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Background: Gerascophobia, or excessive fear of aging, is thought to be caused by a mixture of cognitive, experiential, and physiological factors acting on a person at particular time points. Measurement tools for evaluating geraschophobia remain insufficiently developed, despite this commonplace fear's distress. Objective: The objective of the current study was to develop and validate the Gerascophobia or Excessive Fear of Aging Scale (GEFAS) and analyze its psychometric properties. Methods: Three successive investigations were carried out with a total of 1594 participants. Exploratory and confirmatory factor analyses were conducted to evaluate the construct validity of the GEFAS. Convergent and discriminant validity was assessed by examining relationships with measures of depression, anxiety, stress, death anxiety, psychosocial illness, and life satisfaction. Multiple linear regression was used to investigate factors that predict fear of aging. Results: The GEFAS demonstrated high reliability (Cronbach alpha >0.8). Factor analysis supported a single-factor solution for the scale (fitness indices CFI, TLI, NNFI, NFI, RFI, and MFI all > 0.95; RMSEA=0.06. Significant positive correlations were found between fear of aging and depression (r = 0.270; p < 0.01), anxiety (r = 0.311; p < 0.01), stress (r = 0.285; p < 0.01), death anxiety (r = 0.600; p < 0.01), and psychosocial illness (r = 0.243; p < 0.01). A significant inverse correlation was observed with life satisfaction. Gender differences were also noted, with women exhibiting greater fear of aging than men (p < 0.01; d = 0.488). Conclusion: The GEFAS fills a significant gap in the psychological/psychiatric literature as a useful tool for evaluating the fear of aging. The study concludes that the excessive fear of aging contributes to poor mental health.

This edited volume addresses the environments that exacerbate, exclude, and stigmatise those living with dementia to explore designs and processes that can optimise well-being and independence. Featuring the voices and opinions of people with dementia, the chapters showcase individual homes, special dementia facilities, different forms of care homes, and public spaces, from landscape to urbanism, as examples of how to meet the needs and preferences for those living with dementia now. As a response to a recent Cochrane meta-analysis (2022) which highlighted the problems associated with using traditional, medically orientated evaluative methods for environmental design, this book demonstrates a range of research methods that can be used to inform and investigate good co-design of dementia-enabling environments. Furthermore, the book addresses cultural differences in people’s needs and illustrates past, ongoing, and novel initiatives worldwide. Ultimately, this timely volume focuses on person-centred design that enables empowerment, quality of life, health, and citizenship in people living with dementia. It will be of value to researchers, scholars, and postgraduate students studying gerontology, dementia specifically, and those involved with architecture and the built environment for societal benefit more broadly.

AIM: Older adults are increasingly encouraged to continue living in their own homes with support from home care services. However, few studies have focused on older adults' safety in home care. This study explored associations between the sense of security and factors related to demographic characteristics and home care services. METHODS: The mixed longitudinal design was based on a retrospective national survey. The study population consisted of individuals in Sweden (aged 65+ years) granted home care services at any time between 2016 and 2020 (n=82,834-94,714). Multiple ordinal logistic regression models were fitted using the generalised estimation equation method to assess the strength of relationship between the dependent (sense of security) and independent (demographics, health and care-related factors) variables. RESULTS: The sense of security tended to increase between 2016 and 2020, and was significantly associated with being a woman, living outside big cities, being granted more home care services hours or being diagnosed/treated for depression (cumulative odds ratio 2-9% higher). Anxiety, poor health and living alone were most strongly associated with insecurity (cumulative odds ratio 17-64% lower). Aside from overall satisfaction with home care services, accessibility and confidence in staff influenced the sense of security most. CONCLUSIONS: We stress the need to promote older adults' sense of security for safe ageing in place, as mandated by Swedish law. Home care services profoundly influence older adults' sense of security. Therefore, it is vital to prioritise continuity in care, establish trust and build relationships with older adults. Given the increasing shortage of staff, integrating complementary measures, such as welfare technologies, is crucial to promoting this sense of security.

Introduction: Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population. Aim: To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival. Methods: All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests. Findings: Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05). Conclusion: This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population., Validerad;2024;Nivå 2;2024-03-21 (signyg);Funder: the Borgerskapet in Umeå Research Foundation, the Erik and Anne-Marie Detlof Research Foundation, the Swedish Society of Medicine, the Strategic Research Program in Care Sciences (SFO-V, Sweden);Full text license: CC BY

Introduction: Metabolically healthy obesity may be a transient phenotype, but studies with long follow-up, especially covering late-life, are lacking. We describe conversions between cross-categories of body mass index (BMI) and metabolic health in 786 Swedish twins with up to 27 years of follow-up, from midlife to late-life. Methods: Metabolic health was defined as the absence of metabolic syndrome (MetS). We first visualized conversions between BMI-metabolic health phenotypes in 100 individuals with measurements available at ages 50–64, 65–79, and ≥80. Next, we modeled conversion in metabolic health status by BMI category in the full sample using Cox proportional hazards regression. Results: The proportion of individuals with MetS and with overweight or obesity increased with age. However, one-fifth maintained a metabolically healthy overweight or obesity across all three age categories. Among those metabolically healthy at baseline, 59% converted to MetS during follow-up. Conversions occurred 56% more often among individuals with metabolically healthy obesity, but not overweight, compared to normal weight. Among those with MetS at baseline, 60% regained metabolic health during follow-up, with no difference between BMI categories. Conclusions: Conversions between metabolically healthy and unhealthy status occurred in both directions in all BMI categories. While conversions to MetS were more common among individuals with obesity, many individuals maintained or regained metabolic health during follow-up., CC BY 4.0 DEED© 2023, The Author(s).Published: 02 December 2023Brief communicationCorrespondence Address: I.K. Karlsson; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 17177, Sweden; email: ida.karlsson@ki.se; CODEN: IJOBDThis work was supported by the Strategic Research Program in Epidemiology at Karolinska Institutet; the Swedish Research Council for Health, Working Life and Welfare (2018-01201 and 2022-00672); the Swedish Research Council (2016-03081); Loo and Hans Osterman Foundation for Medical Research (2022-01222 and 2023-01855); Foundation for Geriatric Diseases at Karolinska Institutet (2022-01296 and 2023-01854); Karolinska Institutet’s Research Foundation (2022-01718); and the National Institutes of Health (R01 AG060470 and AG059329). The funding sources had no involvement in the current work. SATSA was supported by the National Institutes of Health (NIH; grants AG04563 and AG10175), the MacArthur Foundation Research Network on Successful Aging, the Swedish Research Council for Working Life and Social Research (FAS; Grants 97:0147:1B, 2009-0795), and the Swedish Research Council (825-2007-7460 and 825-2009-6141). We acknowledge the Swedish Twin Registry for access to data. The Swedish Twin Registry is managed by Karolinska Institutet and receives funding through theSwedish Research Council under the grant no. 2021-00180.Open access funding provided by Karolinska Institute.

Background Older persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults. Methods A qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis. Results The analysis generated three main themes; “It’s like walking in a bubble”, “An eye opener” and “Concerns about ageing and the current structure of geriatric care”. The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability. Conclusions Age suit simulation was d, CC BY 4.0 DEEDCorrespondence: Björn Bouwmeester Stjernetun Bjorn.stjernetun@his.se© 2024 BioMed Central Ltd unless otherwise stated. Part of Springer Nature.Open access funding provided by University of Skövde. This study was funded by the Kamprad Family Foundation for Entrepreneurship, Research & Charity in Sweden [grant number 20210227] and the University of Skövde.

