The aim of the study was to examine the prevalence and self-reported causes of loneliness among Finnish older population. The data were collected with a postal questionnaire from a random sample of ...6786 elderly people (≥75 years of age). The response rate was 71.8% from community-dwelling sample. Of the respondents, 39% suffered from loneliness, 5% often or always. Loneliness was more common among rural elderly people than those living in cities. It was associated with advancing age, living alone or in a residential home, widowhood, low level of education and poor income. In addition, poor health status, poor functional status, poor vision and loss of hearing increased the prevalence of loneliness. The most common subjective causes for loneliness were illnesses, death of a spouse and lack of friends. Loneliness seems to derive from societal life changes as well as from natural life events and hardships originating from aging.
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 ε4 (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.
The extent to which adult height, a biomarker of the interplay of genetic endowment and early-life experiences, is related to risk of chronic diseases in adulthood is uncertain.
We calculated hazard ...ratios (HRs) for height, assessed in increments of 6.5 cm, using individual-participant data on 174374 deaths or major non-fatal vascular outcomes recorded among 1085949 people in 121 prospective studies.
For people born between 1900 and 1960, mean adult height increased 0.5-1 cm with each successive decade of birth. After adjustment for age, sex, smoking and year of birth, HRs per 6.5 cm greater height were 0.97 (95% confidence interval: 0.96-0.99) for death from any cause, 0.94 (0.93-0.96) for death from vascular causes, 1.04 (1.03-1.06) for death from cancer and 0.92 (0.90-0.94) for death from other causes. Height was negatively associated with death from coronary disease, stroke subtypes, heart failure, stomach and oral cancers, chronic obstructive pulmonary disease, mental disorders, liver disease and external causes. In contrast, height was positively associated with death from ruptured aortic aneurysm, pulmonary embolism, melanoma and cancers of the pancreas, endocrine and nervous systems, ovary, breast, prostate, colorectum, blood and lung. HRs per 6.5 cm greater height ranged from 1.26 (1.12-1.42) for risk of melanoma death to 0.84 (0.80-0.89) for risk of death from chronic obstructive pulmonary disease. HRs were not appreciably altered after further adjustment for adiposity, blood pressure, lipids, inflammation biomarkers, diabetes mellitus, alcohol consumption or socio-economic indicators.
Adult height has directionally opposing relationships with risk of death from several different major causes of chronic diseases.
ABSTRACTSerum C-reactive protein (CRP) reflects inflammation and predicts cardiovascular disease in middle-aged individuals. We investigated CRP, risk factors, and 10-year mortality in 3 elderly ...cohorts (aged 75, 80, and 85 years; n=455) of the population-based Helsinki Ageing Study. Clinical and laboratory examinations were performed at baseline, and in 1998, CRP was measured by a sensitive method (sensitivity 0.3 mg/L) from frozen serum samples. Mortality data were retrieved from national registers. Serum CRP ranged from 0.18 to 170.0 mg/L (interquartile range 0.68 to 4.10 mg/L, median 1.60 mg/L). CRP correlated significantly with body mass index and plasma insulin and was associated with smoking at baseline. An inverse correlation was found with albumin and total and HDL cholesterol. CRP was not associated with diabetes or cardiovascular disease but was significantly (P =0.015) higher in persons with (n=70) than without (n=385) dementia. During the 10-year follow-up, 61% (n=278) of the cohort died; half of the deaths were due to cardiovascular diseases. Mean CRP in survivors and nonsurvivors was 3.16 and 5.22 mg/L (P =0.017), respectively. After controlling for age and sex, baseline CRP (per 10 mg/L) significantly predicted the 10-year total mortality (risk ratio 1.20, 95% CI 1.08 to 1.32) and cardiovascular mortality (risk ratio 1.22, 95% CI 1.10 to 1.35). Predictive value was found in the 75-year-old cohort, but it was clearly attenuated in the 80- and 85-year-old cohorts. The results indicate that CRP is associated with several cardiovascular risk factors in the elderly. CRP alone predicts overall and cardiovascular mortality, but the prediction was significant in only the 75-year-old cohort.
Background: Emotional loneliness and social isolation are major problems in old age. These concepts are interrelated and often used interchangeably, but few studies have investigated them ...simultaneously thus trying to clarify their relationship. Objectives: To describe the prevalence of loneliness among aged Finns and to study the relationship of loneliness with the frequency of social contacts, with older people’s expectations and satisfaction of their human relationships. Especially, we wanted to clarify whether emotional loneliness is a separate concept from social isolation. Methods:The data were collected with a postal questionnaire. Background information, feelings of loneliness, number of friends, frequency of contacts with children, grandchildren and friends, the expectations of frequency of contacts as well as satisfaction of the contacts were inquired. The questionnaire was sent to a random sample of 6,786 aged people (>74 years) in various urban and rural areas in Finland. We report here the results of community-dwelling respondents (n = 4,113). Main Results: More than one third of the respondents (39.4%) suffered from loneliness. Feeling of loneliness was not associated with the frequency of contacts with children and friends but rather with expectations and satisfaction of these contacts. The most powerful predictors of loneliness were living alone, depression, experienced poor understanding by the nearest, and unfulfilled expectations of contacts with friends. Conclusion: Our findings support the view that emotional loneliness is a separate concept from social isolation. This has implications for practice. Interventions aiming at relieving loneliness should be focused on enabling an individual to reflect her own expectations and inner feelings of loneliness.
