Abstract Introduction The COVID-19 pandemic has presented a unique possibility to broaden the understanding of people’s reactions to a global crisis. Early on, it became evident that older adults ...were particularly vulnerable to the virus and that the actions of this age group would be crucial to the outcome. This qualitative interview study uses the Health Belief Model (HBM) framework as an analytical tool to examine older people’s experiences of adherence to recommendations during the initial phase of the COVID-19 pandemic. It is important to view this study in the context of Sweden’s voluntary restrictions, which further highlight the unique nature of this research. Method In April-May 2020, 41 adults aged 70–85 participated in unstructured phone interviews. The objective was to investigate older adults’ perceptions of the COVID-19 pandemic, particularly their understanding of the disease and the conditions that influenced their adherence to health recommendations. HBM was used as an analytical framework to guide the analysis of the interviews. Results Despite perceiving COVID-19 as a severe threat to health and society, participants did not let fear dominate their responses. Instead, they demonstrated remarkable resilience and a proactive approach. For some, the perceived susceptibility to the disease was the primary motivator for adherence to the Swedish national recommendations. Notably, trust in the authorities and family members’ requests significantly bolstered adherence. Moreover, adherence was found to contribute to feelings of safety. Conversely, potential barriers to adhering to recommendations included missing loved ones and frustration with sometimes ambiguous information from authorities. Conclusions The results from this study indicate that older adults are willing to adhere to voluntary restrictions during a global pandemic. Relatives of older people are a resource for communicating information regarding safety and health messages, a message that is preferably thorough and consistent. Further, much can be gained if loneliness during isolation can be mitigated since missing loved ones appears to be a potential barrier to adherence.
Introduction The risk for outdoor falls tends to increase during winter due to icy road conditions. Several Swedish municipalities have introduced programs that provide their senior citizens with a ...pair of ice cleats in an attempt to tackle this problem. In this paper, we perform a process evaluation to identify potential barriers to the success of these programs and analyze the logic of their design. Methods We sent a survey to all 290 Swedish municipalities to collect data on the characteristics of ice cleat distribution programs. We also performed focus-group interviews with older adults to gain insight into their thoughts about ice cleat programs. We synthesized our data with existing literature on ice cleats and behavior change theory to populate a logic model to identify and analyze hidden assumptions and potential flaws using program theory analysis. Results On average, about 40% of the eligible population living in the intervention municipalities collected a pair of ice cleats. While we identified some other, but mostly minor, barriers to implementation, the main barrier appears to be a lack of scale (i.e., insufficient procurement and distribution of ice cleats), as 90% of all purchased ice cleats were eventually distributed. While previous research suggests that ice cleats can decrease injury risks if worn, we find that there is limited evidence on the effects of distribution on ice cleat use. Our interviewees emphasized the potential utility of ice cleats for staying safe and active during winter but stressed that ice cleats need to be user-friendly and of high-quality to increase the likelihood that a distribution program encourages behavior change. Conclusion Existing ice cleat distribution programs appear to have reached a meaningful share of the targeted population. Additional research is required to assess their effects on ice cleat use and injury rates.
Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a ...residential care setting.
The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring.
The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 95% CI: 0.46-1.09) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 95% CI: 0.25-0.54). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50-0.80).
The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.
Purpose: Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the ...fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people.
Method: We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017).
Results: The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities.
Conclusions: The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.
A plethora of methods exist to aid decision-making in mitigating disaster risk, many of which fall into the categories of risk, vulnerability and/or resilience assessment methods. The objective of ...the present study is to provide an overview of these methods, with a particular focus on evidence that supports their practical implementation. A scoping study of scientific literature reveal 97 distinct methods. Despite the growing interest in publishing new methods, there seems to be a lack of focus on demonstrating their effectiveness in practice. The few contributions that do include some forms of evaluation typically do so by comparing the method's output with disaster data, by contrasting it with the output of other methods, by having experts evaluate the structure of the method, or by testing the method in practice and evaluating its usage. To further strengthen the relevance of research on this topic, increased attention should be paid to this matter. A good starting point would be to use the ways of evaluation identified in this study and systematically present evidence regarding the practical usefulness of methods for risk, vulnerability and/or resilience assessment.
•A review of methods for risk, resilience and/or vulnerability assessment is presented.•The results reveal a significant interest in the area.•The methods lack a unified knowledge base.•The effectiveness of the methods is not supported by evidence in most cases.•Suggestions of how to develop evidence-based research in the area is given.