Social participation is positively associated with older adults’ health. Health-care services, therefore, need to empower older adults to adapt to the social changes that accompany aging. This systematic review, with a metasynthesis of qualitative studies, aimed to describe and develop an understanding of home-dwelling older adults’ (65 yrs+) experiences of using strategies to maintain and foster their social participation. The main search was performed in March 2022 using the PubMed, CINAHL, PsycINFO, and AMED databases and included peer-reviewed articles published between 2012 and 2022. A total of 35 full-text articles from 15 different countries were included and assessed for quality by the assessment tool for qualitative studies provided by the Critical Appraisal Skills Programme (CASP). The metasynthesis resulted in the main theme: strategically creating routines that foster social participation and two main categories: inward-looking strategies for social participation and outward-looking strategies for social participation. Each main category contained three subcategories. The findings suggest that for perceiving social participation, it is important for older adults to create routines with patterns of activities and to be able to engage in these activities. The findings further reflect that older adults use earlier experiences of social participation to facilitate the making of routines. This indicates that health-care interventions supporting older adults’ social participation must be applied early and with a health-promotive focus. Conclusively, researchers need to develop interventions that support older adults in healthy activity patterns by raising awareness of how to use inward-looking and outward-looking strategies to create routines for social participation. The findings further suggest that older adults’ possibilities for social participation could be supported by designing accessible venues that facilitate spontaneous meetings and encourage older a, Validerad;2024;Nivå 2;2024-03-14 (hanlid);Full text license: CC BY

This study aimed to investigate the prevalence of having plans for the future among very old people and the factors associated with having such plans. A longitudinal population-based study with home visits for 85-, 90-, and ≥95-year-old participants in Sweden and Finland was used. Multivariate logistic regression and Cox proportional-hazards regression models with a maximum 5-year follow-up period were used. The prevalence of having plans for the future was 18.6% (174/936). More men than women and more people living in Sweden than in Finland had plans for the future. In multivariate models, having plans for the future was associated with speaking Swedish, being dentate, and living in the community in the total sample; speaking Swedish and being dentate among women; and speaking Swedish, having a lower Geriatric Depression Scale score, and urban residence among men. Having plans for the future was associated univariately, but not multivariately, with increased survival.

Obesity and metabolic syndrome (MetS) share common pathophysiological characteristics with aging. To better understand their interplay, we examined how body mass index (BMI) and MetS jointly associate with physiological age, and if the associations changed from midlife to late-life. We used longitudinal data from 1,825 Swedish twins. Physiological age was measured as frailty index (FI) and functional aging index (FAI) and modeled independently in linear mixed-effects models adjusted for chronological age, sex, education, and smoking. We assessed curvilinear associations of BMI and chronological age with physiological age, and interactions between BMI, MetS, and chronological age. We found a significant three-way interaction between BMI, MetS, and chronological age on FI (p-interaction = 0·006), not FAI. Consequently, we stratified FI analyses by age: < 65, 65–85, and ≥ 85 years, and modeled FAI across ages. Except for FI at ages ≥ 85, BMI had U-shaped associations with FI and FAI, where BMI around 26-28 kg/m2 was associated with the lowest physiological age. MetS was associated with higher FI and FAI, except for FI at ages < 65, and modified the BMI-FI association at ages 65–85 (p-interaction = 0·02), whereby the association between higher BMI levels and FI was stronger in individuals with MetS. Age modified the MetS-FI association in ages ≥ 85, such that it was stronger at higher ages (p-interaction = 0·01). Low BMI, high BMI, and metabolic syndrome were associated with higher physiological age, contributing to overall health status among older individuals and potentially accelerating aging., CC BY 4.0 DEED© 2023, The Author(s)Published: 16 December 2023Correspondence Address: P. Ler; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Nobels väg 12A, Solna, 171 65, Sweden; email: peggy.ler@ki.seOpen access funding provided by Karolinska Institute. This work was supported by the Swedish Research Council for Health, Working Life and Welfare (Forte; 2022-00672); the Strategic Research Program in Epidemiology (SFOepi) at Karolinska Institutet, Karolinska Institutet’s Research Foundation (2022-01718); Loo and Hans Osterman’s Foundation (2022-01222, 2023-01855); the Foundation for Geriatric Diseases at Karolinska Institutet (2022-01296); the National Institutes of Health (NIH; R01 AG060470, AG059329), and the Swedish Research Council (Vetenskaprådet; 2016–03081). SATSA was supported by the NIH (grants AG04563 and AG10175), the MacArthur Foundation Research Network on Successful Aging, the Swedish Research Council for Working Life and Social Research (97:0147:1B, 2009-0795), and the Swedish Research Council (825-2007-7460 and 825-2009-6141). OCTO-Twin was supported by the NIH (R01AG08861). GENDER was supported by the MacArthur Foundation Research Network on Successful Aging, The Axel and Margaret Ax:son Johnson’s Foundation, The Swedish Council for Social Research, and the Swedish Foundation for Health Care Sciences and Allergy Research. The funders had no role in the study design, data collection, data analysis, interpretation, or writing of the manuscript.

Objectives: The study aimed to investigate how the objective use of a powered toothbrush in frequency and duration affects plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm in elderly individuals with MCI. A second aim was to compare the objective results with the participants’ self-estimated brush use. Materials and methods: Objective brush usage data was extracted from the participants’ powered toothbrushes and related to the oral health variables plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm. Furthermore, the objective usage data was compared with the participants’ self-reported brush usage reported in a questionnaire at baseline and 6- and 12-month examination. Results: Out of a screened sample of 213 individuals, 170 fulfilled the 12-month visit. The principal findings are that despite the objective values registered for frequency and duration being lower than the recommended and less than the instructed, using powered toothbrushes after instruction and information led to improved values for PI, BOP, and PPD ≥ 4 mm in the group of elderly with MIC. Conclusions: Despite lower brush frequency and duration than the generally recommended, using a powered toothbrush improved oral health. The objective brush data recorded from the powered toothbrush correlates poorly with the self-estimated brush use. Clinical relevance: Using objective brush data can become one of the factors in the collaboration to preserve and improve oral health in older people with mild cognitive impairment. Trial registration: ClinicalTrials.gov Identifier: NCT05941611, retrospectively registered 11/07/2023., CC BY 4.0 DEED© 2023, The Author(s)Correspondence Address: J. Flyborg; Department of Health, Blekinge Institute of Technology, Karlskrona, 37179, Sweden; email: johan.flyborg@bth.se

To understand health and well-being in later life, it is vital to consider the meaning of subjective aging. This study aimed to explore how perceived health, self-perceptions of aging, and participation in social activities relate to each other among older persons in the Bothnia region and Åland islands in Finland. Data were analyzed using Spearman’s and polychoric correlation and multinomial logistic regression analyses. The perceived good health and the younger physical, psychological, and social dimensions of subjective age were found to be associated with each other and with participation in social activities outside one's home.

INTRODUCTION: China has the world's largest number of older adults with cognitive impairment (CI). We aimed to examine secular trends in the prevalence of CI in China from 2002 to 2018. METHODS: Generalized estimating equations (GEE) was used to assess changes in CI trend in 44,154 individuals (72,027 observations) aged 65 to 105 years old. RESULTS: The prevalence of CI increased from 2002 to 2008 and then decreased until 2018. The age-standardized prevalence increased from 25.7% in 2002, 26.1% in 2005, to 28.2% in 2008, then decreased to 26.0% in 2011, 25.3% in 2014, and 24.9% in 2018. Females and those ≥ 80 years old had greater CI prevalence. DISCUSSION: The prevalence of CI showed an inverted U shape from early 2000s to late 2010s with a peak in 2008. Follow-up studies are needed to confirm the decreasing trend after 2008 and examine the contributing factors and underlying mechanisms of this trend.

