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Introduction Due to the increasing number of older patients in emergency departments (EDs) with frailty, cognitive impairment and multimorbidity, there is a need for geriatric expertise in EDs. Methods This retrospective study is of older patients visiting Turku University Hospital ED between 2 January and 31 December 2022. Patients aged 75 years of older were screened for frailty using Triage Risk Screening Tool (TRST) and Clinical Frailty Scale (CFS). Nonacute, frail patients (CFS ≥4) suitable for Targeted Geriatric Assessment (TGA) (n  = 1096) were scanned for the risk of delirium, cognitive impairment, change in functional status, falls, malnutrition and depression. A comprehensive patient record was made with recommendations for future care. Results TRST was completed in 70% of the ED visits, and two-thirds of those were considered high-risk. Among the patients assessed by the geriatric team (TGA), nonspecific complaint (38%) and falls (35%) were the main reasons for ED admission. Cognitive impairment was present in over 60% and orthostatic hypotension in 40% of the patients. The 72-hour revisit rate for TGA-patients was 2.3%. For the real-life control group, the 72-hour revisit rate was 4.6% (P  = .001). Thirty-day revisit rates were 10% and 16%, respectively (P  < .001). The need for rehabilitation, cognitive evaluation and intensifying home care were the main recommendations for future care. Conclusions TGA approach provides structured and accurate information on older patients' background. This may lead to more precise diagnostics, a thorough consideration of hospital intake and a secure discharge from the ED. Ensuring continuity of care may help to reduce readmissions to EDs. [ABSTRACT FROM AUTHOR]

Background: In the Finnish policy on older people preventive activities, which maintain functional capacity and independent living, are emphasized. The Turku Senior Health Clinic, aimed at maintaining independent coping of all home-dwelling 75-year-old citizens in the city of Turku, was founded in the beginning of 2020. The aim of this paper is to describe design and protocol of the Turku Senior Health Clinic Study (TSHeC) and provide results of the non-response analysis. Methods: The non-response analysis used data from 1296 participants (71% of those eligible) and 164 non-participants of the study. Sociodemographic, health status, psychosocial and physical functional ability indicators were included in the analysis. Participants and non-participants were also compared in respect to their neighborhood socioeconomic disadvantage. Differences between participants and non-participants were tested using the Chi squared or Fisher´s exact test for categorical variables and t-test for continuous variable. Results: The proportions of women (43% vs. 61%) and of those with only satisfying, poor or very poor self-rated financial status (38% vs. 49%) were significantly lower in non-participants than in participants. Comparison of the non-participants and participants in respect to their neighborhood socioeconomic disadvantage showed no differences. The prevalence of hypertension (66% vs. 54%), chronic lung disease (20% vs. 11%), and kidney failure (6% vs. 3%) were higher among non-participants compared to participants. Feelings of loneliness were less frequent among non-participants (14%) compared to participants (32%). The proportions of those using assistive mobility devices (18% vs. 8%) as well as those having previous falls (12% vs. 5%) were higher in non-participants than in participants. Conclusions: The participation rate of TSHeC was high. No neighborhood differences in participation were found. Health status and physical functioning of non-participants seemed to be slightly worse than those of the participants, and more women than men participated. These differences may weaken the generalizability of the findings of the study. The differences have to be taken into account when recommendation for the content and implementation of preventive nurse-managed health clinic in primary health care in Finland is going to be given. Trial registration: ClinicalTrials.gov Identifier: NCT05634239; registration date; 1st of December 2022. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: In clinical practice, there is a need for an instrument to screen older people at risk of institutionalization. Aims: To analyze the association of frailty, walking-ability and self-rated health (SRH) with institutionalization in Finnish community-dwelling older people. Methods: In this prospective study with 10- and 18-year follow-ups, frailty was assessed using FRAIL Scale (FS) (n = 1087), Frailty Index (FI) (n = 1061) and PRISMA-7 (n = 1055). Walking ability was assessed as self-reported ability to walk 400 m (n = 1101). SRH was assessed by a question of general SRH (n = 1105). Cox regression model was used to analyze the association of the explanatory variables with institutionalization. Results: The mean age of the participants was 73.0 (range 64.0‒97.0) years. Prevalence of institutionalization was 40.8%. In unadjusted models, frailty was associated with a higher risk of institutionalization by FS in 10-year follow-up, and FI in both follow-ups. Associations by FI persisted after age- and gender-adjustments in both follow-ups. By PRISMA-7, frailty predicted a higher risk of institutionalization in both follow-ups. In unadjusted models, inability to walk 400 m predicted a higher risk of institutionalization in both follow-ups and after adjustments in 10-year follow-up. Poor SRH predicted a higher risk of institutionalization in unadjusted models in both follow-ups and after adjustments in 10-year follow-up. Discussion: Simple self-reported items of walking ability and SRH seemed to be comparable with frailty indexes in predicting institutionalization among community-dwelling older people in 10-year follow-up. Conclusions: In clinical practice, self-reported walking ability and SRH could be used to screen those at risk. [ABSTRACT FROM AUTHOR]

