for older people, the Nordic countries have been labelled 'caring states' as reported (Leira, Welfare state and working mothers: the Scandinavian experience, Cambridge University Press, Cambridge, 1992). The emphasis on services and not cash benefits ensures the Nordics a central place in the public service model (Anttonen and Sipilä, J Eur Soc Policy 6:87–100, 1996). The main feature of this ideal model is public social care services, such as home care and residential care services, which can cover the need for personal and medical care, as well as assistance with household chores. These services are provided within a formally and professionally based long-term care system, where the main responsibility for the organization, provision and financing of care traditionally lays with the public sector. According to the principle of universalism (in: Antonnen et al. (eds), Welfare state, universalism and diversity, Elgar, Cheltenham, 2013), access to benefits such as home care and residential care is based on citizenship and need, not contributions nor merit. Also, care services should be made available for all and generally be used by all, with no stigma associated. Vabø and Szebehely (in: Anttonen (ed), Welfare State, universalism and diversity, Edward Elgar Publishing, London, 2012)) further argue that the Nordic service universalism is more than merely issues of eligibility and accessibility, in that it also encompasses whether services are attractive, affordable and flexible in order to meet a diversity of needs and preferences. However, recent decades have seen a continuous tendency towards prioritization of care for the most frail, contributing to unmet need, informalization of care and privatization in the use of topping up with market-based services. These changes have raised questions about increasing inequalities within Nordic long-term care systems. We investigate in the article what effect changes have for equality across social class and gender, for users and informal carers. The article is based on analysis of comparable national and international statistics and a review of national research literature and policy documents. [ABSTRACT FROM AUTHOR]

Overall progress in life expectancy (LE) depends increasingly on survival in older ages. The birth cohorts now reaching old age have experienced considerable educational expansion, which is a driving force for the social change and social inequality. Thus, this study examines changes in old age LE by educational attainment in the Nordic countries and aims to find out to what extent the change in national LEs is attributable to education-specific mortality and the shifting educational composition. We used national register data comprising total 65 + populations in Denmark, Finland, Norway and Sweden to create period life tables stratified by five-year age groups (65–90 +), sex and educational attainment. Difference in LE between 2001 and 2015 was decomposed into the contributions of mortality changes within each educational group and changes in educational composition. Increasing LE at all ages and in all educational groups coincided with persistent and growing educational inequalities in all countries. Most of the gains in LE at age 65 could be attributed to decreased mortality (63–90%), especially among those with low education, the largest educational group in most countries. The proportion of the increase in LE attributable to improved education was 10–37%, with the highest contributions recorded for women in Norway and Sweden. The rising educational levels in the Nordic countries still carry potential for further gains in national LEs. However, the educational expansion has contributed to uneven gains in LE between education groups, which poses a risk for the future increase of inequalities in LE. [ABSTRACT FROM AUTHOR]

Purpose: Becoming widowed is a stressful health-threatening event causing major life changes. We explored how widowed people experience becoming widowed and examined if these experiences are quantitatively associated with widowhood. Methods: A multi-methods study using an exploratory sequential mixed-methods approach including a qualitative descriptive study with widowed people from Denmark and a Swedish cohort study. Qualitative interviews (n = 9) were analysed using qualitative content analysis, describing experiences as explained by the widowed people. The quantitative association of the experiences was examined by identifying proxies for the qualitative experiences of widowhood in the cohort study and examining the occurrence in widowed people compared to married people (n = 1,095). Results: Six categories of experiences emerged: the circumstances around spousal death, mental health and well-being, physical health, social relations, activities and practicalities. The quantitative examination showed a significant association with widowhood regarding mental and physical health problems. Conclusion: The circumstances around spousal death and the time before spousal death, in general, were important to how participants felt being widowed. Being ill negatively affected mental health and well-being, partly because of the inability to participate in activities and social relations. This is important, as health problems are more common among widowed people than married people. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate reasons for insomnia symptoms and their associations with sleep medication prescription in elderly patients in general practice. Design: Over a period of 20 weekdays, general practitioners (GPs) recorded reasons and treatment for insomnia symptoms. Patient characteristics and outcomes were analysed using descriptive statistics. Logistic regression was used to analyse the associations between reasons for insomnia symptoms and prescription. Setting: General practices in the Region of Southern Denmark. Subjects: Consultations (n = 405) with patients older than 65 years presenting with insomnia symptoms. Main outcome measures: Reasons for insomnia symptoms and sleep medication prescription. Results: The most commonly reported reasons for insomnia symptoms were somatic illness (34%) and psychiatric diagnosis (29%). Having a psychiatric diagnosis or multiple reported reasons for insomnia increased the odds for prescription (odds ratio (OR) 4.60, 95% confidence interval (CI) 2.41-9.90 and OR 2.10, CI 1.03-4.28), whereas being first consultation regarding insomnia symptoms decreased the odds (OR 0.17, CI 0.10-0.30). A total of 80% received a prescription, most frequently of Z-hypnotics (49%). About half (52%) of the patients consulting their GP for the first time with insomnia symptoms received a prescription. Conclusion: Somatic and psychiatric diseases were the most commonly reported reasons for insomnia symptoms in the elderly, suggesting a high prevalence of comorbid insomnia. Regardless of reason, a majority of the consultations resulted in prescription of sleep medication with potential serious adverse effects. This indicates that there is still room for improving the management of insomnia among older adults. Key Points Although insomnia is common in the elderly, little is known about its reasons and their associations with prescription patterns. The most commonly reported reasons for insomnia symptoms in the elderly are psychiatric diagnosis and somatic illness. According to guidelines, sleep medication with potential serious adverse effects is prescribed too frequently to elderly patients. An effort should be made to identify and optimally treat comorbid insomnia, which appears to be prevalent in older adults. [ABSTRACT FROM AUTHOR]