Objective: To investigate the associations of triglyceride-glucose (TyG) index, a reliable surrogate marker for insulin resistance, with the function of various cognitive domains and brain structures among older adults. Design: A population-based cross-sectional study. Setting: Older adults living in the rural communities in China. Participants: About 4,541 rural-dwelling dementia-free participants (age ≥65 years; 56.37% women) undertook examinations in March–September 2018 for MIND-China. Measurements: TyG index was calculated as ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. A neuropsychological test battery was used to assess memory, attention, verbal fluency, and executive function. Volumetric brain measures were assessed on magnetic resonance imaging (MRI) in a subsample (n = 1,019). Data were analyzed with restricted cubic spline and multivariable general linear models. Results: An inverted J-shaped association was observed between TyG index and z-scores of multiple cognitive domains, such that among individuals with TyG index ≥8.57 (median), a higher TyG index was significantly associated with lower z-scores of memory, attention, verbal fluency, executive function, and global cognition (all p < 0.05); among people with TyG index <8.57, a higher TyG index was significantly associated with a higher executive function z-score (p < 0.05), but not with any of the other examined cognitive domains. In the MRI subsample, a higher TyG index was significantly associated with lower volumes of total brain tissue, gray matter, and white matter as well as greater cerebrospinal fluid volume (p < 0.05), but not with white matter hyperintensity volume. Conclusions: Insulin resistance, as indicated by a high TyG index, was associated with poor function in multiple cognitive domains and global brain atrophy.

This study suggests that the concept of proto-conversation may be used to describe and understand communication with people with late-stage dementia who have lost their abilities to produce verbal language. In the study, a multimodal conversation analytic method is used to analyze sequences of interactions between professional caregivers in an elderly care home and people with late-stage dementia. The study shows how minimal actions (shift of gaze directions, vocalizations or bodily movements) not instantly recognizable as intentional, communicative conduct, may be recognized and treated as communicative contributions by engaging the person living with dementia in proto-conversations. In such interactional sequences, the caregivers do not only turn the contributions of persons with dementia into actions through their responses, but they also treat the persons as agentive actors and position them as partners in interaction.

Aims. Co-occurring somatic diseases exhibit complex clinical profiles, which can differentially impact the development of late-life depression. Within a community-based cohort, we aimed to explore the association between somatic disease burden, both in terms of the number of diseases and their patterns, and the incidence of depression in older people. Methods. We analysed longitudinal data of depression- and dementia-free individuals aged 60+ years from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression diagnoses were clinically ascertained following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision over a 15-year follow-up. Somatic disease burden was assessed at baseline through a comprehensive list of chronic diseases obtained by combining information from clinical examinations, medication reviews and national registers and operationalized as (i) disease count and (ii) patterns of co-occurring diseases from latent class analysis. The association of somatic disease burden with depression incidence was investigated using Cox models, accounting for sociodemographic, lifestyle and clinical factors. Results. The analytical sample comprised 2904 people (mean age, 73.2 [standard deviation (SD), 10.5]; female, 63.1%). Over the follow-up (mean length, 9.6 years [SD, 4 years]), 225 depression cases were detected. Each additional disease was associated with the occurrence of any depression in a dose–response manner (hazard ratio [HR], 1.16; 95% confidence interval [CI]: 1.08, 1.24). As for disease patterns, individuals presenting with sensory/anaemia (HR, 1.91; 95% CI: 1.03, 3.53), thyroid/musculoskeletal (HR, 1.90; 95% CI: 1.06, 3.39) and cardiometabolic (HR, 2.77; 95% CI: 1.40, 5.46) patterns exhibited with higher depression hazards, compared to those without 2+ diseases (multimorbidity). In the subsample of multimorbid individuals (85%), only the cardiometabolic pattern remained associated with a

Objectives: The educational gradient in late-life health is well established. Despite this, there are still ambiguities concerning the role of underlying confounding by genetic influences and gene-environment (GE) interplay. Here, we investigate the role of educational factors (attained and genetic propensities) on health and mortality in late life using genetic propensity for educational attainment (as measured by a genome-wide polygenic score, PGSEdu) and attained education. Methods: By utilizing genetically informative twin data from the Swedish Twin Registry (n = 14,570), we investigated influences of the educational measures, familial confounding as well as the possible presence of passive GE correlation on both objective and subjective indicators of late-life health, that is, the Frailty Index, Multimorbidity, Self-rated health, cardiovascular disease, and all-cause mortality. Results: Using between-within models to adjust for shared familial factors, we found that the relationship between educational level and health and mortality later in life persisted despite controlling for familial confounding. PGSEdu and attained education both uniquely predicted late-life health and mortality, even when mutually adjusted. Between-within models of PGSEdu on the health outcomes in dizygotic twins showed weak evidence for passive GE correlation (prGE) in the education-health relationship. Discussion: Both genetic propensity to education and attained education are (partly) independently associated with health in late life. These results lend further support for a causal education-health relationship but also raise the importance of genetic contributions and GE interplay.

This review article examined perspectives on the well-being and health of older adults in Japan, a nation renowned for its longevity. We emphasized the impact of social capital and social relationships in local communities, considering both individual and societal factors. The prevailing values in Japanese culture tend to foster a sustained and stable form of interdependent happiness among older adults, suggesting that communal support systems play an important role. This article highlights the value of multi-level datasets, such as the Japan Gerontological Evaluation Study (JAGES) dataset, for understanding the influence of social participation on the health and well-being of older adults. A growing body of evidence underscores the central role of social relationships in the health and well-being of older adults.

Aims: To examine associations of life-course stress with cognition and diurnal cortisol patterns in older adulthood, as well as potential mediation effects of diurnal cortisol patterns and perceived stress on the association between life-course stress and cognition. Methods: 127 participants without dementia were selected from a cohort of Swedish memory clinic patients. Cross-sectional associations between scores on two chronic stress questionnaires (perceived stress, stressful life events (SLEs)), five cognitive domains (overall cognition, memory, working memory, processing speed, perceptual reasoning), and two measures of diurnal cortisol patterns (total daily output, diurnal cortisol slope), as well as potential mediation effects of diurnal cortisol patterns and perceived stress on associations between life-course stress and cognition, were assessed using linear regressions. Results: Greater lifetime exposure to SLEs was associated with worse memory, working memory, and processing speed performance, but not with diurnal cortisol patterns. A greater number of SLEs in late childhood was associated with worse working memory and processing speed, while a greater number of SLEs in non-recent adulthood were associated with better overall cognition and perceptual reasoning. Greater perceived stress was associated with a flattened diurnal cortisol slope, but not with cognition. No evidence for interplay between self-reported and physiological stress markers was found in relation to cognition, although there appeared to be a significant positive indirect association between economic/legal SLEs and the diurnal cortisol slope via perceived stress. Conclusions: The associations between SLEs and cognition depend on the period during which SLEs occur, but seem independent of late-life cortisol dysregulation.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in adults aged 65 years and older. Their gastrointestinal adverse event risk might be further reinforced when using concomitant cholinesterase inhibitors (ChEIs). We aimed to investigate the association between NSAIDs and ChEI use and the risk of peptic ulcers in adults aged 65 years and older. Methods: Register-based self-controlled case series study including adults ≥65 years with a new prescription of ChEIs and NSAIDs, diagnosed with incident peptic ulcer in Sweden, 2007–2020. We identified persons from the Total Population Register individually linked to several nationwide registers. We estimated the incidence rate ratio (IRR) of peptic ulcer with a conditional Poisson regression model for four mutually exclusive risk periods: use of ChEIs, NSAIDs, and the combination of ChEIs and NSAIDs, compared with the non-treatment in the same individual. Risk periods were identified based on the prescribed daily dose, extracted via a text-parsing algorithm, and a 30-day grace period. Results: Of 70,060 individuals initiating both ChEIs and NSAIDs, we identified 1500 persons with peptic ulcer (median age at peptic ulcer 80 years), of whom 58% were females. Compared with the non-treatment periods, the risk of peptic ulcer substantially increased for the combination of ChEIs and NSAIDs (IRR: 9.0, [6.8–11.8]), more than for NSAIDs alone (5.2, [4.4–6.0]). No increased risks were found for the use of ChEIs alone (1.0, [0.9–1.2]). Discussion: We found that the risk of peptic ulcer associated with the concomitant use of NSAIDs and ChEIs was over and beyond the risk associated with NSAIDs alone. Our results underscore the importance of carefully considering the risk of peptic ulcers when co-prescribing NSAIDs and ChEIs to adults aged 65 years and older.