Background: Despite a non-specific nature of self-rated health (SRH), it seems to be a strong predictor of mortality. The aim of this study is to assess the association of SRH and objective health status (OH) with all-cause mortality in 70-year-old community-dwelling older people in Finland.Methods: A prospective study with 5-, 10- and 27-year follow-ups. SRH (n = 1008) was assessed with a single question and OH (n = 962) by the Rockwood's Frailty Index (FI). To assess the association of SRH and OH with mortality, Cox regression model was used.Results: Of the 1008 participants, 138 (13.7%), 319 (31.6%), and 932 deceased (86.3%) during the 5-, 10- and 27-year follow-ups, respectively. In unadjusted models, subjects with poor SRH had almost eightfold risk for mortality compared to those with good SRH during the 5-year follow-up; among those with poor OH, the risk was fourfold compared to those with good OH. In the 10-year-follow up, both poor SRH and poor OH predicted about fourfold risk for mortality compared to those with good health. During the 27-year follow-up, OH was a stronger predictor of mortality than SRH. Poor SRH, compared to good SRH, showed 95% sensitivity and 34% specificity for 5-year mortality; corresponding figures for OH were 54 and 80%, respectively.Conclusions: Single-item SRH seems to be able to capture almost the same as OH in predicting a short-term (less than 10 years) mortality risk among older adults in clinical settings. The use of SHR may also enhance the focus on patient-centered care. [ABSTRACT FROM AUTHOR]

Aims: To compare dementia risk indices among two separate cohorts of 70-year-olds born 20 year apart. Methods: Community-dwelling 70-year-old Finns were examined with similar examinations in 1991 (n = 1032) and in 2011 (n = 960). Dementia risk was assessed with the CAIDE Dementia Risk Score (CAIDE) (n = 1516), the Brief Dementia Risk Index (BDRI) (n = 1598) and the Dementia Screening Indicator (DSI) (n = 1462). Results: The proportion of subjects with moderate or high risk for dementia was significantly higher in earlier than in later born cohort according to CAIDE (99% and 94%, respectively, p < 0.001) and BDRI (41% and 15%, p < 0.001), but not according to DSI (5% and 6%, p = 0.184). The total scores of the earlier born cohort were significantly higher than those of the later born cohort according to all three indices. Conclusions: According to dementia risk indices, it seems that dementia risk has decreased among community-dwelling 70-year-old subjects during the last decades in Finland. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes (T2DM) increases the risk for Alzheimer's disease (AD) but not for AD neuropathology. The association between T2DM and AD is assumed to be mediated through vascular mechanisms. However, insulin resistance (IR), the hallmark of T2DM, has been shown to associate with AD neuropathology and cognitive decline.Objective: To evaluate if midlife IR predicts late-life cognitive performance and cerebrovascular lesions (white matter hyperintensities and total vascular burden), and whether cerebrovascular lesions and brain amyloid load are associated with cognitive functioning.Methods: This exposure-to-control follow-up study examined 60 volunteers without dementia (mean age 70.9 years) with neurocognitive testing, brain 3T-MRI and amyloid-PET imaging. The volunteers were recruited from the Finnish Health 2000 survey (n = 6062) to attend follow-up examinations in 2014-2016 according to their insulin sensitivity in 2000 and their APOE genotype. The exposure group (n = 30) had IR in 2000 and the 30 controls had normal insulin sensitivity. There were 15 APOEɛ4 carriers per group. Statistical analyses were performed with multivariable linear models.Results: At follow-up the IR+group performed worse on executive functions (p = 0.02) and processing speed (p = 0.007) than the IR- group. The groups did not differ in cerebrovascular lesions. No associations were found between cerebrovascular lesions and neurocognitive test scores. Brain amyloid deposition associated with slower processing speed.Conclusion: Midlife IR predicted poorer executive functions and slower processing speed, but not cerebrovascular lesions. Brain amyloid deposition was associated with slower processing speed. The association between midlife IR and late-life cognition might not be mediated through cerebrovascular lesions measured here. [ABSTRACT FROM AUTHOR]