Background the increasing number of multimorbid older people places high demands on future health care systems. To inform the discussion on how to structure future care strategies, we aimed to describe the temporal relationship between admission, and morbidity and mortality in nursing home residents. Methods data on 5,179 older individuals admitted to 94 Danish nursing homes in 12 municipalities during 2015–2017 were linked to the nationwide Danish health registries to retrieve information on the temporal relation between nursing home admission and morbidity and mortality. Results at the time of nursing home admission, the majority were women (63%). Male residents were younger than women (median 82 vs 85 years) and had a higher prevalence of comorbidities (median Charlson score 2 vs 1 among women). The median survival after nursing home admission was 25.8 months, with the 3-year survival being 37%. Three-year survival was lower among men (29 vs 43% among women) and among the oldest residents (23% among those aged ≥90 years vs 64% among individuals ≤65 years). In addition to age and sex, predictors of mortality included hospitalisations prior to nursing home admission and a high burden of comorbidity. The rate of hospitalisations, primarily for reasons related to frailty, increased substantially during the 9 months prior to nursing home admission. Conclusion we provide detailed information on differences in morbidity and mortality across age span and sex at the time of nursing home admission, thereby contributing to the ongoing discussion of how to structure the future health care system. [ABSTRACT FROM AUTHOR]

Background: antipsychotic drugs (APs) have been associated with falls and fractures in elderly individuals but limited knowledge on specific drugs exist. Objective: to investigate the association between individual APs and fractures in elderly persons. Design and setting: nationwide register-based cohort study. Subjects: all Danish individuals aged ≥65 who had not been in treatment with any AP in the year before inclusion. Methods: incidence rate ratios (IRRs) of fractures of hip, pelvis or upper extremities during treatment with commonly used APs were assessed in multivariable Poisson models. Exposure was divided into time periods from initiation of treatment: 0-30 days, 31-365 days or >365 days. Results: one year prior to inclusion, 1,540,915 individuals ≥65 years had not received APs and of these 93,298 initiated treatment with APs. Mean follow-up was 9.6 years. During follow-up, 246,057 (16%) experienced a fracture. Associations were for all APs highest in the initial treatment period (0-30 days) with IRRs for risperidone 1.97 (95% CI: 1.70-2.28), olanzapine 2.31 (95% CI: 1.96-2.73), quetiapine 2.09 (95% CI: 1.73-2.52), zuclopenthixol 2.19 (95% CI: 1.82-2.63), chlorprothixen 1.62 (95% CI: 1.18-2.24), flupenthixol 1.43 (95% CI: 1.06-1.93), levomepromazine 1.19 (95% CI 0.86-1.66), haloperidol 2.98 (95% CI 2.57-3.45), compared with the background population. Conclusions: use of APs is associated with fractures in elderly persons especially in the initial treatment period. If AP use in an elderly person is deemed necessary, individual falls prophylaxis should be considered. [ABSTRACT FROM AUTHOR]