Background and aims: Active aging is the process through which people strive to maintain wellbeing when growing old. Addressing the lack of research on active aging in the context of housing, the aim was to describe active aging among people aged 55 and older considering relocation and investigate whether perceived housing moderates the relationship between functional limitations and active aging. Methods: We utilized cross-sectional data from a sub-sample (N = 820; mean age = 69.7; 54% women) of the Prospective RELOC-AGE. Functional limitations were reported using 10 dichotomous questions. Active aging was assessed with the University of Jyvaskyla Active Aging Scale (UJACAS; 17 items, self-rated for four perspectives). Perceived housing was self-rated with four usability questions and meaning of home (MOH; 28 items). Cross-sectional associations and interactions were analysed using linear regression models, adjusting for gender and educational level. Results: Each functional limitation decreased the active aging score by almost five points (p < 0.001). Usability did not moderate that relationship while MOH significantly attenuated the association between functional limitations and active aging (p = 0.039). Those with high MOH had two points less decrease in active aging score compared to those with low MOH. Discussion and conclusions: Having a home with more personal meaning attached to it seems to provide more ability and opportunity for meaningful activities, thus supporting active aging despite functional limitations. This sheds new light on the known association between MOH and different aspects of wellbeing in old age and has relevance for theory development, housing policies and housing counselling targeting younger older adults.

Rapporten använder demografiska uppgifter för att beskriva vad vi statistiskt vet om dagens nära familjeband bland svenskar och vad familjemedlemmar gör för varandra. För att begripliggöra de ”torra” sakuppgifterna ramas de in av historiska data och jämförs med internationella mönster. Familj och familjeliv beskrivs ofta i mörka färger, med bräckliga relationer, krympande familjer och stora avstånd, i kontrast till hur man tror att det var ”förr”. Här skildras svenska familjer med kalla siffror fram till 2022, men också med ett historiskt perspektiv och med bilder samt tragiska och roande exempel ur familjelivet. Partner, barn, föräldrar och syskon utgör familjens och därmed samhällets kärna. Här ges fakta om och perspektiv på den svenska befolkningen, med historiska och internationella utblickar. Allt fler har föräldrar i livet, fler lever med en partner, har syskon, barn och man har ofta familjemedlemmar i närheten. Aldrig förr har så många levt så länge med partnern och haft så god tillgång på anhöriga som idag. Allt fler hinner träffa mor- och farföräldrar, allt fler tar hand om barnbarn. Hjälp, omsorg och vård inom familjen är omfattande och växande, och Sverige har inte världsrekord i ensamboende eller ensamhet. Vi lever allt mer traditionella liv, men tror oss vara originella. Svenska familjeband beskrivs i rapporten av professor emeritus Gerdt Sundström, Institutet för gerontologi, Hälsohögskolan i Jönköping.

Background Previous phase 3 studies showed that the AS01E-adjuvanted respiratory syncytial virus (RSV) prefusion F protein-based vaccine for older adults (RSVPreF3 OA) is well tolerated and efficacious in preventing RSV-associated lower respiratory tract disease in adults ≥ 60 years of age. This study evaluated lot-to-lot immunogenicity consistency, reactogenicity, and safety of three RSVPreF3 OA lots. Methods This phase 3, multicenter, double-blind study randomized (1:1:1) participants ≥ 60 years of age to receive one of three RSVPreF3 OA lots. Serum RSVPreF3-binding immunoglobulin G (IgG) concentration was assessed at baseline and 30 days post-vaccination. Lot-to-lot consistency was demonstrated if the two-sided 95 % confidence intervals (CIs) of the RSVPreF3-binding IgG geometric mean concentration (GMC) ratios between each lot pair at 30 days post-vaccination were within 0.67 and 1.50. Solicited adverse events (AEs) within four days, unsolicited AEs within 30 days, and serious AEs (SAEs) and potential immune-mediated diseases within six months post-vaccination were recorded. Results A total of 757 participants received RSVPreF3 OA, of whom 708 were included in the per-protocol set (234, 237, and 237 participants for each lot). Lot-to-lot consistency was demonstrated: GMC ratios were 1.06 (95 % CI: 0.94–1.21), 0.92 (0.81–1.04), and 0.87 (0.77–0.99) between the lot pairs (lot 1/2; 1/3; 2/3). For the three lots, the RSVPreF3-binding IgG concentration increased 11.84-, 11.29-, and 12.46-fold post-vaccination compared to baseline. The reporting rates of solicited and unsolicited AEs, SAEs, and potential immune-mediated diseases were balanced between lots. Twenty-one participants reported SAEs; one of these–a case of atrial fibrillation–was considered by the investigator as vaccine-related. SAEs with a fatal outcome were reported for four participants, none of which were considered by the investigator as vaccine-related. Conclusion This study demonstrated lot-to-lot i

Background: Stimulating activities are associated with a decreased risk of dementia. However, the extent to which this reflects a protective effect of activity or non-participation resulting from dementia is debated. We investigated the association of stimulating leisure-time activity in late adulthood with the risk of dementia across up to two decades' follow-up. Methods: We used data from five prospective cohort studies from Finland and Sweden. Mental, social, outdoor, consumptive and physical leisure-time activities were self-reported. Incident dementia was ascertained from clinical diagnoses or healthcare and death registers. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Of the 33 263 dementia-free individuals aged ≥50 years at baseline, 1408 had dementia during a mean follow-up of 7.0 years. Active participation in mental (HR: 0.52, 95% CI: 0.41 to 0.65), social (HR: 0.56 95% CI: 0.46 to 0.72), outdoor (HR: 0.70, 95% CI: 0.58 to 0.85), consumptive (HR: 0.67, 95% CI: 0.53 to 0.94) and physical (HR: 0.62, 95% CI: 0.51 to 0.75) activity, as well as variety (HR: 0.54, 95% CI: 0.43 to 0.68) and the overall frequency of activity (HR: 0.41, 95% CI: 0.34 to 0.49) were associated with a reduced risk of dementia in <10 years' follow-up. In ≥10 years' follow-up all associations attenuated toward the null. Conclusion: Stimulating leisure-time activities are associated with a reduced risk of dementia in short-term but not long-term follow-up. These findings may reflect a reduction in leisure-time activity following preclinical dementia or dilution of the association over time., CC BY 4.0 Deed© 2024 The Author(s)Correspondence Address: K. Heikkilä; Department of Public Health, University of Turku, Turku, Kiinamyllynkatu 10, 20520, Finland; email: katriina.heikkila@utu.fi; CODEN: AANGASNAC-K receives financial support from the Swedish Research Council (Vetenskapsrådet, 2011-6,243; 2017-06088), the Swedish Research Council for Health, Working Life and Welfare (FORTE, 2016-07175), and is supported by the Swedish Ministry of Health and Social Affairs and the participating County Councils and Municipalities. MK was supported by Wellcome Trust (221854/Z/20/Z), UK Medical Research Council (S011676, Y014154), US National Institute on Aging (NIH, R01AG056477, R01AG062553), and Research Council Finland (350426). JV was supported by the Academy of Finland (321409 and 329240). S Stenholm was supported by Research Council Finland (332030), Juho Vainio Foundation and Signe and Ane Gyllenberg Foundation. S Stenlund was supported by Signe and Ane Gyllenberg Foundation. The authors thank the research teams that collected, linked and curated data and especially all the individuals who participated in the longitudinal cohort studies.

During the COVID-19 outbreak, the care services interruption/delay resulted in increased amount of care for informal caregivers of older people with long-term care needs. This study aimed at understanding how the Pandemic affected physical health, mental well-being and quality of life of older people' informal caregivers of different ages and to what extent starting caregiving affected such life realms among new caregivers. An online survey was carried out in Winter 2020-2021 targeted to informal caregivers living in 16 European countries. A sub-sample of 848 adult (aged 18-64) was compared to another of 542 older (over 65) informal caregivers. People who started caring during the Pandemic were also identified and the impact of the Pandemic on the three life realms of this group were analysed separately by gender and age. The differences between the two groups of adult and older caregivers were estimated using logistic regression, adjusted for potential confounders. Analyses were repeated after propensity score matching. During the second Pandemic wave hitting Europe in Winter 2020-21, regardless of age, being female entailed a worsening in physical health, mental well-being and quality of life, in line with previous research Also new caregivers were mostly females and their physical health and quality of life were worsened by caregiving. Gender-specific work-life balance policies and measures are needed to support female working caregivers. More attention should be paid to older female caregivers through scheduled physical and mental health screenings and home visits. Future studies on the topic in a gender and intergenerational perspective are encouraged.

