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Introduction: Loneliness, social inactivity, and social isolation are intertwined concepts. When assessed separately, they indicate poor well-being, adverse health effects, and increased mortality. Studies exploring overlapping and comparing the prognosis of these concepts are scarce. We investigated (1) overlapping of concepts of loneliness, social inactivity, and social isolation, (2) characteristics of groups: group 0 (not lonely, socially inactive, or socially isolated), group 1 (lonely), group 2 (not lonely but socially inactive and/or socially isolated), and (3) the health-related quality of life (HRQoL), psychological well-being (PWB), and 3.6-year mortality of these groups. Methods: The home-dwelling older adults (n = 989; 75 y+) of the Helsinki Aging Study in 2019–2022 completing all required questionnaires were assessed. Group 0 included 494, group 1 included 280, and group 2 included 215 participants. Variables studied were demographics, diagnoses, mobility, physical functioning (Barthel index), and cognition (Mini-Mental State Examination). Outcomes were HRQoL (15D) and PWB. Mortality was retrieved from central registers. Results: Half of the sample was lonely, socially inactive, or socially isolated, but only 2% were simultaneously lonely, socially inactive, and socially isolated. Of lonely participants, 38% were also socially inactive and/or socially isolated. The lonely participants were significantly more often widowed or lived alone and had the lowest HRQoL and poorest PWB compared with the other groups. After adjustments (age, sex, Charlson Comorbidity Index), mortality did not statistically differ between the groups. Conclusion: Loneliness is an independent determinant of poor HRQoL and PWB, and it should be considered separately from social inactivity and social isolation. [ABSTRACT FROM AUTHOR]

With the substantial growth of an aging population, professionals in gerontology need to know how to work with groups of older people. Group work has become a popular means of helping the elderly, for example, to cope with losses (support groups) and to engage in social activities with peers (groups in day centers) as well as to support caregivers of dementia patients (caregivers' groups). We started group interventions to relieve loneliness among older people and developed long-term training to enhance the group leadership skills of professionals and to promote their self-reflection capabilities. Our training process consciously took advantage of constructive learning theory and a reflective learning model. The education process used modern activating learning methods to attain its goals. In this article we describe the main steps of this educational process and show the results of the trainees' evaluation, how they experienced the training process, and how the learning objectives were achieved.

A Finnish nursing home's team development process included brainstorming on the characteristics of good teams, profiling of team members' nursing skills, analysis of tasks, and identification of ways to improve work quality and information flow to residents. Team building required clarification of work structures, determination of the decision-making process, and acceptance of differences. (Contains 30 references.) (SK)

Background. Loneliness is a distressing feeling of a lack of satisfying human relationships. It is associated with poor quality of life. impaired health, and increased mortality among older individuals. The study aim was to determine the effects of new psychosocial group rehabilitation on the subjective health, use and costs of health services, and mortality of lonely older individuals. Methods. This randomized, controlled trial was performed in seven day care centers. A total of 235 older people (>74 years) suffering from loneliness participated. Intervention was implemented in 15 groups (each with 7-8 participants and 2 professional group leaders) meeting for 3 months altogether 12 times. Group intervention aimed to empower elderly people, and to promote their peer support and social integration. Intervention was based on the effects of closed-group dynamics. The groups had the following activities according to the participants' interests: (a) therapeutic writing and group psychotherapy, (b) group exercise and discussions, and (c) art activities. Group leaders received thorough training and tutoring. Subjective health, use and costs of health services, and mortality were measured. Results. At 2 years, survival was 97% in the intervention group (95% confidence interval [CI], 91-99) and 90% in the control group (95% CI, 85-95) (p = .047). The intervention group showed a significant improvement in subjective health, thus resulting in significantly lower health care costs during the follow-up: the difference between the groups was -943 [euro]/person per y (95% C1-1955 to -127:p = .039). Conclusions. Psychosocial group rehabilitation was associated with lower mortality and less use of health services. Key Words: Loneliness--Aged--Psychosocial rehabilitation--Randomized controlled trial.

