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Background: Maintaining physical activity (PA) and functioning (mobility, balance) is essential for older adults' well-being and quality of life. However, current methods (functional tests, self-reports) and available techniques (accelerometers, sensors, advanced movement analysis systems) for assessing physical activity and functioning have shown to be less reliable, time- and resource-consuming with limited routine usage in clinical practice. There is a need to simplify the assessment of physical activity and functioning among older adults both in health care and clinical studies. This work presents a study on using Skeleton Avatar Technology (SAT) for this assessment. SAT analyzes human movement videos using artificial intelligence (AI). The study compares handy SAT based on 2D camera technology (2D SAT) with previously studied 3D SAT for assessing physical activity and functioning in older adults. Objective: To explore whether 2D SAT yields accurate results in physical activity and functioning assessment in healthy older adults, statistically compared to the accuracy of 3D SAT. Method: The mobile pose estimation model provided by Tensorflow was used to extract 2D skeletons from the video recordings of functional test movements. Deep neural networks were used to predict the outcomes of functional tests (FT), expert-based movement quality assessment (EA), accelerometer-based assessments (AC), and self-assessments of PA (SA). To compare the accuracy with 3D SAT models, statistical analysis was used to test whether the difference in the predictions between 2D and 3D models is significant or not. Results: Overall, the accuracy of 2D SAT is lower than 3D SAT in predicting FTs and EA. 2D SAT was able to predict AC with 7% Mean Absolute Error (MAE), and self-assessed PA (SA) with 16% MAE. On average MAE was 4% higher for 2D than for 3D SAT. There was no significant difference found between the 2D and the 3D model for AC and for two FTs (30 seconds chair stand test, 30sCST and Timed up and go, TUG). A significant difference was found for the 2D- and 3D-model of another FT (4-stage balance test, 4SBT). Conclusion: Altogether, the results show that handy 2D SAT might be used for assessing physical activity in older adults without a significant loss of accuracy compared to time-consuming standard tests and to bulky 3D SAT-based assessments. However, the accuracy of 2D SAT in assessing physical functioning should be improved. Taken together, this study shows promising results to use 2D SAT for assessing physical activity in healthy older adults in future clinical studies and clinical practice., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Negative attitudes towards aging are common in society. However, few studies have investigated how older adults perceive this phenomenon. This study investigated (a) how older adults in Sweden perceive general attitudes towards the older population and whether negative perceptions are associated with low life satisfaction, self-compassion, and health-related quality of life (HRQL), and (b) whether perceived attitudes predict life satisfaction when controlling for HRQL, self-compassion, and age. The sample comprised 698 randomly selected participants, aged 66-102 years, from the Blekinge part of the Swedish National Study on Ageing and Care. The results showed that 25.7% of the participants held negative attitudes towards older adults and reported lower life satisfaction and HRQL. Self-compassion was related to higher life satisfaction, perceived positive attitudes, and better mental HRQL. Overall, perceived attitudes, HRQL, self-compassion, and age predicted 44% of the participants' life satisfaction. Understanding the factors that influence older adults' life satisfaction is crucial, as health-related losses might reduce the opportunity for a successful life. Our study makes an important contribution to the field, showing that perceived attitudes explained 1.2% of the variance of life satisfaction, whereas mental and physical HRQL accounted for 18% of life satisfaction.

Background: The EQ-5D index often fails to detect the effect of ophthalmic diseases and sight loss. Investigating predictors of individual EQ-5D health dimensions might reveal the underlying reasons. The aim of this study was to investigate predictors of health dimension ratings obtained with the EQ-5D-3L from participants with impaired vision representing a spectrum of eye diseases., Methods: Observational cross-sectional study with participants recruited at four public hospitals in Portugal. Outpatients with visual acuity of 0.30 logMAR(6/12) or worse in the better-seeing eye were invited to participate. Participants completed two instruments: the EQ-5D-3L (measures participants' perceived health-related quality-of-life) and the Massof Activity Inventory (measures visual ability-ability to perform vision-related activities). This study used logistic regression models to identify factors associated with responses to the EQ-5D-3L., Results: The study included 492 participants, mean age 63.4 years (range = 18-93), 50% females. The most common diagnosis was diabetic retinopathy (37%). The mean visual acuity in the better seeing eye was 0.65 logMAR (SD = 0.48) and the mean visual ability was 0.62 logits (SD = 2.04), the correlation between the two was r = - 0.511 (p < 0.001). Mobility and self-care were the health dimensions with the fewest problems (1% reported extreme problems), anxiety and depression the dimension with the most problems (24% reported extreme problems). ROC curve analysis showed that the EQ-5D index was a poor predictor of cases of vision impairment whilst visual ability given was a good predictor of cases of vision impairment. Visual ability was an independent predictor of the response for all dimensions, higher ability was always associated with a reduced odds of reporting problems. The odds of reporting problems were increased for females in 3 out of 5 dimensions. Comorbidities, visual acuity and age-category were predictors of the odds of reporting problems for one dimension each., Conclusions: The odds of reporting problems for the five health dimensions of the EQ-5D-3L were strongly influenced by the ability to perform vision-related activities (visual ability). The EQ-5D index showed poor performance at detecting vision impairment. These findings are informative and relevant for the clinic and for research evaluating the impact of eye diseases and disease treatments in ophthalmology., (© 2022. The Author(s).)