This thesis addresses the pressing issue of frailty management in an aging population,aiming to develop a simulation model to evaluate the effectiveness of preventioninterventions among elderly individuals. Through a systematic approach integratingliterature reviews, interviews, and computational modeling, five separate simulationmodels are created to analyze intervention effects on frailty components. Theresults highlight significant differences in intervention impacts, with nutritionalinterventions notably delaying frailty onset in slowness and activity components byup to 4.5 and 26 years, respectively. Physical interventions also play a crucial rolein delaying frailty, particularly in slowness and activity. However, combinationinterventions do not simply sum benefits, suggesting potential interactions amonginterventions. Additionally, cognitive interventions exhibit notable impacts onexhaustion and weakness components, emphasizing their multifaceted nature inpromoting overall well-being in older adults. The simulation models underscorethe importance of considering intervention compatibility and synergistic effects.This research contributes evidence-based insights into effective frailty preventionstrategies, bridging theoretical understanding with practical application for healthcareprofessionals, policymakers, and stakeholders involved in promoting healthyaging., Denna avhandling behandlar den angelägna frågan om hantering av skörhet ien åldrande befolkning, med målet att utveckla en simuleringsmodell för attutvärdera effektiviteten av förebyggande interventioner bland äldre individer.Genom en systematisk metod som integrerar litteraturöversikter, intervjuer ochdatormodellering skapas fem separata modeller för att analysera interventionernaseffekter på skörhetskomponenter. Resultaten belyser betydande skillnader iinterventionernas påverkan, där näringsinterventioner märkbart fördröjer skörhetensbörjan i komponenterna långsamhet och aktivitet med upp till 4,5 respektive 26år. Fysiska interventioner spelar också en avgörande roll i att fördröja skörhet,särskilt i långsamhet och aktivitet. Kombinationer av interventioner summerardock inte helt enkelt fördelarna, vilket antyder potentiella interaktioner mellaninterventionerna. Dessutom visar kognitiva interventioner betydande effekter påutmattning och svaghet, vilket understryker deras mångfacetterade natur i att främjaäldre vuxnas allmänna välbefinnande. Simuleringen betonar vikten av att beaktainterventioners kompatibilitet och synergistiska effekter. Denna forskning bidrarmed evidensbaserade insikter i effektiva strategier för förebyggande av skörhet, ochförenar teoretisk förståelse med praktisk tillämpning för vårdpersonal, beslutsfattareoch andra intressenter som arbetar för att främja ett hälsosamt åldrande

Healthy ageing is a global priority due to a growing older population, which increases the need for preventive measures and tailored technology. In health technology development, co-design is emphasised as a valuable strategy to support a person-centred approach. Co-design, a value-driven and collaborative approach, involves end users in development processes to overcome barriers connected to capability, opportunity, and motivation. While a growing number of older adults are involved in design processes, there is a deficit of suitable methodologies for achieving active involvement. Additionally, the COVID-19 pandemic necessitated a shift to developing methodological skills and tools to facilitate co-design remotely in a digital setting. Here, we draw on experiences of conducting iterative co-design workshops with a Canadian and a Swedish cohort of older adults about technology development to support mobility, balance, and confidence in daily movement. We describe and discuss methodological and ethical challenges and opportunities to provide recommendations for conducting co-design research in a digital setting with older adults (+65 years). Our recommendations include the use of live mind mapping to facilitate participation involvement, and we address the issue of 'homework' in co-design and the importance of setting expectations.

Bakgrund: Enligt rapporter från svenska palliativregistret där man lagt fokus på palliativ vård i särskilt boende (SÄBO), framkommer det att den palliativa vården inte är jämlik i Sverige. Det är ett komplext uppdrag att bedriva vård och omsorg av äldre. Personerna som bor i ett SÄBO har ofta en multisjuklighet, många av patienterna har även en demenssjukdom och oftast en hög ålder. Personer med stora omvårdnadsbehov och kognitiva nedsättningar behöver tillgång till insatser av god kvalitet dygnet runt. För att samarbetet ska fungera krävs insatser inom fler olika professioner. För att patienten ska få så bra vård som möjligt från start av sin inflyttning på SÄBO genom palliativt beslut och livets slutskede är samarbetet och teamet runt patienten av största vikt. Personalgruppens kompetens och sammansättning är viktiga faktorer, de får för den enskilde äldre patienten direkta effekter och konsekvenser i varje möte under hela dygnet. I dessa möten blir vårdens och omsorgens kvalitet synliga och påtagliga. När den äldre försämras är det viktigt för denne att känna en trygghet i att sjuksköterska känner till personen och har kunskap inom vård av äldre i livets slut. Kvaliteten på vården i livets slutskede lämnar idag rum för förbättring. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av förutsättningar för att ge omvårdnad till äldre personer i livets slutskede inom särskilt boende (SÄBO). Metod: Kvalitativ intervjustudie med induktiv ansats. Resultat: Analysen av intervjuerna resulterade i tre kategorier;“Tillgång till omvårdnadsinformation i hela vårdteamet”, “Tillgång till beslut som möjliggör god palliativ vård” samt “Tillgång till egna och kollegors erfarenheter och kunskap om palliativ omvårdnad”. Slutsats: Studien visade att palliativ vård är en viktig del av sjuksköterskans arbete inom SÄBO, eftersom patienterna ofta är multisjuka och har kort förväntad överlevnad. Studien visade även att bedömningen av vårdbehov är komplext och erfarenhet kräva

Bakgrund: Antalet äldre med skörhet ökar i samband med stigande ålder. Muskelsvaghet, ofrivillig viktnedgång, känsla av trötthet och infektionskänslighet är hälsoproblem som uppstår vid biologiskt åldrande. Till följd av dessa symtom upplever ofta multisjuka äldre svårigheter med att hantera vardagen. Det är sjuksköterskans ansvar att utgå från holistiskt perspektiv samt tillämpa vetenskapliga kunskaper för självständig vardag. Syfte: Att beskriva vilka aspekter sköra äldre i behov av omvårdnadsinsatser upplever som betydelsefulla för en bra vardag. Metod: Arbetet var av systematisk litteraturstudie och genomförd enligt tematisk syntetisk design. Resultat: Studiens resultat är grundat i tolv artiklar med kvalitativ design för att besvara studiens syfte. Dataanalysen resulterade i tre huvudteman; psykisk påverkan i vardagen, fysisk påverkan i vardagen och vården och anhörigas påverkan. Äldre upplevde att deras sociala liv påverkades av fysiska begräsningar, hjälpmedelsbehov och andelen kommunala insatser. Att få klara av sin vardag självständigt var de äldres främsta önskan., Background: The number of elderly people with frailty is growing, with increasing age. Muscle weakness, involuntary weight loss, a feeling of exhaustion, and susceptibility to infection are health problems that occur at a rising age. As a result of these symptoms, the elderly experience difficulties coping with everyday life. To achieve independence for the elderly, it is the nurse’s responsibility to have a holistic perspective and scientific knowledge. Purpose: Describing the important aspect of a good everyday life for frail elderly individuals in need of nursing interventions. Method: The method of this study has been systematic literature review and is implemented according to the thematic synthetic design. Result: The results of the study are based on twelve articles with a qualitative design to answer the purpose. The analysis results in three main categories: the psychological impact in everyday life, the physical impact in everyday life, and lastly, health care and the role of impact. The results also show that elderly people felt that their social lives were affected by physical limitations, the need for assistive devices, and the proportion of municipal interventions. To be able to manage and cope with their everyday lives independently was their main desire.

