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Age and closeness of death as determinants of health and social care utilization: a case-control study.

https://arctichealth.org/en/permalink/ahliterature152068
Source
Eur J Public Health. 2009 Jun;19(3):313-8
Publication Type
Article
Date
Jun-2009
Author
Leena Forma
Pekka Rissanen
Mari Aaltonen
Jani Raitanen
Marja Jylhä
Author Affiliation
Tampere School of Public Health, University of Tampere, Finland. leena.forma@uta.fi
Source
Eur J Public Health. 2009 Jun;19(3):313-8
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Case-Control Studies
Female
Finland
Health Services - utilization
Home Care Services - utilization
Hospitalization - statistics & numerical data
Humans
Long-Term Care - utilization
Male
Sex Factors
Social Work - statistics & numerical data
Terminal Care - utilization
Terminally Ill - statistics & numerical data
Time Factors
Abstract
We used case-control design to compare utilization of health and social services between older decedents and survivors, and to identify the respective impact of age and closeness of death on the utilization of services.
Data were derived from multiple national registers. The sample consisted of 56,001 persons, who died during years 1998-2000 at the age of > or = 70, and their pairs matched on age, gender and municipality of residence, who were alive at least 2 years after their counterpart's death. Data include use of hospitals, long-term care and home care. Decedents' utilization within 2 years before death and survivors' utilization in the same period of time was assessed in three age groups (70-79, 80-89 and > or = 90 years) and by gender.
Decedents used hospital and long-term care more than their surviving counterparts, but the time patterns were different. In hospital care the differences between decedents and survivors rose in the last months of the study period, whereas in long-term care there were clear differences during the whole 2-year period. The differences were smaller in the oldest age group than in younger age groups.
Closeness of death is an important predictor of health and social service use in old age, but its influence varies between age groups. Not only the changing age structure, but also the higher average age at death affects the future need for services.
PubMed ID
19286838 View in PubMed
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Always one step behind: husbands' narratives about taking care of their demented wives.

https://arctichealth.org/en/permalink/ahliterature180713
Source
Health (London). 2004 Apr;8(2):159-81
Publication Type
Article
Date
Apr-2004
Author
Tapio Kirsi
Antti Hervonen
Marja Jylhä
Author Affiliation
University of Tampere, Finland. tapio.kirsi@uta.fi
Source
Health (London). 2004 Apr;8(2):159-81
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Caregivers - psychology
Dementia - nursing
Family Health
Female
Finland
Humans
Interpersonal Relations
Interviews as Topic
Male
Men - psychology
Narration
Social Support
Spouses - psychology
Stress, Psychological - psychology
Visitors to Patients
Abstract
Based on an analysis of extracts from 11 free-form written texts and 13 focused interviews with Finnish husbands who had given care to their demented wives, this study was aimed at finding out how husbands signify their action as spousal caregivers. The data were approached qualitatively from a social constructionistic point of view. Husbands' written material described their action of caregiving mainly in a passive voice that echoed duty and responsive agency. Analysis of the interview talk revealed a wider spectrum of voices and more agentive talk about caregiving. The results of the study challenge interpretations of men as either ineffective or capable caregivers and highlight, instead, the contextual nature of the way that men construct their agencies, depending upon the purposes and audiences of their narration.
PubMed ID
15068635 View in PubMed
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Among nonagenarians, congruence between self-rated and proxy-rated health was low but both predicted mortality.