Background: Life expectancy has increased markedly in the past decades. Thus, it is of great importance to understand how people are ageing and if the trajectories of health and disability are changing over time. This study aimed to examine trends in functional abilities and health in independent cohorts of people aged 75–95 over three decades. Methods: This Helsinki Ageing Study consists of repeated cross-sectional postal surveys examining independent cohorts of old people (75, 80, 85 and 90+ years old). This study combined data from four waves (1989, 1999, 2009 and 2019). Results: In the most recent wave, there was an increase in the portion of participants who were able to walk outdoors easily (75-year-olds p =0.03, 80-year-olds p =0.002, 85-year-olds p <0.001; p for linearity for the study year effect, all adjusted for sex). Fewer people in the youngest age group (75-year-olds) needed daily help from another person in 2019 compared to the earlier waves (p =0.02 for linearity for the study year). Over the past three decades, the proportions of self-reported good mobility have risen 8.7% (95% confidence interval (CI) 2.3–15.1) in 75-year-olds, 11.7% (95% CI 3.9–19.6) in 80-year-olds and 20.1% (95% CI 10.7–29.4) in 85-year-olds, after adjusting for sex. Furthermore, in 2019, more people rated their health as good and scored better in psychological well-being than in the previous waves among 75-, 80- and 85-year-olds. However, no improvements were found among 90+-year-olds in any of these variables. Conclusions: People between 75 and 85 years old are presently feeling and functioning better than their predecessors. This may be an important objective for both economics and health policy. [ABSTRACT FROM AUTHOR]

Background. The detrimental effects of delirium on functioning and mortality are well known, but health-related quality of life (HRQoL) and costs of care have rarely been investigated among patients with delirium. We studied the effects of multicomponent geriatric treatment on costs of care and HRQoL in delirious inpatients. Methods. A randomized, controlled trial of 174 inpatients with delirium was performed in an acute geriatric hospital. The intervention was individually tailored geriatric treatment. The HRQoL was measured by the 15D instrument and subjective health by a four-level ordinal scale. Health care costs including intervention costs were calculated for 1 year after the delirium episode. Results. Mean age of the patients was 83 years; 31% had prior dementia. After the index hospitalization for delirium, a greater proportion in the intervention group than in the control group stated that they felt healthy (71% vs 49%, p = .050). HRQoL deteriorated in both groups as a consequence of delirium. Deterioration was, however, slower in the intervention group (-0.026, 95% confidence interval [CI], -0.051 to -.001) than in the control group (-0.065, 95% CI, -0.09 to -0.040; p = .034). Counting all costs of hospital care, long-term care, skilled home nursing visits, and costs related to intervention, the intervention group used, on average, 19,737 [euro] during the follow-up year, whereas the respective figure for the control group was 19,557 [euro]. The difference between the groups was nonsignificant (180 [euro] [95% CI, -5,006 to 5,064 [euro]]). Conclusions. Comprehensive geriatric intervention improved HRQoL without increasing overall costs of care. Key Words: Delirium--Multicomponent geriatric treatment--Quality of life--Cost of care.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2006.02.006 Byline: Timo E. Strandberg, Kaisu H. Pitkala, Saila Berglind, Markku S. Nieminen, Reijo S. Tilvis Abstract: We aimed to examine whether better use of preventive methods and treatments of cardiovascular disease would reduce recurrent events in home-dwelling patients 75 years or older. Author Affiliation: Department of Public Health Science and General Practice, University of Oulu, University Hospital, Oulu, Finland Department of Medicine, Geriatric Clinic and Division of Cardiology, University of Helsinki, Helsinki, Finland Article History: Received 13 October 2005; Accepted 5 February 2006 Article Note: (footnote) DEBATE was supported by the Academy of Finland (grant 48613), the Lions Organization (Punainen Sulka-Red Feather), the Ragnar Ekberg Foundation, the Finnish Foundation for Cardiovascular Research (Sydantutkimussaatio), and the Helsinki University Central Hospital. Dr Strandberg was a senior investigator of the Academy of Finland in 2000 to 2005. Conflict of interest: All authors have had various cooperation with companies marketing cardiovascular drugs.

Background. Delirium is a common syndrome with poor prognosis affecting elderly inpatients. Treatment is mainly based on common sense with wide variations in practice. We investigated whether intensified, multicomponent geriatric treatment could improve the prognosis of delirious patients. Methods. We performed a randomized, controlled trial of 174 patients with delirium in six general medicine units from an acute hospital in Helsinki, Finland. The intervention group received individually tailored geriatric treatment. The primary endpoint was the sum of those deceased individuals and the patients permanently institutionalized. Secondary endpoints included the number of days in hospitals and other institutions, delirium intensity, and cognition. Results. The mean age of patients was 83 years, and 31% had previous dementia. The intervention group (N-87) received significantly more acetylcholinesterase inhibitors (58.6% vs 9.2%), atypical antipsychotics (69.8% vs 30.2%), specialist consultations (49.4% vs 28.7%), hip protectors (88.5% vs 3.4%). physiotherapy (87.4% vs 47.1%), and fewer conventional neuroleptics (8.0% vs 23.0%) than did the control group (N = 87). During the 1 year follow-up, 60.9% of the intervention group and 64.4% of controls were either deceased or permanently institutionalized (p = .638). The intervention group spent a mean of 126 days in institutions, and the control group 140 days (p = .688). Delirium was, however, alleviated more rapidly during hospitalization, and cognition improved significantly at 6 months in the intervention group. Conclusions. Faster alleviation of delirium and improved cognition justify good, comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis.