BACKGROUND: An increasing number of cross-sectional studies suggests that diet may impact memory and cognition in healthy older adults. However, randomized, controlled trials investigating the effects of whole-diet interventions on memory and cognition in healthy older adults are rather rare and conflicting results are often reported. OBJECTIVE: Therefore, a systematic review was conducted to compile the current evidence regarding the potential effects of whole-diet interventions on 1) memory and, 2) other cognitive outcomes in older adults. METHODS: Studies that reported on randomized, controlled trials with dietary interventions in healthy older adults (60 yrs. and older) were included. Studies utilizing supplements, single food items or trials in specific patient groups (ie neurodegenerative diagnoses) were excluded. RESULTS: For the 23 included articles, the main outcomes examined fell into one or more of the following categories: cognitive task-based outcomes related to memory, other cognitive task-based outcomes, and additional outcomes related to cognitive function or disease risk. Three of the studies that investigated dietary interventions alone and two multi-domain study showed positive effects on memory function, whereas five multi-domain interventions and one intervention that focused on diet alone showed positive effects on other cognitive outcomes. CONCLUSIONS: The effect of randomized, controlled whole-diet interventions on memory and cognitive function in healthy older adults is modest and inconclusive, highlighting the need for more well-designed, sufficiently powered studies. Furthermore, the potential mechanisms by which diet impacts cognition in healthy aging need to be elucidated. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: This systematic review is registered in PROSPERO under ID CRD42022329759.

BACKGROUND: Loneliness is a public health concern and more than half of the residents in nursing homes experience lonliness. Risk factors are age and loss of close relatives. PURPOSE: This study aimed to describe experiences of loneliness among older people living in an academic nursing home. METHODS: Qualitative semi-structured interviews were conducted with ten older people and data analysed with systematic text condensation inspired by a phenomenological approach. RESULTS: Three themes were identified: "Relatives and health care professionals matter"; "Acceptance and meaningful existence alleviate loneliness"; and "Challenges affecting the experience of loneliness". The older persons described themselves as lonely, but their experience of loneliness differed. They managed loneliness by adapting to it or getting used to it; some also chose to be alone. To add meaningfulness to their daily life, talking about memories and their past were appriciated. Personality traits and variations in functional ability were identified as barriers to social interactions. CONCLUSIONS: Health care professionals can reduce negative experiences of loneliness by listening to nursing home residents, creating a meaningful daily life with individualized activities, and by encouraging contacts with close relatives. This can be a way of maintaining older persons' dignity and coping with the longing for what has been.

Introduction Previous research has shown that nursing home applicants had negative experiences of living and receiving care in their ordinary housing due to several factors, such as difficulties in everyday activities and being depressed. However, whether these experiences stand solely for nursing home applicants, or are common in an older population in general needs to be investigated. Aim of this study was to compare nursing home applicants with matched older adults with respect to difficulties in everyday life, life satisfaction and depressive mood. Methods Using a case-control design, 34 participants (17 in each group) were compared using Wilcoxon signed rank test for continuous variables and McNemar test for binary variables. The magnitude of associations was explored using conditional logistic regression. Results Nursing home applicants experienced more difficulties in daily life and were more depressed than their matched peers, and this difference between groups was significant. To experience several difficulties in everyday life and being depressed increased the odds for a nursing home application. Conclusions As aging in place is the societal norm, older adults with increased likelihood of nursing home applications need to be identified and catered for in an early stage, to prevent nursing home admission.

Introduction Societal norms and policies encourage older adults to age and receive care in their home, referred to as ageing in place. Nevertheless, Swedish older adults apply for nursing home admission. To understand how ageing in place better could be supported, the aim was to study descriptions of older adults’ reasons for applying to a nursing home in documents of granted nursing home decisions. Methods 160 granted nursing home decisions underwent document analysis, to study if reasons occurred due to person, environmental or occupational factors according to occupational theory model Canadian Model of Occupation Performance- Engagement. Result Several factors in different parts of life were experienced to lead to a nursing home application, e.g., multiple impairments, anxiety, loneliness, or longing to be closer to relatives or healthcare staff. Additionally, reasons could also be recommendations from healthcare staff or that a spouse didn´t want to live together with support from home-based care. Conclusions The results highlight societal injustices that occurred for older adults who age in place, which expedited the applications. The documents described how ageing in place shrunk their opportunities for activity, social cohesion, and the possibility to proximity to staff.

Changing demographics with an increased proportion of older adults indicate the need to develop new health-promoting interventions where the potential of digitization is considered. The aim was to explore and create an understanding of how social online meetings are experienced by older adults. Interviews with older adults generated data that were analyzed using a grounded theory approach. The participants were interviewed after participating in a digital health promotion group initiative provided in a municipality context. A core conceptual category and three subcategories reflected an intertwined process of discovering facets of social participation where internal reflections on personal values and needs were nurtured by an external driven process of becoming part of a group in an online context. Occupational therapists and other health and social care professionals need to consider the various facets of social participation when supporting older adults active and healthy aging., Full text license: CC BY

Background: A body of research from around the world has reported positive effects of bilingualism on cognitive ageing and dementia. However, little is known about whether foreign language learning could be applied as an intervention for people already living with dementia. Yet, before it is possible to determine the efficacy of language courses as an intervention for people living with dementia (PLWD), it is necessary to establish whether such an intervention is feasible. Our study explored this possibility. Methods: We conducted an exploratory study to examine the feasibility and tolerability of 2-week Italian beginner courses for PLWD in early stages and their family carers in two Scottish Dementia Resource Centres (DRCs). The courses were delivered by trained tutors from Lingo Flamingo, a social enterprise specialising in language teaching for older learners and learners with dementia. Twelve PLWD and seven carers participated in the study. Focus groups preceded and followed the courses. Additional post-course open interviews with the DRC managers were conducted, with a follow-up via telephone approximately one year later. Results: Qualitative content analysis resulted in 12 themes, 5 reflected in the interview schedule and 7 arising from the focus groups and interviews. Overall, the courses were perceived positively by PLWD, carers, and DRC managers, although a few logistically and linguistically challenging aspects were also mentioned. The courses were found to positively impact both the individual by increasing self-esteem and producing a sense of accomplishment as well as the group by creating a sense of community. Notably, no adverse effects (in particular no confusion or frustration) were reported. Conclusion: The positive outcomes of our study open a novel avenue for future research to explore foreign language training in dementia as an intervention and its implications., Validerad;2024;Nivå 2;2024-04-22 (hanlid);Funder: University of Edinburgh; AHRC Open WorldResearch Initiative (AH/N004671/1);Full text license: CC BY

Background: This article examines the intersection of two global trends, super-diversity and globalized aging, in the context of urban communities. Super-diversity refers to the impact of changing immigration patterns on social, health, and economic systems. Interdisciplinary by definition, gerontological social work practice bridges macro, mezzo, and micro modalities, as well as professional and disciplinary false divides. Objective: The authors aim to highlight how urban gerontology practice can benefit from reaching across borders and boundaries. Goals include identifying best practices of care that can serve as models in a range of environments. Methods: The authors used a qualitative case study approach. Data collection consisted of individual interviews and focus groups. Findings: Findings suggest the ongoing relevance of ecological theory in the context of identifying best practices in social work gerontology. Discussion: Through the lens of super-diversity and globalized aging, the authors examine processes and impacts at the intersection of migration, advanced age, and care systems in the urban context. Findings indicate the need to further de-colonize aging care.