https://arctichealth.org/en/permalink/ahliterature125866
Source
J Clin Epidemiol. 2012 May;65(5):553-9
Publication Type
Article
Date
May-2012
Author
Merja Vuorisalmi
Tytti Sarkeala
Antti Hervonen
Marja Jylhä
Author Affiliation
Tampere School of Health Sciences, University of Tampere, Medisiinarinkatu 3, Tampere 33014, Finland. merja.vuorisalmi@uta.fi
Source
J Clin Epidemiol. 2012 May;65(5):553-9
Date
May-2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Diagnostic Self Evaluation
Finland
Health status
Health Status Indicators
Humans
Logistic Models
Male
Middle Aged
Mortality
Proportional Hazards Models
Proxy
Abstract
The congruence between self-rated global health (SRH) and proxy-rated global health (PRH), the factors associated with congruence between SRH and PRH, and their associations with mortality are examined using data from the Vitality 90+ study.
The data consist of 213 pairs of subjects--aged 90 years and older--and proxies. The relationship between SRH and PRH was analyzed by chi-square test and Cohen's kappa. Logistic regression analysis was used to find out the factors that are associated with the congruence between health ratings. The association between SRH and PRH with mortality was studied using Cox proportional hazard models.
The subjects rated their health more negatively than the proxies. Kappa value indicated only slight congruence between SRH and PRH, and they also predicted mortality differently. Good self-reported functional ability was associated with congruence between SRH and PRH.
The results imply that the evaluation processes of SRH and PRH differ, and the measures are not directly interchangeable. Both measures are useful health indicators in very old age but SRH cannot be replaced by PRH in analyses.
PubMed ID
22445085 View in PubMed
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Are IADLs comparable across countries? Sociodemographic associates of harmonized IADL measures.

https://arctichealth.org/en/permalink/ahliterature52041
Source
Aging Clin Exp Res. 2003 Dec;15(6):451-9
Publication Type
Article
Date
Dec-2003
Author
Suvi Nikula
Marja Jylhä
Carola Bardage
Dorly J H Deeg
Jacob Gindin
Nadia Minicuci
Saskia M F Pluijm
Angel Rodríguez-Laso
Author Affiliation
University of Tampere, School of Public Health, Tampere, Finland. Suvi.Nikula@uta.fi
Source
Aging Clin Exp Res. 2003 Dec;15(6):451-9
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aging
Comparative Study
Demography
Europe
Female
Geriatric Assessment
Humans
Internationality
Israel
Male
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Sex Characteristics
Socioeconomic Factors
Abstract
BACKGROUND AND AIMS: Independence in Instrumental Activities of Daily Living (IADLs) is determined not only by physical ability but also by the environmental and cultural surroundings of the individual. The present study describes the harmonization of data on IADL functioning of the Comparison of Longitudinal European Studies on Aging (CLESA) Project. The focus of this report is to examine the comparability of IADLs across countries and to study the association of IADLs with age, gender and socioeconomic status, and the scalability of the measure. METHODS: The study base includes data from five European countries (Finland, Italy, The Netherlands, Spain, Sweden) and Israel, for older people aged 65-89 living both in the community and in institutions, for a total of 11,557 subjects. In this report, only community-dwelling respondents were included (N=8420). The common IADL items in all six countries were: preparing meals, shopping, and doing housework. The analyses include how these items are distributed by age group and gender, and the associations between independence in these items and socioeconomic status (SES) with logistic regression modeling. The scale properties of these three items are also examined. RESULTS: Independence in IADLs decreases steadily with age in all countries. Associations with gender and SES follow largely similar patterns across countries. The reliability of the 3-item scale is satisfactory in most countries, and Cronbach's alpha-coefficient for the complete CLESA sample was 0.75. CONCLUSIONS: The associations between sociodemographic variables and independence in preparing meals, shopping, and doing housework are similar across countries. Results suggest that the predictors of IADLs in different countries are comparable.
PubMed ID
14959947 View in PubMed
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Association of Body Mass Index and Waist Circumference With Physical Functioning: The Vitality 90+ Study.