We have made a comprehensive and quantitative analysis of the lipid composition of caveolae from primary rat fat cells and compared the composition of plasma membrane inside and outside caveolae. We ...isolated caveolae from purified plasma membranes using ultrasonication in carbonate buffer to disrupt the membrane, or extraction with nonionic detergent, followed by density gradient ultracentrifugation. The carbonate‐isolated caveolae fraction was further immunopurified using caveolin antibodies. Carbonate‐isolated caveolae were enriched in cholesterol and sphingomyelin, and the concentration was three‐ and twofold higher, respectively, in caveolae compared to the surrounding plasma membrane. The concentration of glycerophospholipids was similar suggesting that glycerophospholipids constitute a constant core throughout the plasma membrane. The composition of detergent‐insoluble fractions of the plasma membrane was very variable between preparations, but strongly enriched in sphingomyelin and depleted of glycerophospholipids compared to carbonate‐isolated caveolae; indicating that detergent extraction is not a suitable technique for caveolae preparation. An average adipocyte caveola contained about 22 × 103 molecules of cholesterol, 7.5 × 103 of sphingomyelin and 23 × 103 of glycerophospholipid. The glycosphingolipid GD3 was highly enriched in caveolae, whereas GM3, GM1 and GD1a were present inside as well as outside the caveolae membrane. GD1b, GT1b, GM2, GQ1b, sulfatide and lactosylceramide sulfate were not detected in caveolae.
A principal metabolic function of adipocytes is to synthesize triacylglycerol (TG) from exogenous fatty acids. The level of fatty acids has to be tightly controlled in the adipocyte, as they can act ...as detergents that rapidly dissolve the plasma membrane, causing cell lysis if allowed to accumulate. Fatty acids therefore have to be efficiently converted to TG and stored in the central lipid droplet. We report that in intact primary adipocytes exogenous oleic acid was taken up and directly converted to TG in the plasma membrane, in a novel subclass of caveolae that specifically contains the protein perilipin. Isolated caveolae catalyzed de novo TG synthesis from oleic acid and glycerol 3-phosphate. Electron microscopy revealed the presence of caveolin and perilipin in caveolae and in lipid-laden bulbs in the plasma membrane, and fluorescence microscopy demonstrated colocalization of fatty acids/TG with caveolin and perilipin at the plasma membrane. A second caveolae fraction was isolated, which lacked perilipin and the triacylglycerol synthesizing enzymes. Both caveolae fractions contained caveolin-1 and the insulin receptor. The findings demonstrate that specific subclasses of caveolae carry out specific functions in cell metabolism. In particular, triacylglycerol is synthesized at the site of fatty acid entry in one of these caveolae classes.
ABSTRACTThe insulin receptor is a transmembrane protein of the plasma membrane, where it recognizes extracellular insulin and transmits signals into the cellular signaling network. We report that ...insulin receptors are localized and signal in caveolae microdomains of adipocyte plasma membrane. Immunogold electron microscopy and immunofluorescence microscopy show that insulin receptors are restricted to caveolae and are colocalized with caveolin over the plasma membrane. Insulin receptor was enriched in a caveolae‐enriched fraction of plasma membrane. By extraction with β‐cyclodextrin or destruction with cholesterol oxidase, cholesterol reduction attenuated insulin receptor signaling to protein phosphorylation or glucose transport. Insulin signaling was regained by spontaneous recovery or by exogenous replenishment of cholesterol. β‐Cyclodextrin treatment caused a nearly complete annihilation of caveolae invaginations as examined by electron microscopy. This suggests that the receptor is dependent on the caveolae environment for signaling. Insulin stimulation of cells prior to isolation of caveolae or insulin stimulation of the isolated caveolae fraction increased tyrosine phosphorylation of the insulin receptor in caveolae, demonstrating that insulin receptors in caveolae are functional. Our results indicate that insulin receptors are localized to caveolae in the plasma membrane of adipocytes, are signaling in caveolae, and are dependent on caveolae for signaling.—Gustavsson, J., Parpal, S., Karlsson, M., Ramsing, C., Thorn, H., Borg, M., Lindroth, M., Peterson, K. H., Magnusson, K.‐E., Strålfors, P. Localization of the insulin receptor in caveolae of adipocyte plasma membrane. FASEB J. 13, 1961–1971 (1999)
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