Microalbuminuria, defined as urine albumin-to-creatinine ratio (UACR)>3.0 mg/mmol and ≤ 30 mg/mmol, is an early marker of endothelial damage of the renal glomeruli. Recent research suggests an association among microalbuminuria, albuminuria (UACR > 3.0 mg/mmol), and cognitive impairment. Previous studies on microalbuminuria, albuminuria, and cognition in the middle-aged have not provided repeated cognitive testing at different time-points. We hypothesized that albuminuria (micro- plus macroalbuminuria) and microalbuminuria would predict cognitive decline independently of previously reported risk factors for cognitive decline, including cardiovascular risk factors. In addition, we hypothesized that UACR levels even below the cut-off for microalbuminuria might be associated with cognitive functioning. These hypotheses were tested in the Finnish nationwide, population-based Health 2000 Survey (n = 5,921, mean age 52.6, 55.0% women), and its follow-up, Health 2011 (n = 3,687, mean age at baseline 49.3, 55.6% women). Linear regression analysis was used to determine the associations between measures of albuminuria and cognitive performance. Cognitive functions were assessed with verbal fluency, word-list learning, word-list delayed recall (at baseline and at follow-up), and with simple and visual choice reaction time tests (at baseline only). Here, we show that micro- plus macroalbuminuria associated with poorer word-list learning and a slower reaction time at baseline, with poorer word-list learning at follow-up, and with a steeper decline in word-list learning during 11 years after multivariate adjustments. Also, higher continuous UACR consistently associated with poorer verbal fluency at levels below microalbuminuria. These results suggest that UACR might have value in evaluating the risk for cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Identification of predictive factors on institutionalization provides the basis for the development and application of preadmission assessment. There is a lack of evidence for predictors of institutionalization for older people. Aims: To examine the effect of predictive factors on institutionalization in home-dwelling 70-year-old people. Methods: The data were collected in 1991 by the clinical examinations, a postal questionnaire, and an interview from the residents of Turku, Finland, born in 1920 ( n = 1032). Institutionalization was defined as entry into a nursing home or sheltered housing at any time during a 22-year follow-up. Results: A rate of institutionalization was 22.0%. In multivariable Cox regression analysis, impaired cognitive function (MMSE 18-26) (hazard ratio 1.71, confidence interval 1.24-2.36) and low BMI (<25 kg/m) (compared to both BMI of 25-29.9 and that of ≥30, respectively, 1.88, 1.32-2.67, and 1.66, 1.05-2.60), having several falls during the previous year (2.50, 1.28-4.90). Conclusions: We conclude that impaired cognitive function, low BMI, and frequent falling predicted institutionalization during the 22-year follow-up. To reduce or postpone institutionalization, interventions should target risk factors, such as frailty, physical limitations, and falling. In addition, community-based services according to the needs and functional ability of the home-dwelling older people should be developed. [ABSTRACT FROM AUTHOR]

Objective: to compare cardiovascular morbidity and risk factor profiles of two 70-year-old cohorts of Finns examined in 1991 and 2011 and to describe prevalence of statin use according to cardiovascular risk in the later cohort. Methods: 1920-born cohort of community-dwelling 70-year-old persons (n = 1032) participated in comprehensive health surveys, physical and laboratory examinations in the Turku Elderly Study (TUVA) during 1991--92. In 2011, identical examination pattern was performed, in a 1940-born cohort of 70-year-old persons (n = 956) from the same area. Prevalence of cardiovascular diseases (CVD) and risk factors in the two cohorts was compared. Further, each cohort was divided into three cardiovascular risk groups (high, moderate and low) based on their estimated risk. Prevalence of statin use was calculated among each risk group in the 1940 cohort. Results: coronary heart disease (25 versus 11 %) and peripheral artery disease (9 versus 2%) were more common in the 1920 than 1940 cohort, respectively. Lipid profile was worse and blood pressure higher in the earlier cohort, whereas use of statins and antihypertensives was more common in the later cohort. Forty-two per cent of the 1920 cohort and 29% of the 1940 cohort were estimated to have high cardiovascular risk. In the 1940 cohort, a total of 36% used statins. Statin use was most common among high-risk persons. Conclusions: seventy-year olds examined in 2011 had less CVD morbidity than their counterparts 20 years earlier, and their cardiovascular risk factors were better controlled which is reflected in higher use of preventive medications, such as statins and antihypertensives. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to explore nurses' knowledge of foot care and related factors in home care nursing. Background Nurses caring for older people are increasingly confronted with clients who have multiple foot problems and need support with their foot health. The role of nurses in promoting foot health, caring for existing foot problems and supporting older people in foot self-care is especially important in the home care context. However, this entails up-to-date foot care knowledge and practices. Design A cross-sectional correlational survey study design. Methods Nurses' knowledge of foot care was evaluated using the Nurses' Foot Care Knowledge Test developed for this study. The data were analysed with descriptive and inferential statistics. Results Nurses (registered nurses, public health nurses and licensed practical nurses) from public home care ( n = 322, response rate 50%) participated the study. Nurses' knowledge in foot care varied. The knowledge scores were highest for skin and nail care and lowest for the identification and care of foot structural deformities. Longer working experience in the current work place and participation in continuing education explained higher Nurses' Foot Care Knowledge Test scores. Conclusions Nurses need more knowledge, and hence continuing education, in the foot care of older people to effectively prevent, recognise and care for foot problems and promote independent living in the community. Relevance to clinical practice Nurses' have clinically relevant knowledge gaps. Therefore, foot care knowledge of nurses needs to be improved by continuing education in clinical settings. Adequate foot care knowledge among nurses is important to identify, prevent and care foot problems especially in older people. [ABSTRACT FROM AUTHOR]