Background Sleep disturbances as well as cortisol hypersecretion are increasingly acknowledged as risk factors for Alzheimer's disease (AD). However, the mechanisms underlying the association, and the interplay with cortisol abnormalities, remain unclear. Objectives This study aims to identify how self-reported sleep disturbances are associated with structural brain measures and diurnal cortisol dysregulation among memory clinic patients. Design A cross-sectional study performed at Karolinska University Hospital Memory Clinic, Sweden. Participants The study was based on 146 memory clinic patients diagnosed with either subjective cognitive impairment or mild cognitive impairment. Measurements Self-reported sleep was measured using the Karolinska Sleep Questionnaire. MRI or CT was used to quantify structural brain measures using four visual rating scales (Scheltens, Pasquier, Koedam, and Fazekas scales), and salivary cortisol was sampled to measure diurnal cortisol patterns through measures of cortisol immediately after awakening, cortisol awakening response, bedtime cortisol, total cortisol from awakening to bedtime, and the AM/PM cortisol ratio. Results Increased sleep apnea index (OR=1.20, 95% CI=1.04:1.39, p=0.015) was associated with greater odds of posterior brain atrophy, measured by the Koedam visual rating scale, and reduced awakening Cortisol (beta=-0.03, 95% CI=- 0.07:0.00, p=0.045). Increased daytime sleepiness was associated with both reduced awakening cortisol (beta=-0.03, 95% CI=-0.06:0.00, p=0.025) and a reduced AM/PM cortisol ratio (beta=-0.04, CI=-0.08:-0.01, p= 0.021). Conclusion In a memory clinic cohort self-reported sleep disturbances are associated with both worse structural brain tissue integrity and altered diurnal cortisol profiles. These findings may add insights into possible mechanisms behind sleep disturbances in aging with subjective and cognitive impairment.

Having access to places and activities outside the home is known to be a central part of living a meaningful and fulfilled life. Such access is often dependent upon using different modes of transport (i.e. public bus, private car) and handling different types of everyday technologies (i.e. ticket and parking machines, payment devices). However, there are few studies which map how transportation and associated technologies impact access to places and activities among people living with dementia. This chapter details problematic situations that people living with dementia have described and sets the stage for what can be changed in rural and urban contexts to improve the dementia-friendliness of sustainable cost-effective transportation options using co-design methods.

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers’ scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.

Background Existing studies have used ADL and IADL separately as measures of dependency. However, dependency is a heterogeneous and complex issue, and the dependency of each older adult is a synergistic combination of several functional activities. In this study, we assess the pattern of multidimensional dependency of older adults based on ADL, IADL, visual impairment, difficulty in climbing a flight of stairs, pushing or pulling objects, depressive symptoms, cognitive impairment, marital status, and economic distress. It is important to classify the dependency status of older adults because this will be key to evaluating the needs for care, and plan services that effectively cater for the needs of the older adults. The classification into different latent classes means that older adults within each class have the same needs of dependency but different needs between the latent classes. Our objective is to identify patterns of multidimensional dependency in older adults. Methods Data from the Longitudinal Ageing Study in India (LASI) Wave-1, was used, the analytical sample consisted of 32,827 individuals of age 45 years and above. LCA was used to identify the multidimensional dependency class. LCA was conducted in R statistical package, using the poLCA package. The optimal number of classes was selected based on the comparison of model fit statistics. Independent variables were incorporated to explore the association between these variables and the latent class. Results Based on nine indicator variables, three latent classes were identified: Active Older adults, Moderately independent and Psychological and physically impaired. The Active older adults profile is comprised of older adults who have a very low probability of needing help for any ADL, IADL and other activities. The Moderately independent class were characterized as those older adults who were visually impaired but less likely to need help for IADL activities. The Psychological and physically impaired, the

Introduction: Educational differences in cognitive performance among older adults are well documented. Studies that explore this association typically estimate a single average effect of education on cognitive performance. We argue that the processes that contribute to the association between education and cognitive performance are unlikely to have equal effects at all levels of cognitive performance. In this study, we employ an analytical approach that enables us to go beyond averages to examine the association between education and five measures of global and domain-specific cognitive performance across the outcome distributions. Methods: This cross-sectional study included 1,780 older adults aged 58–68 years from the Longitudinal Aging Study Amsterdam. Conditional quantile regression was used to examine variation across the outcome distribution. Cognitive outcomes included Mini-Mental State Examination (MMSE) score, crystallized intelligence, information processing speed, episodic memory, and a composite score of global cognitive performance. Results: The results showed that the associations between education and different cognitive measures varied across the outcome distributions. Specifically, we found that education had a stronger association with crystallized intelligence, MMSE, and a composite cognitive performance measure in the lower tail of performance distributions. The associations between education and information processing speed and episodic memory were uniform across the outcome distributions. Conclusion: Larger associations between education and some domains of cognitive performance in the lower tail of the performance distributions imply that inequalities are primarily generated among individuals with lower performance rather than among average and high performers. Additionally, the varying associations across some of the outcome distributions indicate that estimating a single average effect through standard regression methods may overlook variati

Objectives: This scoping review presents an overview of the available research on symptoms, comorbidities, and associated challenges among older adults with ADHD. Method: The literature study followed Arksey and O’Malley’s five-stage framework. The search was conducted in ProQuest Central, Scopus, PsycInfo, CINAHL, and PubMed. Articles were included if they were peer-reviewed, ethically approved primary studies, written in the English language, concerning ADHD, and including people 60 years of age and older. Results: The review included 17 articles. Symptoms of ADHD persist throughout life. Older adults with ADHD experience similar core symptoms as younger individuals, but their manifestation and intensity may differ. The most common comorbidity found was mental illness, for example depression and anxiety. ADHD in older adults is linked to several challenges, such as difficulty with relationships and social isolation. Conclusion: Older adults with ADHD face various symptoms, comorbidities, and challenges that affect their quality of life. Age-related changes can amplify ADHD symptoms and increase the perceived burden of illness. More research is needed to understand the complex relationship between these factors and enable tailored interventions to improve their quality of life and well-being.

Background: Populations are ageing, making the quality of old age a crucial issue. Some adversity in old age, such as loss of loved one or loss of physical function, is often experienced, as is the need for recovery from such adversity. Resilience in later life has become an important topic and has accumulated much empirical research. However, the research has mainly centred on individual factors, such as personality, rather than social factors, such as family relationships or community engagement. There is no systematic review of the social dimensions of resilience in old age, a focus that should be especially important for policy and practice seeking to create supporting environments. Methods: Our review comprises quantitative and qualitative empirical original English language studies, published 2013–2023, using predefined search phrases including ‘resilience’ and various terms for old age and social dimensions. Titles and abstracts are screened by the first two authors using registered exclusion criteria. Final inclusion, based on full-text reading, is decided using registered inclusion criteria, and verified by co-authors. Qualitative articles are read by authors specialized in qualitative research and quantitative articles by authors specialized in quantitative research. Due to large expected heterogeneity, meta-analysis is not conducted, but weighted effect sizes or funnel plots may be prepared if parallel quantitative studies are encountered. Qualitative studies are synthesized using meta-aggregation. The risk of bias is evaluated with applicable Joanna Briggs Institute checklists for each study design. A narrative synthesis brings together the qualitative and quantitative studies. Conclusion: Methodological strengths and weaknesses of the included studies are reported to assess the quality of the research. Summary of the most significant social dimensions of resilience in old age is prepared, emphasizing interactions between contexts, stressors, mechanisms

There is an increasing recognition of the impact of built environment in the neighbourhood on healthy ageing, especially in the context of ageing in place. This study examines perceptions of third place and its potential value for mitigating loneliness in older adults. Thirty participants aged 65–89, living in ordinary housing across three neighbourhoods in the city of Stockholm, Sweden, conducted the interview-based sorting procedures, namely, Multiple Sorting Tasks (MST). In each individual MST procedure, the participant was asked to sort twenty pictures into groups using his or her own categories. The data were analysed using Multidimensional Scalogram Analysis, integrating qualitative data input and quantitative statistical analysis of the categorisations. Accessible local third places, which facilitate physical activities (especially walking) and community building (meaningful social connections) and provide options for food (a medium for social interactions), were seen as vital resources to combat loneliness. Thus, these places are supportive built environment elements of healthy ageing and ageing in place. The management aspect in third places operated by municipalities, including designing diverse public programs and services, and the service mentality of the staff members play an important role in making these places feel safe, at home, and potentially lessen the experience of loneliness to some extent. This study adds an urban design and planning perspective that can be integrated into environmental approaches to combat loneliness among older adults living in the community.