Background. The search for preventable and remediable risk conditions of cognitive decline is ongoing, but results have thus far been inconsistent. According to the hypothesis of our 10-year prospective study, the predictive values of different risk indicators change over time in a general 75+ population. Methods. A population-based sample of 75-, 80-, and 85-year-old individuals (n = 650) underwent comprehensive clinical examinations in 1990 in Helsinki, Finland. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and/or Clinical Dementia Rating (CDR) at baseline and after 1, 5, and 10 years. Results. At baseline, a low MMSE score was associated with age, history of stroke, apolipoprotein E allele [epsilon]4 (APOE4), and intermittent claudication. After 1 year, cognitive decline was typical of participants suffering from vascular diseases, e.g., heart failure and intermittent claudication. Five-year decline was predicted by the presence of atrial fibrillation (RR [relative risk] 2.8), APOE4 (RR 2.4), elevated C-reactive protein (CRP) (RR 2.3). diabetes mellitus (RR 2.2), and heart failure (RR 1.8). They also tended to increase 5-year all-cause mortality. At 10 years, the decline associated with APOE4 (RR 3.3), slightly elevated serum ionized calcium (RR 3.3), and feelings of loneliness (RR 3.0). Conclusions. Long follow-up of a general aged population explains several inconsistencies of earlier reports. In 75+ individuals, general ill health is a strong associate of cognitive deficits. The strongest predictors of both cognitive decline and mortality are age, APOE4, manifest vascular diseases, and diabetes. The role of new potential predictors, feelings of loneliness and hypercalcemia, needs clinical testing.

Abstract Background Use of inappropriate drugs is common among institutionalized older people. Rigorous trials investigating the effect of the education of staff in institutionalized settings on the harm related to older people’s drug treatment are still scarce. The aim of this trial is to investigate whether training professionals in assisted living facilities reduces the use of inappropriate drugs among residents and has an effect on residents’ quality of life and use of health services. Methods and design During years 2011 and 2012, a sample of residents in assisted living facilities in Helsinki (approximately 212) will be recruited, having offered to participate in a trial aiming to reduce their harmful drugs. Their wards will be randomized into two arms: one, those in which staff will be trained in two half-day sessions, including case studies to identify inappropriate, anticholinergic and psychotropic drugs among their residents, and two, a control group with usual care procedures and delayed training. The intervention wards will have an appointed nurse who will be responsible for taking care of the medication of the residents on her ward, and taking any problems to the consulting doctor, who will be responsible for the overall care of the patient. The trial will last for twelve months, the assessment time points will be zero, six and twelve months. The primary outcomes will be the proportion of persons using inappropriate, anticholinergic, or more than two psychotropic drugs, and the change in the mean number of inappropriate, anticholinergic and psychotropic drugs among residents. Secondary endpoints will be, for example, the change in the mean number of drugs, the proportion of residents having significant drug-drug interactions, residents' health-related quality of life (HRQOL) according to the 15D instrument, cognition according to verbal fluency and clock-drawing tests and the use and cost of health services, especially hospitalizations. Discussion To our knowledge, this is the first large-scale randomized trial exploring whether relatively light intervention, that is, staff training, will have an effect on reducing harmful drugs and improving QOL among institutionalized older people. Trial registration ACTRN12611001078943

Abstract Background Nutritional status often deteriorates in Alzheimer’s disease (AD). Less is known about whether nutritional care reverses malnutrition and its harmful consequences in AD. The aim of this study is to examine whether individualized nutritional care has an effect on weight, nutrition, health, physical functioning, and quality of life in older individuals with AD and their spouses living at home. Methods AD patients and their spouses (aged >65 years) living at home (n = 202, 102 AD patients) were recruited using central AD registers in Finland. The couples were randomized into intervention and control groups. A trained nutritionist visited intervention couples 4–8 times at their homes and the couples received tailored nutritional care. When necessary, the couples were given protein and nutrient-enriched complementary drinks. All intervention couples were advised to take vitamin D 20 μg/day. The intervention lasted for one year. The couples of the control group received a written guide on nutrition of older people. Participants in the intervention group were assessed every three months. The primary outcome measure is weight change. Secondary measures are the intake of energy, protein, and other nutrients, nutritional status, cognition, caregiver’s burden, depression, health related quality of life and grip strength. Discussion This study provides data on whether tailored nutritional care is beneficial to home-dwelling AD patients and their spouses. Trial registration ACTRN 12611000018910