Background A positive life orientation ( PLO) is important for staying healthy physically, mentally and functionally. However, little is known about the factors connected with PLO in home-dwelling older people, even though it is an important topic. Aim The aim of this study was to identify factors connected with positive life orientation among home-dwelling older people. Study design An explorative, population-based cross-sectional study of the age cohort of 70-year-olds living at home at the age of 70, 80, 85 and 90. Methods The data were collected in 1991 among all residents of Turku, Finland, born in 1920 (N = 1530). Follow-ups were conducted in 2001 (n = 656), 2006 (n = 304) and 2011 (n = 156). A multiple regression analysis was conducted to estimate a model of factors that connected with PLO. Results Several factors were significantly connected with PLO at ages 70, 80, 85 and 90. For example, if 70-year-old respondents perceived themselves as being in better health than others of the same age, it improved their PLO. We also observed that PLO was improved by good self-rated health during the past 12 months at 80, good self-rated health at 85 and good self-rated health compared to others of the same age at 90. The various explanatory models explained between 24 and 36% of the variance in outcomes. Conclusion Overall, our results showed that the respondents' own subjective views were significant independent factors of PLO in all four analyses (70, 80, 85 and 90 years). These subjective experiences remained significant even when objective indicators such as medication use, the presence of diseases and functional capacity were taken into account. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the development process of the foot health assessment instrument for the assessment of foot health in older people and to evaluate the psychometric properties of the foot health assessment instrument. Background In clinical nursing, assessment of foot health and recognition of foot problems in older people is fundamental for maintain older persons' independent functional ability. However, valid and reliable nurse-administered foot health assessment instruments are lacking. Design A cross-sectional methodological design. Methods The foot health assessment instrument was developed in 2008-2011 based on a literature review and expertise in podiatry and nursing. Content validity was evaluated in four expert panels. Inter-rater reliability between nurses' and researcher ( MS) assessments was evaluated in the pilot test and in the empirical testing of the instrument with a sample of visiting home nurses. Inter-rater reliability was calculated with Cohen's kappa, internal consistency reliability was examined with Cronbach's alpha coefficients and item analysis, and construct validity was evaluated by principal component analysis with Varimax rotation and confirmatory factor analysis. Results Content validity was guaranteed by the expert analyses. Inter-rater reliability improved after pilot test. The Cronbach's alpha coefficient for the total foot health assessment instrument was satisfactory. Item-to-total correlations varied between but most of them were acceptable. Principal component analysis and confirmatory factor analysis supported the four component structure of the foot health assessment instrument. Conclusions The 23-item foot health assessment instrument showed preliminary acceptable psychometric properties. However, further modifications and testing are needed to strengthen the psychometric properties of the foot health assessment instrument. Relevance to clinical practice The existence of a foot health assessment instrument and its application would considerably improve the assessment of foot health in daily nursing practice. The foot health assessment instrument developed in this study is short and easy to administer. [ABSTRACT FROM AUTHOR]

Aims and objectives. To assess the foot health of older people and their self-care activities in home care. The ultimate goal is to prevent foot problems in older people and to develop the assessment skills of nurses working in home care. Background. Foot health problems are one reason why older people seek home care services. These problems are prevalent in older people, and they can impair performance of daily activities and threaten functional ability. However, studies in this field have concentrated on foot problems related to specific diseases. Non-disease-related research on foot health from the preventative perspective is lacking. Design. A descriptive explorative design was used. Methods. The foot health of older people was assessed by visiting home nurses with the Foot Health Assessment Instrument, and older people's foot self-care activities were evaluated with the Foot Self-Care Activities Structured Interview in 2010. The data were analysed statistically. Results. Older people in home care have multiple foot health problems. The most prevalent problems were oedema, dry skin, thickened and discoloured toenails and hallux valgus. Caring for one's feet was a problem for many older people. Conclusions. Older people's foot health needs to be assessed regularly to recognise foot health and self-care problems. Health care professionals have a vital role in preventing, recognising and caring for foot health in older people. Relevance to clinical practice. The foot health of older people needs to be improved by supporting older people in foot self-care and developing preventive nursing interventions. Regular foot health assessments and their documentation are crucial in preventing serious foot problems in older people. Moreover, multiprofessional collaboration is important to promote foot health in older people. [ABSTRACT FROM AUTHOR]

Background/Aims: The relationship between baseline 11C-Pittsburgh compound B (11C-PIB) uptake and cognitive decline during a 2-year follow-up was studied in 9 patients with mild cognitive impairment (MCI) who converted to Alzheimer's disease (AD) and 7 who remained with MCI. Methods:11C-PIB PET scan was conducted at baseline and cognitive assessment both at baseline and at follow-up. To obtain quantitative regional values of 11C-PIB uptake, automated region of interest analysis was done using spatially normalized parametric ratio (region-to-cerebellar cortex) images. Results: At baseline, there were statistically significant differences in 11C-PIB uptake, but not in cognitive test performances between the converters and nonconverters. Memory and executive function declined only in the converters during follow-up. In the converters, lower baseline frontal 11C-PIB uptake was associated with faster decline in verbal learning. Higher baseline uptake in the caudate nucleus was related to faster decline in memory consolidation, and higher temporal uptake was associated with decline in executive function. Conclusion: Higher 11C-PIB uptake in the caudate nucleus and temporal lobe was related to decline in memory and executive functions, whereas lower frontal uptake was related to decline in verbal learning. The results indicate that in prodromal AD, frontal amyloid accumulation reaches its maximum in the MCI stage, characterized by memory problems without full-blown dementia. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

An abstract of the article "Longitudinal Changes in Serum Lipids in Older People: The Turku Elderly Study 1991-2006," by Evelina Upmeier and colleagues is presented.