Sweden and West Germany have had persistently high divorce rates in recent decades, but these two welfare states were differently equipped to mitigate the economic consequences of divorce for individual security in old age: Sweden followed a gender-equal policy approach to enable women and men to achieve economic autonomy, while West Germany, following the male-breadwinner model, introduced the system of 'divorce-splitting' to account for differences in women's and men's income. Against this background, this study uses large-scale register data from the German Public Pension Fund and the Swedish population registers to examine how divorce is related to the monthly public old-age pension income of women and men. The main comparison groups are divorced and (re)married individuals who entered retirement between 2013 and 2018. We descriptively show annual income histories from ages 20 to 65, and calculate monthly public old-age pension income with respect to lifetime income and pension regulations, such as the supplements/deductions for 'divorce-splitting'. Multiple ordinary least square regression models further examine how family status relates to monthly public old-age pension income by gender. The results reveal that women and men in Sweden experience similar working histories, although women's incomes are lower. This is also reflected in women still having lower pension incomes than men. However, divorced and married women show comparable pension incomes, while divorced men receive approximately 26 per cent less pension income than married men. In West Germany, divorced women have significantly higher pension incomes than married women. The system of 'divorce-splitting' increases women's and decreases men's pension incomes, which seems to equalise their pension incomes. However, both stay below a married man's pension income. The findings indicate economic inequality in public old-age pension income by family status in Sweden and West Germany.

Background: The objective of this study is to explore the bidirectional, longitudinal associations between self-reported sensory functions (hearing/vision) and cognitive functioning among older adults in Sweden and Denmark during the period 2004–2017. Methods: The study is based on data from The Survey of Health, Ageing and Retirement in Europe and consists of 3164 persons aged 60 to 93 years. Within-person associations between sensory and cognitive functions were estimated using random intercept cross-lagged panel models. Results: The results indicated that cognitive and sensory functions were associated within their respective domains over time. The results on the bidirectional associations between sensory functions and cognition over time showed weak and statistically non-significant estimates. Conclusion: Our study showed no clear evidence for cross-lagged effects between sensory functions and cognitive functioning. Important to note, however, is that using longitudinal data to estimate change within persons is a demanding statistical test and various factors may have contributed to the absence of conclusive evidence in our study. We discuss several of these factors.

Background and aims: Transportation noise is an environmental exposure with mounting evidence of adverse health effects. Besides the increased risk of cardiovascular and metabolic diseases, recent studies suggest that long-term noise exposure might accelerate cognitive decline in older age. We examined the association between transportation noise and cognitive function in a cohort of older adults. Methods: The present study is based on 2594 dementia-free participants aged 60 + years from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Global cognition score and CIND (cognitive impairment, no dementia) were assessed with a comprehensive neuropsychological battery at baseline and up to 16 years. Residential transportation noise resulting from road traffic, railway, and aircraft were estimated at the most exposed façade and the time-weighted average exposure was assessed. Linear mixed-effect models were used to assess the effect of long-term traffic noise exposure on the rate of change in global cognition score. Hazard ratios (HRs) and 95 % confidence intervals (CIs) of CIND by transportation noise exposure were obtained with Cox proportional hazard models. Results: Global cognition score decreased at an average rate of −0.041 (95 %CI −0.043, −0.039) per year. Aircraft noise was associated with a 0.007 (per 10 dB Lden; 95 %CI −0.012, −0.001) faster annual rate of decline. Global cognition score seems to be not affected by road traffic and railway noise. During the follow-up, 422 (21 %) participants developed CIND. A 10-dB Lden difference in exposure to aircraft and railway noise was associated with a 16 % (HR 1.16, 95 %CI 0.91, 1.49) and 26 % (HR 1.26, 95 %CI 1.01, 1.56) increased hazard of CIND in the multi-pollutant model, respectively. No association was found for road traffic (HR 1.00, 95 %CI 0.83, 1.21). Conclusions: Transportation noise was linked to cognitive impairment and faster cognitive decline among older adults. Future studies are war

Participation of older workers in the labor market depends, among other things, on older workers employment chances. This study examines age differences regarding risk of unemployment and reemployment outcomes in late working life in Sweden. Using Swedish registry data, we analyzed the probability of unemployment as well as work-related activity following unemployment (wage- or self-employment; exit; downward mobility) of all people born between 1954 and 1968 (aged 49–63) and registered in Sweden between the years 2012 and 2018. Results show that although risk of unemployment does not differ significantly across age groups, younger age groups are more likely to be reemployed as wage-employed while older age groups are more likely to be reemployed as self-employed or exit working life. After an unemployment period, older employees are more likely to have a lower wage than during their previous employment or become part-time unemployed. We conclude that different age groups have unequal chances in late working life in terms of reemployment, risk of exit, and risk of downward mobility following unemployment. Policies for extending working life and promoting inequality should include measures for increasing employability of older workers such as anti-discriminatory laws and dealing with skills mismatch.

The nature of the relationship between sleep problems and dementia remains unclear. This study investigated the relationship between sleep measures and dementia in older adults (≥ 65) using data from the English Longitudinal Study of Ageing (ELSA) and further investigated the causal association in Mendelian randomization (MR) analysis. In total of 7,223 individuals, 5.7 % developed dementia (1.7 % Alzheimer's disease (AD)) within an average of 8 (± 2.9) years. Cox regression models and MR were employed. Long sleep duration (>8 h) was associated with 64 % increased risk of incident dementia and 2-fold high risk of AD compared to ideal sleep duration (7–8 h). This association was particularly evident in older-older adults (≥70 years) and those who consumed alcohol. Short sleep duration (<7 h) was associated with lower risk of incident dementia among older-older but higher risk among younger-older adults. Sleep disturbances and perceived sleep quality were not associated with dementia or AD. The MR study did not reveal causal associations between sleep duration and dementia. These findings suggest that self-reported short sleep in younger-older and long sleep in older-older adults and those with frequent alcohol consumption are associated with dementia. Early detection of these sleep patterns may help identify individuals at higher dementia risk.

Background This study aimed to assess the associations of orthostatic hypotension (OH), in the presence or absence of frailty, with dementia and mortality in older adults. Methods We conducted a 15-year population-based cohort study including 2 703 baseline dementia-free individuals from the Swedish National Study on Aging and Care in Kungsholmen. At baseline, OH was defined as a decline in systolic/diastolic blood pressure ≥20/10 mm Hg 1 minute after standing up from a supine position. Frailty status was defined following Fried's frailty phenotype. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders-fourth edition criteria. Multistate flexible parametric survival models were used to estimate associations of OH and frailty with dementia and mortality. Results Robust people with OH (adjusted hazard ratio [HR] = 2.28; 95% confidence interval [CI] = 1.47-3.54) and frail people without OH (HR = 1.98; 95% CI = 1.40-2.82) or with OH (HR = 2.73; 95% CI = 1.82-4.10) had a higher dementia risk than OH-free and robust people. Moreover, frail people, independently of the presence of OH, had higher mortality rate than OH-free and robust people. In individuals who developed dementia during the follow-up period, neither OH nor frailty was significantly associated with mortality. Conclusions Older adults with OH, whether robust or frail, may have a higher dementia risk than those without OH. Older adults with OH, when having frailty, may have a higher mortality rate than those without OH. The concurrent assessments of OH and frailty may provide prognostic values in terms of dementia and mortality risk in older adults.

This systematic review synthesized prior quantitative research on individual, family, job, and organizational factors associated with retirement intentions (RI) among older long-term care (LTC) workers. Seven databases were searched for peer-reviewed studies. RI were defined as early (<65 years) or late (>65 years). To assess the methodological quality, we used JBI's checklists. The PRISMA statement guided this review. After duplicates were removed, 4 489 records were identified. A final sample of six articles was selected as eligible for inclusion. Current findings show weak social support, high physical job demands, and type of LTC occupation as important determinants for early RI. Strong social support and good job resources are important determinants fore late RI. In contrast to earlier research on other groups of older workers, this review shows no statistically associations between health nor emotional job demands and early RI for LTC workers. The results are discussed using the JD-R theory. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)