Sense of coherence is a sensitive measure for changes in subjects with Parkinson's disease during 1 year.

To investigate subjective and objective changes in function in subjects with Parkinson's disease (PD) home visits with interviews were performed with a 1-year interval. Depressive symptoms were rated with the Geriatric Depression Scale, subjective health with the generic SF-36 scale and the disease-specific PDQ-8 scale; objective changes were assessed according to the Hoehn and Yahr scale; insomnia was rated with an eight-item questionnaire and the sense of coherence (SOC) was determined with the short version of that scale. A total of 91 subjects (39 women and 52 men with a mean age of 70 years) living at home, most of them moderately to severely disabled, were interviewed. Time since diagnosis was 10 years for 32%. During the studied year the subjects' status declined significantly as shown by changes in both the PDQ-8 and the Hoehn and Yahr scales. The most striking finding was a pronounced decrease in the SOC scale (p < 0.0001). This indicates that the subjects' ability to handle stress-related problems secondary to the progress of disease might have decreased. In order to optimize nursing care for subjects with PD, in addition to medical treatment, an assessment of the SOC could aid nursing staff in evaluating subjects' ability to handle their life situation

Formal support, mental disorders and personal characteristics: a 25-year follow-up study of a total cohort of older people.

The present study was designed to describe the pattern of long-term formal support received by people with mental disorders, and to investigate the relationship between the medical, psychological and social characteristics of the participants and types of formal support. This study is based on a cohort (n = 192) of people born in 1902 and 1903 in a community in Southern Sweden. The research participants were assessed using interviews, psychological tests and medical examinations. Information was collected about the use of primary healthcare and social services. The first assessment took place when the cohort was aged 67 years, and then on eight further occasions until they were 92. The participation rate ranged from 72% to 100%. During the observation period of 25 years, 53% of people with dementia eventually received both home help and institutional care compared to 34% of people with other psychiatric diagnoses and 12% of people with good mental health. The last group had all physical health problems and/or problems with activities of daily living. However, 35% of the dementia group, 46% with other psychiatric diagnoses and 52% of people with good mental health did not receive any formal support. Males and self-employed people were significantly less likely to use formal support. The institutionalised group reported loneliness significantly more often than the other two groups. In a logistic regression analysis, loneliness, low social class, high blood pressure and low problem-solving ability were predictors of formal support use. People with a mental disorder, including dementia, were significantly more likely to use formal support compared to people with good mental health. Social factors were the main factors predicting formal support

The gender differences in growth hormone-binding protein and leptin persist in 80-year-old men and women and is not caused by sex hormones.

objective Leptin and growth hormone-binding protein (GHBP) both show gender differences that might be explained by sex hormones. To study the potential relevance of oestradiol and testosterone, we have examined 80-year-old subjects in whom oestradiol is higher in men than in women. The interrelationships between leptin, insulin, GHBP and fat mass in this age group were also investigated. design and subjects Ninety-four subjects (55 females and 39 males), all 80 years old, were investigated in a community-based study. None of the investigated subjects was being treated for diabetes mellitus and none of the women had oestrogen replacement. methods Levels of testosterone, oestradiol, SHBG, IGF-I, GHBP, glucose, insulin and leptin were analysed. Body composition was measured with bioimpedance analysis (BIA). results As in younger age groups, serum leptin, the ratio leptin/kilogram fat mass and serum GHBP were higher in the women (all, P 0·1). Leptin correlated to kilogram fat mass in both women (r = 0·55, P 0·2). Insulin and leptin were significantly associated with GHBP, both in women (r = 0·48, P < 0·001 and r = 0·43, P = 0·001, respectively) and in men (r = 0·40, P = 0·01 and r = 0·34, P = 0·03, respectively). conclusions Although the 80-year-old men had higher oestradiol levels than the women, the women had higher levels of leptin and GHBP. There were no correlations between sex hormones and leptin and GHBP, which indicates that the gender differences are not caused by sex hormones in old age. In contrast to studies in younger subjects, GHBP did not correlate to fat mass in the investigated 80-year-old men and women. In the older subjects investigated, as in younger subjects, GHBP was significantly correlated with leptin and insulin