Background and aims: The purpose of this study was to assess the quality of life (QoL) of peripheral arterial disease (PAD) amputees. Patients and methods: Fifty-nine PAD patients (mean age 75.2, SD 10.7, range 39-96, 47% men) who had undergone their first major lower leg amputation (LEA) on average 2.7 years earlier (in 1998-2002) were interviewed, and 118 age- and gender-matched controls completed a postal questionnaire. Outcomes were assessed with 15D Health-Related QoL instrument, Rand-36 Physical Functioning- and General Health subscales, Geriatric Depression Scale, 6-item Brief Social Support Questionnaire, and Self-reported Life Satisfaction score. Results: The amputees had more diseases than their controls. HRQoL was lower among amputees than among controls. Half the amputees lived in institutional care, 25% had a Mini-Mental Examination score <18, and 22% had unilateral below- knee amputations only. The amputees had a similar self-assessed sense of their general state of health, life satisfaction and perceived social support as controls. Amputees who were institutionalized and those who did not use prostheses had more symptoms of depression than those who lived at home or used pros- theses. Conclusion: Home-dwelling amputees had a relatively good QoL, whereas institutionalization was associated with depressive symptoms. In rehabilitation programs, not only physical disability assessment but also QoL should be considered. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented concerning a study expanding documentation of the viral etiology and clinical significance of respiratory disease in older patients by examining the association between respiratory illness and viral infection and between viral diseases and chronic illness which required hospitalization.

Background and aims: To determine whether high levels of serum total cholesterol and low levels of high-density lipoprotein cholesterol (HDL-c) are associated with increased mortality in the elderly. Methods: Prospective cohort study of 1032 non-institutionalized people aged 70 in the city of Turku, Southern Finland. The cohort population was recruited as part of a larger longitudinal aging study, the Turku Elderly Study. Fasting serum levels of total cholesterol, HDL-c and triglycerides were measured, and the amount of low-density lipoprotein cholesterol was calculated at baseline. The cohort was followed for mortality for 12 years, and the causes of death were recorded and further classified into cardiovascular and other causes of death. The hazard ratios of dying for subjects in various cholesterol quartiles were computed by the Cox proportional hazards model, adjusting for cardiovascular risk factors and pre-existing medical conditions. Results: Low levels of serum total cholesterol and HDL-c were associated with a greater risk of death over a follow-up of 12 years. After adjustment for several cardiovascular risk factors, the association between total cholesterol and survival changed. All-cause mortality seemed to be highest in the highest quartile of total cholesterol and nearly as high in the lowest quartile of total cholesterol, suggesting a U-shaped connection, but the differences were not statistically significant. However, cardiovascular mortality was significantly lowest in the lowest quartile of total cholesterol and significantly highest in the lowest quartile of HDL-c. Conclusions: High levels of serum total cholesterol and particularly low levels of HDL-c seem to be risk factors for cardiovascular mortality even in the elderly population. [ABSTRACT FROM AUTHOR]

Background and aims: The methods of treating peripheral arterial disease (PAD) have changed and become more prophylactic. This study describes and analyzes 1) the incidence rates of major lower extremity amputation (LEA) due to PAD, 2) occurrence of re-amputation, and 3) the survival of amputees and factors predicting survival. Methods: The series consisted of 210 patients (mean age 76.6, SD 10.7 yrs, 45.2% men) who underwent their first, i.e. index, major leg amputation because of PAD, in 1998-2002, in the city of Turku, Finland, population 175,000. Results. The age and gender-standardized incidence rate of combined above-knee and below-knee amputations was 24.1/100,000 person-years during 1998-2002. Thirty-four per cent of amputees underwent repetitive amputation. One-month mortality was 21% (n=45), one-year mortality 52% (n=109) and overall mortality 80% (n=168). Cardiovascular diseases predicted equally well 31-day, one-year, and overall mortality in age- and gender-adjusted analysis. Multiple co-morbidities (p=0.023) and unilateral above-knee amputations (p=0.047) were significant predictors for overall mortality in age- and gender-adjusted analysis. Cardiovascular diseases remained a significant predictor for 31-day and overall mortality in multivariate analysis (p=0.008 and p=0.015, respectively). Amputated patients' previous vascular procedures did not have any effect on mortality in the Cox model. Most revascularizations were performed less than six months before the index/first major LEA. Conclusion: Major LEAs seem to have been done late, and mainly for pain relief in the end-stage of patients with peripheral arterial disease. [ABSTRACT FROM AUTHOR]

Examines the effect of low-dose aspirin therapy on long-term survival of cardiovascular patients in Finland. Improvement in the life expectancy of the patients; Factors affecting long-term survival; Correlation between cardiovascular mortality and age.