Purpose of Study: To gain Swedish norm value for the Life Satisfaction Index-A (LSI-A) in a population 60-93+ years old stratified for sex and age and to relate these norm values with respect to number of chronic diseases and functional impairment., Materials and Methods: The study population included a random sample of 2656 men (45.7%) and 3159 (54.3%) women from the longitudinal national studies' "Good Aging in Skåne" (GÅS) and SNAC-B, both part of the Swedish National Study on Aging and Care (SNAC). Data on Neugartens Life Satisfaction Index-A (LSI-A), medical history, activities of daily life (ADL) and socio-demographics were collected through structured interviews and questionnaires., Results: Men scored significantly higher than women; 28.5, sd=6.9, and 27.3, sd=6.6, respectively, out of maximum 40 points. For both genders the scores decreased with age, mean score 6.0 points, lower for men and 7.1 points lower for women between 60 and 93+ years. The highest score was noted for healthy individuals where both men and women scored 29.5 points, sd=6.2. Increased number of chronic diseases and dependency in ADLs were associated with lower LS., Conclusion: Norm values here presented may facilitate assessments and evaluation of life satisfaction in the general elder population and as reference values to clinical trials. Female sex, rising age, morbidity and impaired functional ability were all associated with impaired LS., Competing Interests: The authors declare no potential conflicts of interest., (© 2020 Elmståhl et al.)

Background: For a significant proportion of the older population, increasing age is associated with health problems and worsening health. Older family caregivers are largely responsible for care of next-of-kin living at home, which impacts their own physical and mental health both positively and negatively. However, evidence is insufficient regarding the health situation of older caregivers. The aim of this study was to investigate health-related quality of life (HRQoL) and pain, and their associations, among caregivers aged ≥60 years., Methods: The participants (n = 3444) were recruited from the Swedish National Study on Aging and Care-Blekinge and Good Aging in Skåne during 2001-2004. Participants aged ≥60 years were selected randomly and underwent cognitive tests, with demographic information obtained through questionnaires. The response rate was 60%. A predefined research protocol was used. HRQoL was measured with the Short-Form Health Survey, dimension mental health. Logistic regression models were used to investigate the associations between HRQoL and pain as well as control factors., Results: Family caregiving was reported by 395 (11.5%) of the participants, and 56.7% of the caregivers reported pain. Family caregivers reported lower pain intensity on the Visual Analogue Scale and were younger, on median, than non-caregivers. Irrespective of caregiver status, pain was associated with mental HRQoL. Concerns about personal health and financial status had the strongest associations with mental HRQOL in both groups, but the levels were higher among caregivers., Conclusion: Pain was one factor associated with low HRQoL regardless of family caregiver status and remained important when controlling for factors related to advanced age. This finding remained among family caregivers, though they reported lower pain intensity. Factors other than pain were shown to be important to mental HRQoL and should also be taken into consideration when discussing actions for family caregivers to maintain and improve health and HRQoL., Trial Registration Number: Not applicable.

Background: Age increases the risk of emergency department [ED] visits. Health related quality of life (HRQoL) is often estimated as an outcome of ED visits, but it can be a risk factor of ED visits. This study aims to assess the association of HRQoL with time to first ED visit and/or frequent ED use in older adults during four-year period and if this association differs in 66-80 and 80+ age groups., Methods: Data from the Swedish National Study on Aging and Care-Blekinge of wave 2007-2009 was used in combination with electronic health records on ED visits. The analytical sample included 673 participants of age 66 years and older with information on HRQoL. Cox proportional hazard model was used to assess the association between HRQoL and time to first ED visit. Logistic regression analysis was performed to estimate the association of HRQoL with frequent ED use., Results: During the study period, 55.3% of older adults visited the ED and 28.8% had a frequent ED use. Poor physical HRQoL was independently associated with first ED visit both in total sample (p < 0.001) and in 66-80 (p < 0.001) and 80+ (p = 0.038) age groups. Poor mental HRQoL had no significant association with first ED visit and frequent ED use., Conclusion: Findings suggest that poor physical HRQoL is associated with time to first ED visit in older adults. Therefore, physical HRQoL should be considered while planning interventions on the reduction of ED utilisation in older adults. Explanatory factors of frequent ED use may differ in age groups. Further studies are needed to identify associated factors of frequent ED visits in 80+ group.