https://arctichealth.org/en/permalink/ahliterature265788
Source
J Gerontol A Biol Sci Med Sci. 2015 Jul;70(7):885-91
Publication Type
Article
Date
Jul-2015
Author
Inna Lisko
Sari Stenholm
Jani Raitanen
Mikko Hurme
Antti Hervonen
Marja Jylhä
Kristina Tiainen
Source
J Gerontol A Biol Sci Med Sci. 2015 Jul;70(7):885-91
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged, 80 and over
Body mass index
Cross-Sectional Studies
Exercise Tolerance - physiology
Female
Finland
Health status
Humans
Male
Motor Activity - physiology
Obesity, Abdominal - complications - physiopathology
Residence Characteristics
Self Report
Thinness - complications - physiopathology
Waist Circumference
Abstract
Both obesity and underweight are associated with impaired physical functioning, but related information on the oldest old population is scarce. Our purpose was to examine whether body mass index, waist circumference (WC), and their combination are associated with physical performance and activities of daily living (ADL) disability in 90-year-old women and men.
Data are from the Vitality 90+ Study, which is a population-based study of persons with age =90 years living in the area of Tampere, Finland. Altogether 416 women and 153 men, aged 90-91 years, provided data on body mass index, WC, chair stand, and Barthel Index. Comorbidity, physical exercise, smoking history, living residence, and sample year were used as covariates in multinomial logistic and logistic regression models.
Women in the highest WC tertile had lower physical performance and were more likely unable to perform the chair stand than women in the lowest WC tertile. Women in the highest WC tertile were also more likely to have ADL disability, compared to the lowest WC tertile. In women, overweight and obesity were associated with ADL disability, but not when WC was included in the model. Men with body mass index =25 kg/m(2) and WC
PubMed ID
25394617 View in PubMed
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Association of urgency symptoms with self-rated health, mood and functioning in an older population.

https://arctichealth.org/en/permalink/ahliterature159494
Source
Aging Clin Exp Res. 2007 Dec;19(6):465-71
Publication Type
Article
Date
Dec-2007
Author
Maria Nuotio
Teuvo L J Tammela
Tiina Luukkaala
Marja Jylhä
Author Affiliation
Geriatric Unit, South-Ostrobothnia Hospital District, Seinäjoki Central Hospital, Seinäjoki, Finland. maria.nuotio@netikka.fi
Source
Aging Clin Exp Res. 2007 Dec;19(6):465-71
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Affect
Age Factors
Aged
Aged, 80 and over
Comorbidity
Cross-Sectional Studies
Depression - epidemiology
Female
Finland - epidemiology
Health status
Humans
Male
Mobility Limitation
Sex Factors
Social Isolation
Urination Disorders - epidemiology - psychology
Abstract
Lower urinary tract symptoms (LUTS) with comorbidities are common in old age. The aim here was to investigate the associations of urgency symptoms with self-rated health, mood and functioning in a random older population adjusted for comorbid conditions.
A population-based cross-sectional survey was made involving 343 people (159 men and 184 women) aged 70 years and over. LUTS were categorized as symptoms with or without urgency. Perceived inconvenience from LUTS, self-rated health, mood, social activity and activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility disability were the outcome measures. Ageand gender-adjusted and multivariate logistic regression models were constructed in order to examine the associations of urgency and non-urgency symptoms with the outcomes. The covariates were age, gender, and self-reported cardiovascular, musculoskeletal, neurological and other chronic diseases.
Perceived inconvenience from urgency symptoms was more frequent than that from non-urgency symptoms (64% vs 20%, p
PubMed ID
18172368 View in PubMed
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Body Mass Index and Waist Circumference as Predictors of Disability in Nonagenarians: The Vitality 90+ Study.