Examines the association of apolipoprotein E (apo E) on survival of centenarians in Finland. Prevalence of apo E in late-onset Alzheimer's disease; Susceptibility of apo E to the development of vascular dementia in nondemented populations; Development of Cox proportional hazard models to quantify the association between apo E and mortality in aged.

Objective This study aimed to examine loneliness among two birth cohorts, born 20 years apart, when they were 70 years of age, and to identify factors explaining loneliness. Methods The cohorts consisted of older home-dwelling residents of Turku, Finland, from the birth cohort 1920 in 1991 ( N = 1530) and the birth cohort 1940 in 2011 ( N = 1307). Suffering from loneliness was assessed with the question: ‘Do you suffer from loneliness?’ Cross-tabulations with chi-square test, general linear model (GLM) and multiple regression analysis were used in statistical testing and modeling. Results In the 1940 cohort, around one-fifth (18%) of the respondents suffered from loneliness at least sometimes, while the corresponding figure in the 1920 cohort was around one-fourth (26%). Our analyses indicated that the effect of cohort was not a statistically significant explanatory factor of loneliness. Living status, self-rated health and memory compared to age peers were statistically significant explanatory factors for suffering from loneliness. When we controlled the effect of depressiveness on the experience of loneliness, it was shown that the effects of living status and self-rated health remained statistically significant, whereas memory compared to age peers did not. Depressiveness itself was highly important. The combined effect of living status and self-rated health emerged as the most significant explanatory factor for loneliness. Older people with poor self-rated health who lived alone were most likely to suffer from loneliness. Conclusion The findings give healthcare professionals an opportunity to plan for interventions aimed at combating loneliness among home-dwelling older people. [ABSTRACT FROM AUTHOR]

Abstract: Background: Positive life orientation (PLO) is considered an important dimension of successful aging. Aim: To investigate how self-reported PLO changed among home-dwelling people from age 70 to 80 and 85 years. Study design: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. Subjects and methods: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (N =1530). Follow-ups using the same procedure were conducted in 2001 and 2006. PLO was assessed with the following items: life satisfaction, feeling needed, having plans for the future, having zest for life, feeling depressed, and suffering from loneliness. We created a PLO score from the answers to these questions, where 1 represented the best PLO and 0 the poorest. Results: At baseline, the participants showed rather high levels of positive life orientation (PLO total score 0.83). PLO declined markedly after the 70-year-old participants reached the age of 80 and 85 years (p <.001). However, depressive feelings remained quite stable. The decrease was similar among men and women except for the items suffering from loneliness and feeling needed. At age 70 and 80 years women suffered more from loneliness than men, while men experienced feeling needed more than women. Conclusions: Positive life orientation declines during old age, especially from age 70 to 80 years. Thereafter the decline is less steep except for changes in future plans and feeling needed. [Copyright &y& Elsevier]

Background: We conducted a comparative analysis of hypertension prevalence, progression, and treatment in two Finnish population-based cohorts comprising older adults born 20 years apart. The study covered data from pre- and post-HYVET Study eras and spanned the onset of the COVID-19 pandemic., Methods: All 70-year-old home-dwelling citizens of Turku, in Southwest Finland, were invited to participate in the survey in 1990 (1920-born TUVA cohort) and in 2010 (1940-born UTUVA cohort) with a 25-year follow-up plan. The analyses included those with available data for systolic and diastolic blood pressure (BP), yielding 1015 TUVA and 888 UTUVA participants at baseline. Biomarkers associated with BP were analysed with t - and chi-square tests., Results: At baseline, 83.4% of TUVA and 74.3% of UTUVA participants had uncontrolled BP, with respective antihypertensive medication usage at 36.0% and 55.9% ( p  < .001 for both between-cohort differences). Systolic BP exhibited an inverted U-shaped trajectory, with TUVA initially 7.8 mmHg higher at 155.4 mmHg than UTUVA ( p  < .001). However, by the ages 80-82, the difference in systolic BP trajectories between the cohorts was attenuated to 4.0 mmHg ( p  = .03). Diastolic BP differences were less clinically significant. UTUVA demonstrated higher use of all five conventional antihypertensive categories than TUVA ( p  ≤ .02 for all categories)., Conclusions: In the early years of older adulthood, the 1940-born cohort showed a positive trend in hypertension management, yet maintained a 74.3% baseline rate of uncontrolled BP. Furthermore, by the ages 81-82, the benefits observed over the 1920-born cohort had lessened, influenced by the COVID-19 pandemic or other lasting factors. Heightened efforts to improve hypertension treatment in older adults remain crucial in the post-HYVET era.