Liver cirrhosis is a chronic liver disease. Patients with liver cirrhosis need to manage the symptoms of the disease and possible complications. Symptoms due to ascites, encephalopathy, and/or varices are hard to manage and live with. Self-care is necessary for coping with the symptoms and for improving the patient's life situation. The aim of this study was to explore the areas of life situation and self-care among patients suffering from liver cirrhosis with complications. Interviews with patients with liver cirrhosis (n = 13), seven women and six men (46-70 years), were performed. Data were analyzed using inductive content analysis. The experience of the patient's life situation was described from two aspects: vulnerability and reflection on life. Vulnerability was expressed as symptom experience, feelings of loneliness, preconceptions, and limits in daily life. In reflection on life, the patients expressed acceptance and sadness. Self-care dealt with (a) being responsible by observing symptoms and signs; (b) adhering to treatment, prescription, and advice; and (c) the need for more understanding of and information about the disease. When caring for patients with liver cirrhosis, it is important to identify symptoms and feelings and help patients individually to maintain health through self-care.

Objectives: This study aimed to assess the prevalence of undernutrition among elderly and to investigate the association of risk of undernutrition with health-related quality of life and life satisfaction controlling for age, gender, marital status, economic status, housing arrangement, education level, functional ability, and diseases., Design: A cross-sectional study design was used for this study. The baseline data (2001-2003) of "The Swedish National Study of Aging and Care-Blekinge (SNAC-B)" was used., Setting: This population-based study focused on both home-living and special-housing residents., Participants: The participants (n=1402) were randomly selected and included both males and females 60-96 years of age residing in a municipality of south-east Sweden., Measurements: The risk of undernutrition was estimated by the occurrence of at least one anthropometric measure (body mass index, mid-arm circumference, and calf circumference) below cut-off, in addition to the presence of at least one subjective measure (declined food intake, weight loss, and eating difficulty). The dependent variables, health-related quality of life and life satisfaction, were measured by the validated short form health survey (SF-12) and Liang's life satisfactions index A (LSIA), respectively., Results: According to the criterion, 8.5% of the participants were at risk of undernutrition, and subjects at nutritional risk were significantly older, female, unmarried/widowed/divorced, residing in special housing, and functionally impaired. The risk of undernutrition was significantly associated with poor health-related quality of life, both in the physical (OR 2.31, 95% CI 1.18-4.52) and mental (OR 2.34, 95% CI 1.22-4.47) dimensions. However, no significant association was observed between nutritional status and life satisfaction (OR 1.30, 95% CI 0.70-2.40)., Conclusion: The risk of undernutrition significantly increases the risk of poor physical and mental health-related quality of life but has negligible impact on life satisfaction. This study also highlights the importance of functional ability both for the prevention of undernutrition and promotion of quality of life. However, more studies are needed to validate the tool used here for undernutrition risk assessment before it can be used in clinical or population settings.

Objective: The relationship between sleep complaints, comorbidity and health-related quality of life (HRQoL) in advanced age has not been clearly established. The aim of this study is therefore to investigate the presence of sleep complaints and discuss their association with morbidity and the HRQoL among the people aged 60 years and above., Methods: Data regarding demography, sleep, comorbidity and HRQoL were collected through questionnaires and interviews among 1128 people in Sweden. The Johns Hopkins adjusted clinical groups (ACG®) Case-Mix System 6.0 and the Short-Form Health Survey-12 were used to assess morbidity and HRQoL, respectively., Results: There was a divergence in the number of sleep complaints between those with no morbidity and those who had a high degree of comorbidity. Most of the sleep complaints related to low HRQoL were found among those with a high degree of comorbidity., Conclusions: People with a high degree of comorbidity appear to be a group with a high risk of having both sleep complaints and a low HRQoL. Thus, this study suggests that even if sleep complaints appear to be difficult to identify and treat successfully, it is important to pay particular attention to those people who suffer from a high degree of comorbidity if their HRQoL is to be maintained.

Background and Aims: Knowledge about Health-Related Quality of Life (HRQoL) in advanced age is sparse. This study investigated to what extent mobility factors explained older people's HRQoL when age, gender and functional ability (ADL) were controlled for., Methods: Subjects were 1128 people aged 60-96 participating in a Swedish longitudinal multi-center cohort study. Besides descriptive and correlation statistics, a three-tier multiple logistic regression analysis was performed, which included the ADL scale, mobility tests and items, with physical and mental HRQoL as outcome variables., Results: In the models containing the control variables, functional ability was found to be associated with both physical and mental HRQoL. In the models including both functional ability and mobility factors, the importance of functional ability remained for mental but not for physical HRQoL. The mobility factors were found to have a stronger negative influence on HRQoL, i.e., physical and mental, than functional ability in itself., Conclusions: For optimal identification of various types of disabilities and their impact on older people's HRQoL, the ADL scale should be used together with more targetspecific tests of disabilities. However, in certain situations, it appears that one mobility factor alone - the ability to walk - has the capacity to pick up changes in both physical and mental HRQoL. Thus, it is important that healthcare professionals should focus activities toward maintaining older people's mobility as a means of enhancing their HRQoL.