https://arctichealth.org/en/permalink/ahliterature286877
Source
J Gerontol A Biol Sci Med Sci. 2017 Oct 12;72(11):1569-1574
Publication Type
Article
Date
Oct-12-2017
Author
Inna Lisko
Kristina Tiainen
Jani Raitanen
Juulia Jylhävä
Mikko Hurme
Antti Hervonen
Marja Jylhä
Sari Stenholm
Source
J Gerontol A Biol Sci Med Sci. 2017 Oct 12;72(11):1569-1574
Date
Oct-12-2017
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged, 80 and over
Aging - physiology
Body mass index
Disability Evaluation
Disabled Persons
Female
Finland - epidemiology
Follow-Up Studies
Humans
Incidence
Male
Obesity - diagnosis - epidemiology - rehabilitation
Odds Ratio
Prospective Studies
Risk factors
Time Factors
Waist Circumference
Abstract
Only scarce data exist on the association between obesity and disability in the oldest old. The purpose of this prospective study is to examine if body mass index and waist circumference (WC) are associated with incident mobility and activities of daily living (ADL) disability in nonagenarians.
We used longitudinal data from the Vitality 90+ Study, which is a population-based study conducted at the area of Tampere, Finland. Altogether 291 women and 134 men, aged 90-91 years, had measured data on body mass index and/or WC and did not have self-reported mobility or ADL disability at baseline. Incident mobility and ADL disability was followed-up on median 3.6 years (range 0.6-7.8 years). Mortality was also followed-up. Multinomial logistic regression models were used for the analyses, as death was treated as an alternative outcome. The follow-up time was taken into account in the analyses.
Neither low or high body mass index, nor low or high WC, were associated with incident mobility disability. In women, the lowest WC tertile (
PubMed ID
28329171 View in PubMed
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Body mass index, waist circumference, and waist-to-hip ratio as predictors of mortality in nonagenarians: the Vitality 90+ Study.

https://arctichealth.org/en/permalink/ahliterature131940
Source
J Gerontol A Biol Sci Med Sci. 2011 Nov;66(11):1244-50
Publication Type
Article
Date
Nov-2011
Author
Inna Lisko
Kristina Tiainen
Sari Stenholm
Tiina Luukkaala
Antti Hervonen
Marja Jylhä
Author Affiliation
School of Health Sciences, University of Tampere, Finland. inna.lisko@uta.fi
Source
J Gerontol A Biol Sci Med Sci. 2011 Nov;66(11):1244-50
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Body Composition
Body Height - physiology
Body mass index
Body Size - physiology
Body Weight - physiology
Female
Finland - epidemiology
Health status
Humans
Male
Nutritional Status
Obesity - mortality
Obesity, Abdominal - mortality
Proportional Hazards Models
Waist Circumference
Waist-Hip Ratio
Abstract
The associations of body mass index (BMI) and abdominal obesity with mortality among very old people are poorly known. The purpose of this study was to investigate the association of BMI, waist circumference (WC), and waist-to-hip ratio with mortality in nonagenarians.
This study is part of a prospective population-based study, Vitality 90+, including both community-dwelling and institutionalized persons from Tampere, Finland. Altogether 192 women and 65 men aged 90 years were subjected to anthropometric measurements, a baseline interview, and a 4-year mortality follow-up. Cox proportional hazards models were used in the statistical analyses.
In men, normal weight indicated a three times higher mortality risk (hazard ratio [HR] 3.09, 95% confidence interval [CI] 1.35-7.06) compared with overweight, and WC was inversely associated with mortality (HR 0.96, 95% CI 0.93-1.00) after adjustment for covariates. In women, the univariate waist-to-hip ratio (HR 1.43, 95% CI 1.06-1.92) and BMI-adjusted waist-to-hip ratio (HR 1.45, 95% CI 1.07-1.97) were positively associated with mortality. Also, overweight women whose WC was
PubMed ID
21860016 View in PubMed
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Burdensome transitions at the end of life among long-term care residents with dementia.