Purpose: The ageing population is increasingly multimorbid. This challenges health care and elderly services as multimorbidity is associated with institutionalization. Especially dementia increases with age and is the main risk factor for institutionalization. The aim of this study was to assess the association of chronic conditions and multimorbidity with institutionalization in home-dwelling older people, with and without dementia., Methods: In this prospective study with 18-year follow-up, the data on participants' chronic conditions were gathered at the baseline examination, and of conditions acquired during the follow-up period from the municipality's electronic patient record system and national registers. Only participants institutionalized or deceased by the end of the follow-up period were included in this study. Different cut-off-points for multimorbidity were analyzed. Cox regression model was used in the analyses. Death was used as a competing factor., Results: The mean age of the participants (n = 820) was 74.7 years (64.0‒97.0). During the follow-up, 328 (40%) were institutionalized. Dementia, mood disorders, neurological disorders, and multimorbidity defined as five or more chronic conditions were associated with a higher risk of institutionalization in all the participants. In people without dementia, mood disorders and neurological disorders increased the risk of institutionalization., Conclusion: Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization. These risk factors should be recognized when providing and targeting care and support for older people still living at home., (© 2021. The Author(s).)

Background: Objective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Also, self-reported assessment of health by simple self-rated health (SRH) has been shown to predict mortality and institutionalization. The aim of this study was to assess the association of objective and subjective health with mortality and institutionalization in Finnish community-dwelling older adults., Methods: In this prospective study with 10- and 18-year follow-ups, objective health was measured by registered illnesses and subjective health was evaluated by simple SRH, self-reported walking ability (400 m) and self-reported satisfaction in life. The participants were categorized into four groups according to their objective and subjective health: 1. subjectively and objectively healthy, 2. subjectively healthy and objectively unhealthy, 3. subjectively unhealthy and objectively healthy and 4. subjectively and objectively unhealthy. Cox regression model was used in the analyses. Death was used as a competing factor in the institutionalization analyses., Results: The mean age of the participants (n = 1259) was 73.5 years (range 64.0-100.0). During the 10- and 18-year follow-ups, 466 (37%) and 877 (70%) died, respectively. In the institutionalization analyses (n = 1106), 162 (15%) and 328 (30%) participants were institutionalized during the 10- and 18-year follow-ups, respectively. In both follow-ups, being subjectively and objectively unhealthy, compared to being subjectively and objectively healthy, was significantly associated with a higher risk of institutionalization in unadjusted models and with death both in unadjusted and adjusted models., Conclusions: The categorization of objective and subjective health into four health groups was good at predicting the risk of death during 10- and 18-year follow-ups, and seemed to also predict the risk of institutionalization in the unadjusted models during both follow-ups. Poor subjective health had an additive effect on poor objective health in predicting mortality and could therefore be used as part of an older individual's health evaluation when screening for future adverse outcomes.

Objective: To examine whether early β-amyloid (Aβ) accumulation and metabolic risk factors are associated with neuroinflammation in elderly individuals without dementia., Methods: We examined 54 volunteers (mean age 70.0 years, 56% women, 51% APOE ɛ4 carriers) with the translocator protein (TSPO) tracer [ 11 C]PBR28 to assess neuroinflammation and with [ 11 C] Pittsburgh compound B (PiB) to assess cerebral Aβ accumulation. [ 11 C]PBR28 and [ 11 C]PiB standardized uptake value ratios (SUVRs) were quantified in 6 regions of interests by using the cerebellar cortex as a pseudo-reference and reference region, respectively. Fasting venous glucose, insulin, and high-sensitivity C-reactive protein (hs-CRP) values were determined. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated. A subset of individuals (n = 11) underwent CSF sampling, and Aβ 40 , Aβ 42 , total tau, phospho-tau, soluble TREM2, and YKL-40 levels were measured., Results: Among the whole study group, no significant association was found between [ 11 C]PiB and [ 11 C]PBR28 SUVR composite scores (slope 0.02, p = 0.30). However, higher [ 11 C]PiB binding was associated with higher [ 11 C]PBR28 binding among amyloid-negative ([ 11 C]PiB composite score ≤1.5) (TSPO genotype-, age- and sex-adjusted slope 0.26, p = 0.008) but not among amyloid-positive (slope -0.004, p = 0.88) participants. Higher CSF soluble TREM2 ( r s = 0.72, p = 0.01) and YKL-40 ( r s = 0.63, p = 0.04) concentrations were associated with a higher [ 11 C]PBR28 composite score. Higher body mass index, HOMA-IR, and hs-CRP were associated with higher [ 11 C]PBR28 binding in brain regions where Aβ accumulation is first detected in Alzheimer disease., Conclusions: While there was no association between amyloid and neuroinflammation in the overall study group, neuroinflammation was associated with amyloid among the subgroup at early stages of amyloid pathology., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Purpose: Psychosocial resources have been considered to be associated with survival among frail older adults but the evidence is scarce. The aim was to investigate whether psychosocial resources are related to survival among non-robust community-dwelling older people., Methods: This is a prospective study with 10- and 18-year follow-ups. Participants were 909 non-robust (according to Rockwood's Frailty Index) older community-dwellers in Finland. Psychosocial resources were measured with living circumstances, education, satisfaction with friendship and life, visiting other people, being visited by other people, having someone to talk to, having someone who helps, self-rated health (SRH) and hopefulness about the future. To assess the association of psychosocial resources for survival, Cox regression analyses was used., Results: Visiting other people more often than once a week compared to that of less than once a week (hazard ratio 0.61 [95% confidence interval 0.44-0.85], p = 0.003 in 10-year follow-up; 0.77 [0.62-0.95], p = 0.014 in 18-year follow-up) and good SRH compared to poor SRH (0.65 [0.44-0.97], p = 0.032; 0.68 [0.52-0.90], p = 0.007, respectively) were associated with better survival in both follow-ups. Visiting other people once a week (compared to that of less than once a week) (0.77 [0.62-0.95], p = 0.014) was only associated with better 18-year survival., Conclusions: Psychosocial resources, such as regularly visiting other people and good self-rated health, seem to be associated with better survival among non-robust community-dwelling Finnish older people. This underlines the importance of focusing also on psychosocial well-being of frail older subjects to remain or promote their resilience.