Geriatric Rehabilitation as an Integral Part of Geriatric Medicine in the Nordic Countries

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Firstly to outline the theoretical and practical framework for geriatric rehabilitation in Iceland and other Nordic countries and secondly to survey the scientific medical publications for evidence based geriatric rehabilitation. Methods: Brain storming on geriatric rehabilitation in a working group of Nordic teachers in geriatric medicine. Papers on scientific programs for geriatric rehabilitation from Internet sources were collected and analyzed. All articles describing randomized studies in geriatric rehabilitation were selected for overview. The papers were divided into four groups according to diseases, infirmity and resource settings; 1) stroke, 2) hip-fractures, 3) acute admissions and 4) programs conducted in nursing homes, day hospitals and home services. Results: A spectrum of biological and social events creates the conditions underlying most causes for illness and disability in old people. The process of established geriatric services promotes the efficiency of geriatric rehabilitation. The literature survey included 27 scientific studies (8586 patients) on randomized studies with valid endpoints. Geriatric rehabilitation programs for stroke patients in geriatric settings, six studies (1138 patients), reduced mortality and the need for nursing home placement but the outcome for ADL. Function and length of stay was more variable between the studies. The outcome of geriatric rehabilitation was even more decisive in the randomized hip-fracture studies, six studies (2171 patients). Eight studies were found comparing the outcome between acute admission of frail elderly to either geriatric (GEMU, GRU) or general medical wards. The outcome as regards to mortality rate at one year, placement to a nursing home, physical function, contentment with services, readmission rate and cost was all significantly better in the geriatric settings. Internal comparisons of geriatric programs in nursing homes, day hospitals and in home service, seven studies (1261 patient), revealed some differences in outcomes in function, contentment and costs. Conclusions: Specialized geriatric rehabilitation is complicated but effective when properly performed. Interdisciplinary teamwork, targeting of patients, comprehensive assessment and intensive and patient-targeted rehabilitation seem to characterize the most effective programs. Rehabilitation of frail elderly people poses a major challenge for the future and has to be developed further for the sake of quality of life of elderly people as well as for economic reasons.Markmið: Að gera úttekt á öldrunarendurhæfingu á Íslandi og öðrum Norðurlöndum, marka hinn hugmyndafræðilega grunn, tengja hann norrænum veruleika og taka saman vísindalegar niðurstöður um árangur öldrunarendurhæfingar. Aðferð: Hugarflugsfundir vinnuhóps kennara í öldrunarlækningum um öldrunarendurhæfingu. Sértæk leit í helstu læknatímarita á Medline í greinum sem fjalla um aðferðir og meðferðarleiðir endurhæfingar fyrir aldraða á vísindalegan hátt. Um er að ræða samantekt á rannsóknum sem notast við slembiúrtök og taka til elstu aldurshópa. Greinunum var skipt niður í fjóra flokka eftir sjúkdómum, færni og staðsetningu; 1) heilablóðfall, 2) mjaðmarbrot, 3) bráðveikir og hrumir, 4) prógrömm á hjúkrunarheimilum, dagspítölum og í heimaþjónustu. Niðurstöður: Lífeðlisfræðilegir og félagslegir þættir marka veikindaferli og fötlun aldraðra. Verklag öldrunarþjónustunnar skiptir miklu um árangur öldrunarendurhæfingar. Leit í 27 tímaritsgreinum náði til 8586 sjúklinga en þær báru saman slembiúrtök og höfðu haldbærar viðmiðanir. Endurhæfing aldraðra heilablóðfallssjúklinga á öldrunarlækningadeild, sex rannsóknir (1138 sjúklingar), dró úr dánarlíkum og minnkaði þörf fyrir stofnanavist en breyting á mælanlegri færni og legudagafjöldi varð ekki afgerandi hjá öllum. Enn betri árangur náðist við endurhæfingu eftir mjaðmarbrot, sex rannsóknir (2171 sjúklingur). Átta rannsóknir (4016 sjúklingar) báru saman árangur öldrunarlækningadeilda borið saman við almennar lyflæknisdeildir í meðhöndlun bráðveikra og hrumra sjúklinga. Niðurstöður voru flestar afgerandi betri á öldrunarlækningadeildum hvað varðar dánartíðni að ári, vistun á hjúkrunarheimili, líkamlega færni, ánægju, endurinnlagnir og kostnað. Innbyrðis samanburður á endurhæfingaraðferðum fyrir aldraða á hjúkrunarheimilum, dagspítölum og í heimaþjónustu, sjö rannsóknir (1261 sjúklingur), sýndu mun á nokkrum viðmiðunum í færniþáttum, ánægju og kostnaði. Ályktanir: Sérhæfð endurhæfing aldraðra er flókin en skilar árangri þegar rétt er á haldið. Bestur árangur næst með fjölfaglegri teymisvinnu, val á þeim sjúklingum sem mestu áhættuna hafa, alhliða öldrunarmati og virkri og einstaklingsmiðaðri endurhæfingu. Endurhæfing á hrumu gömlu fólki er og verður vaxandi viðfangsefni fyrir heilbrigðisþjónustuna og mikilvægt að hún nái því markmiði að auka lífsgæði aldraðs fólks. Benda rannsóknir einnig til að við það skapist einnig efnahagslegur ávinningur fyrir land og þjóð