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.
It is well known that depression predicts mortality in old age. However, little is known about the impact of positive emotions. We investigated the impact of positive life orientation on mortality ...and permanent institutional care in aged birth cohorts.
Participants (born 1904, 1909, and 1914) underwent detailed assessments with follow-up at 5 and at 10 years. Positive life orientation was determined as answering “yes” to all the following items: being satisfied with life, having zest for life, having plans for the future, feeling needed, seldom feeling lonely or depressed.
Of participants, 102 (20.8%) had a positive life orientation. After 10 years, 54.5% of them were alive, whereas in the rest of the sample 39.5% survived (
P
=
.004). After controlling for age, gender, and health measures, the impact of positive life orientation was still significant (HR
=
0.89, 95% CI 0.83–0.93). At 5 years, only 2.9% of those having a positive life orientation but 17.5% of the rest of the sample were in permanent institutional care (
P
=
0.003), with a positive life orientation remaining a significant protector against institutional care (OR 0.58, 95% CI 0.36–0.93).
Positive attitudes have a long-standing impact on prognosis in old age.
Our aim was to investigate the long-term prognosis of delirium in the frailest elderly, and to clarify whether delirium is just a marker of the underlying severe disease. We used logistic regression ...analysis to determine the independent prognostic significance of delirium. A representative sample of 425 patients (≥70 years) in acute geriatric wards and nursing homes were assessed at baseline and followed up for 2 years. DSM-IV was used for classification. The prevalence of delirium at baseline was 24.9% (106/425). The prognosis of delirium was poor: mortality at 1 year was 34.9 vs. 21.6% in nondelirious subjects (p = 0.006), and at 2 years 58.5 vs. 42.6% (p = 0.005). Among home-dwelling people at baseline, 54.4% of the delirious vs. 27.9% of others were permanently institutionalized within 2 years (p < 0.001). In logistic regression analysis, delirium was an independent predictor for mortality at 1 year (OR 1.86, 95% CI 1.1–3.1), at 2 years (OR 1.76, 95% CI 1.1–2.8), and for permanent institutionalization (OR 2.45, 95% CI 1.2–4.9). Delirious patients with prior dementia tended to have a better prognosis than those without.
Background and Purpose— Inflammation and infectious etiology have been implicated in the pathogenesis of dementia. We sought to investigate whether the seropositivity of common infections was ...associated with cognitive function.Methods— Viral burden (seropositivity for herpes simplex virus type 1 HSV-1, herpes simplex virus type 2 HSV-2, or cytomegalovirus CMV) and bacterial burden (Chlamydia pneumoniae and Mycoplasma pneumoniae) were related to cognitive status and its impairment among 383 home-dwelling elderly with cardiovascular diseases (mean age, 80 years). The Mini-Mental State Examination (MMSE) and its changes and the Clinical Dementia Rating (CDR) were used to define cognitive impairment.Results— At baseline, 0 to 1, 2, and 3 positive titers toward viruses were found in 48 (12.5%), 229 (59.8%), and 106 individuals (27.7%), respectively. MMSE points decreased with increasing viral burden (P=0.03). At baseline, 58 individuals (15.1%) had cognitive impairment, which after adjustments was significantly associated with seropositivity for 3 viruses (hazard ratio, 2.5; 95% CI, 1.3 to 4.7). MMSE score decreased in 150 (43% of 348) during 12-month follow-up. After adjustment for MMSE score at baseline and with 0 to 1 seropositivities as reference (1.0), the hazard ratios were 1.8 (95% CI, 0.9 to 3.6) and 2.3 (95% CI, 1.1 to 5.0) for 2 and 3 seropositivities, respectively. The prevalence of possible or definite dementia according to CDR also increased with viral burden. No significant associations were observed between bacterial burden and cognition.Conclusions— Viral pathogen burden of HSV and CMV was associated with cognitive impairment in home-dwelling elderly persons with cardiovascular diseases. The results need to be tested in larger databases, but they may offer a preventable cause of cognitive decline.
Detection of cognitive impairment among hospitalized older individuals has shown to be insufficient. A point prevalence study in two geriatric hospitals in Helsinki, Finland, was performed among 219 ...acutely ill individuals over 70 years to assess the detection of dementia and delirium. Documentation of dementia and delirium in medical records, and recordings of confusional symptoms in nurses' notes were compared with the researchers' diagnosis made after a detailed assessment of cognitive status. The cognitive decline was mentioned in medical records in 70/88 (79.5%) of the cases. Cognitive testing was performed on 42/88 (47.7%) of the dementia patients, and the diagnosis of dementia was recorded in 47/88 (53.4%) of them. A specific etiological diagnosis was recorded in only 4/88 (4.5%) cases. Cognitive impairment in at least one of these four means was recorded in 80/88 (90.9%) of cases (sensitivity 0.93). Eight patients had a false-positive diagnosis of dementia (specificity 0.94). Delirium was diagnosed in 77 (35.2%) patients by the researchers, but it was recorded in only 31/77 (40.3%) in medical records. In 64/77 (83.1%) cases signs of confusion were recorded in nurses' notes. Poor detection and documentation may lead to undertreatment of both disorders.
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