Background and Aims: Depressive symptoms are common symptoms impairing the quality of life of older people. This population-based birth year cohort study investigated the prevalence of depressive symptoms and factors associated with them among home-dwelling older people., Study Design: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland., Methods: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (n=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. All examinations included an identical study protocol; the participants' self-reported health status/habits and depressive symptoms were investigated via a questionnaire. Afterwards, thorough clinical examinations including the Zung depression scale were conducted by a nurse and physician/geriatrician., Results: The mean of the Zung depression scale total score was 34 (SD 7.7) at the age of 70 and a significant increase was found in both re-examinations. At the age of 80 the mean of the Zung score was 35.8 (SD 7.5) while it was 37.6 (SD 8.9) at the age of 85 years. A similar increasing trend was found in the proportion of persons classified into the high Zung score group (≥45 points) indicating more depressive symptoms over the 15 year follow-up. Univariate and multivariate analyses showed that mostly functional and social factors were associated with subjectively reported depressive symptoms, while few associations were evidenced between depressive symptoms and medical conditions or poor health., Conclusions: Our findings revealed an increase in prevalence of depressive symptoms throughout the course of the investigation. Our findings suggest that even in the absence of a diagnosis of major depression, depressive symptoms assume importance in the evaluation of the health status and need for health care services among older people.

Background and Objective: Pharmaceutical care is one of the most important therapeutic tools in older people care. The aim of this study was to describe the knowledge and attitudes of older home-dwelling people's about their perceptions of pharmaceutical care and use of medication., Material and Methods: The data were collected using theme interviews with 16 older Finnish people (born 1920). Inductive content analysis was used in analyzing the data., Results: Older people's knowledge about their pharmaceutical care varied widely: some had precise knowledge whereas others had none. Guidance in pharmaceutical care was not readily available. The interviewees took a positive attitude toward their pharmaceutical care and favored a minimum use of medication. Being able to cope independently with their pharmaceutical care strengthened the older people's sense of control over their lives., Conclusions: The study offers new knowledge about the significance of older people's individual pharmaceutical care at home. By listening to and utilizing older people's experiences, we can recognize the factors that promote the independent coping and inclusion of older people in their pharmaceutical care. This enables health care providers to increase the safety and quality of pharmaceutical care for older people.

Background and Aims: Major lower extremity amputation (LEA) leads to great loss in mobility, exposing old people to the risk of losing their independent living status. This study applies predictors for institutionalization and considers prosthesis use by major lower leg amputees with peripheral arterial disease (PAD)., Methods: 119 PAD patients admitted from home (mean age 73.6, SD 11.5 years, 48% men) underwent their first major LEA, 1998- 2002, and survived at least one month after the operation. Logistic regression analysis was run to clarify institutionalization predictors. Prosthesis use and ambulatory capacity were recorded during the follow-up., Results: Older age, living alone, and unilateral above-knee amputation (AKA) or bilateral amputation predicted institutionalization. Of prosthesis users, 69% (27/39) were younger than 75 and 44% (17/39) were able to walk both in- and outdoors. Reasons for not receiving a prosthesis after amputation were: 1) short expected survival; 2) old age, combined with unilateral AKA or bilateral amputation; 3) unilateral AKA or bilateral amputation and a comorbid condition such as hemiparesis, paraplegia, uremia, dementia, or alcohol misuse. After one year, 72% (36/50) of amputees who were able to return home and 9% (3/32) of amputees in institutional care used a prosthesis., Conclusion: The majority of amputated patients cannot return home after their first LEA. Comorbid conditions particularly influencing functional capacity also hinder ambulation with a prosthesis.