Factors of importance to the caregiver burden experienced by family caregivers of Parkinson's disease patients

Background and aims: Caregivers of Parkinson's disease patients are vulnerable to detrimental factors related to caregiving because of the progressive course of the disease. Studies of care-givers of these patients are scarce. The aim of this study was to examine the caregiver burden in Parkinson's disease by analyzing caregiver and patient-related factors. Methods: Every 3(rd) patient with Parkinson's disease registered at the outpatient clinic of the Neurology Department was invited to participate. One year after the first investigation, a follow-up was performed with a study of caregiver burden. A total of 65 caregivers took part. In-home interviews with patients and caregivers were performed. Assessments: a) caregiver burden, 22 items, comprising five indices: general strain, isolation, disappointment, emotional involvement, and environment; b) sense of coherence, 13 items, with the components comprehensibility, manageability and meaningfulness; c) depressive symptoms, using the Geriatric Depression Scale, 15 items; d) social contacts, 6 items; e) patient subjective health, assessed with the Parkinson's disease questionnaire, 39 items; and f) patient functional status. Results: Bivariate analyses showed significant correlations between caregiver burden and sense of coherence in caregivers, patient functional status, depressive symptoms in caregiver and patient, patient subjective health and time since diagnosis. Multivariate analysis showed depressive symptoms and sense of coherence in caregiver, and functional status in patient to be the most important variables for caregiver burden. Conclusions: To ease the caregiver burden, attention should be paid to patient functional status and caregivers depressive symptoms. The sense of coherence in caregivers is probably more difficult to influence. (C) 2002, Editrice Kurtis

Monochromatic phototherapy in elderly patients: A new way of treating chronic pressure ulcers?

Background and aims: Monochromatic pulsating light may have effects of importance for wound healing, and promising results were obtained in an open study on the healing of pressure ulcers, which motivated the present study. Methods: One hundred and sixty-four in- and outpatients with grade II and III ulcers were treated with monochromatic pulsating light or placebo over the ulcerated area, according to a specific therapeutic program. Results: No significant effects were observed in the total material. In a sub-analysis of grade II ulcers, there was a tendency toward better healing in the monochromatic light group (p=0.06). A significantly larger reduction in pressure ulcer size was noted among patients in the treatment group with low body weight (BMI<20). Conclusions: Monochromatic pulsating light may have effects on pressure ulcer healing, and a new study focusing only on grade II ulcers is under way. (C)2003, Editrice Kurti