https://arctichealth.org/en/permalink/ahliterature262778
Source
J Am Med Dir Assoc. 2014 Sep;15(9):643-8
Publication Type
Article
Date
Sep-2014
Author
Mari Aaltonen
Jani Raitanen
Leena Forma
Jutta Pulkki
Pekka Rissanen
Marja Jylhä
Source
J Am Med Dir Assoc. 2014 Sep;15(9):643-8
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Continuity of Patient Care
Dementia - mortality
Female
Finland - epidemiology
Hospitalization - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Long-Term Care
Male
Patient Transfer - statistics & numerical data
Registries
Retrospective Studies
Terminal Care - statistics & numerical data
Abstract
The purpose of the study was to examine the frequency of burdensome care transitions at the end of life, the difference between different types of residential care facilities, and the changes occurring between 2002 and 2008.
A nationwide, register-based retrospective study.
Residential care facilities offering long-term care, including traditional nursing homes, sheltered housing with 24-hour assistance, and long-term care facilities specialized in care for people with dementia.
All people in Finland who died at the age of 70 or older, had dementia, and were in residential care during their last months of life.
Three types of potentially burdensome care transition: (1) any transition to another care facility in the last 3 days of life; (2) a lack of continuity with respect to a residential care facility before and after hospitalization in the last 90 days of life; (3) multiple hospitalizations (more than 2) in the last 90 days of life. The 3 types were studied separately and as a whole.
One-tenth (9.5%) had burdensome care transitions. Multiple hospitalizations in the last 90 days were the most frequent, followed by any transitions in the last 3 days of life. The frequency varied between residents who lived in different baseline care facilities being higher in sheltered housing and long-term specialist care for people with dementia than in traditional nursing homes. During the study years, the number of transitions fluctuated but showed a slight decrease since 2005.
The ongoing change in long-term care from institutional care to housing services causes major challenges to the continuity of end-of-life care. To guarantee good quality during the last days of life for people with dementia, the underlying reasons behind transitions at the end of life should be investigated more thoroughly.
PubMed ID
24913211 View in PubMed
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Cardiometabolic and Inflammatory Biomarkers as Mediators Between Educational Attainment and Functioning at the Age of 90 Years.

https://arctichealth.org/en/permalink/ahliterature273716
Source
J Gerontol A Biol Sci Med Sci. 2016 Mar;71(3):412-9
Publication Type
Article
Date
Mar-2016
Author
Linda Enroth
Jani Raitanen
Antti Hervonen
Terho Lehtimäki
Juulia Jylhävä
Mikko Hurme
Marja Jylhä
Source
J Gerontol A Biol Sci Med Sci. 2016 Mar;71(3):412-9
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Aging
Biomarkers - blood
Cardiovascular Diseases - blood - physiopathology - psychology
Enzyme-Linked Immunosorbent Assay
Female
Finland
Health status
Humans
Inflammation - blood - physiopathology - psychology
Male
Motor Activity - physiology
Patient Education as Topic
Social Class
Abstract
Low socioeconomic status is associated both with poorer functioning and elevated levels of inflammatory and cardiometabolic biomarkers; however, knowledge of such relations for the oldest old is limited. Our aim was to study whether education is associated with cardiometabolic (cholesterol levels, body mass index, and leptin) and inflammatory (C-reactive protein, interleukin-6, interleukin-1Ra) biomarkers for the 90-year-olds who participated in the Vitality 90+ study. In addition, we investigated whether these biomarkers explain educational inequalities in functioning.
All persons in Tampere, Finland, who were born in 1909 or 1910, were invited to participate, irrespective of their health status or dwelling place. The sample consisted of 262 participants who went through the home interview and blood tests. The socioeconomic status indicator used was the highest education, and physical functioning was assessed using the Barthel index. The association of education with individual and combined biomarker scores, and with functioning, was analyzed cross-sectionally applying generalized linear models.
The low- and mid-level-educated participants had greater odds of belonging to the high risk group in cardiometabolic biomarkers than did the high-educated. Differences were statistically significant in three individual biomarkers (high-density lipoprotein-cholesterol, leptin, and body mass index) and in a cardiometabolic score. There were no educational differences in inflammatory biomarkers. When all biomarkers were combined, they mediated educational differences in functioning on an average of 23%. After controlling for smoking, alcohol use and diseases, biomarkers mediated part of the differences between the mid-level- and high-educated.
High education was associated with better cardiometabolic biomarkers and functioning among the 90-year-olds. In part, educational inequalities in functioning were explained by cardiometabolic biomarkers.
PubMed ID
26328604 View in PubMed
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44 records – page 1 of 5.