Objective: to examine whether the Danish 1905 cohort members had more active hospital treatment than the 1895 cohort members from ages 85 to 99 years and whether it results in higher in-hospital and post-operative mortality.Methods: in the present register-based follow-up study the complete Danish birth cohorts born in 1895 (n = 12,326) and 1905 (n = 15,477) alive and residing in Denmark at the age of 85 were followed from ages 85 to 99 years with regard to hospitalisations and all-cause and cause-specific surgical procedures, as well as in-hospital and post-operative mortality.Results: the 1905 cohort members had more frequent hospital admissions and operations, but they had a shorter length of hospital stay than the 1895 cohort at all ages from 85 to 99 years. The increase in primary prosthetic replacements of hip joint was observed even within the 1895 cohort: no patients were operated at ages 85–89 years versus 2.2–3.6% at ages 95–99 years. Despite increased hospitalisation and operation rates, there was no increase in post-operative and in-hospital mortality rates in the 1905 cohort. These patterns were similar among men and women.Conclusions: the observed patterns are compatible with more active treatment of the recent cohorts of old-aged persons and reduced age inequalities in the Danish healthcare system. No increase in post-operative mortality suggests that the selection of older patients eligible for a surgical treatment is likely to be based on the health status of old-aged persons and the safety of surgical procedures rather than chronological age. [ABSTRACT FROM PUBLISHER]

Purpose: to examine the combined effect of cohabitation status and social participation, respectively, and socioeconomic position on onset of mobility limitations in a prospective study among older Danes.Design and methods: logistic regression analyses with combined exposure variables were performed in a study population of 2,839 older men and women from the Danish Intervention Study on Preventive Home Visits.Results: among men low financial assets, living alone or having low social participation significantly increased the odds ratios (OR) for onset of mobility limitations. Among women only low financial assets and low social participation significantly increased the ORs for onset of mobility limitations. Analyses with combined exposure variables showed that simultaneous exposure to low financial assets and poor social relations significantly increased the ORs for onset of mobility limitations among both genders, yet the tendencies appeared stronger for males. In particular, men with simultaneous exposure to low financial assets and low social participation had increased odds ratios for onset of mobility limitations, OR = 5.36 (2.51–11.47), compared with the non-exposed.Conclusion: the study suggests that future interventions to increase social participation might alleviate the negative effects on mobility experienced by older people in low socioeconomic position, perhaps especially among older males. [ABSTRACT FROM AUTHOR]

More than two decades of research has consistently indicated that feelings of loneliness among older people are more common in southern Europe than in its northern parts, with the lowest rates in Denmark and Sweden. Our analyses based on analysis of 2004–2006 data from 8,787 individuals aged 65 years or older in the SHARE project replicate, update, and extend these findings. We found, similar to previous studies, that the prevalence of feelings of loneliness was more common in the Mediterranean countries than in Northern Europe. Living together with a spouse/partner was consistently associated with the lower prevalence of loneliness across countries. The combination of living alone and having bad health was associated with 10 times higher odds of feeling lonely as compared with living together with someone and having good health. With regard to gender and health, we found signs of differences between countries in how these factors were related to loneliness. Our results indicate the importance of both contextual features and cultural expectations in interpreting reported loneliness, that is, loneliness across Europe has both nomothetic and idiographic features. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials have demonstrated that a restrictive red blood cell (RBC) transfusion strategy lowers transfusion frequency without affecting mortality. However, the external validity of these trials has not been tested in a large cohort. The purpose was to estimate the effect of introducing a National Clinical Guideline (NCG) for a restrictive hemoglobin transfusion threshold on transfusion frequency and mortality in hip fracture patients > 65 years old. Methods: A consecutive cohort study of hip fracture patients > 65 years old residing in the southern region of Denmark was conducted using prospectively gathered data from registers during two separate 1-year time periods. The first period from October 1, 2012, to September 30, 2013, included 1494 patients and used a liberal transfusion threshold, whereas the second period from October 1, 2015, to September 30, 2016, including 1414 participants used a restrictive threshold from the NCG. Participant data for age, sex, body mass index, Charlson Comorbidity Index, time to surgery, and death were retrieved from the Danish Interdisciplinary Registry of Hip Fractures and were merged with RBC transfusion and medication data extracted from the Danish Transfusion and Odense Pharmacoepidemiological Databases, respectively. Cox proportional hazards models were used to test relative mortality risk for the restrictive group compared with the liberal group at 30 and 90 days. Results: Overall RBC transfusions decreased from 42 to 30% (p < 0.001). The 30-day mortality rate (95% CI) was 9% (8;11) in the restrictive group and 13% (11;14) in the liberal group (p < 0.008), whereas the adjusted relative mortality risk was 0.72 (0.57;0.91). The 90-day mortality rate was 15% (13;17) in the restrictive group and 19% (17;21) in the liberal group, whereas the adjusted relative mortality risk was 0.78 (0.65;0.94). Conclusion: These data suggest that the introduction of an NCG on restrictive blood transfusion leads to lower transfusion frequency in hip fracture patients > 65 years old. Even though this reduction is associated with decreased mortality at both 30 and 90 days, it may be explained by other issues than restrictive transfusion strategy. There has been an improvement in the mortality of hip fracture patients in Denmark, and we suggest that a restrictive transfusion strategy does not lead to increased mortality. [ABSTRACT FROM AUTHOR]