Feasibility-Usability Study of a Tablet App Adapted Specifically for Persons with Cognitive Impairment—SMART4MD (Support Monitoring and Reminder Technology for Mild Dementia)

Population ageing within Europe has major social and economic consequences. One of the most devastating conditions that predominantly affects older people is dementia. The SMART4MD (Support Monitoring and Reminder Technology for Mild Dementia) project aims to develop and test a health application specifically designed for people with mild dementia. The aim of this feasibility study was to evaluate the design of the SMART4MD protocol, including recruitment, screening, baseline examination and data management, and to test the SMART4MD application for functionality and usability before utilization in a full-scale study. The feasibility study tested the protocol and the app in Spain and Sweden. A total of nineteen persons with cognitive impairment, and their informal caregivers, individually performed a task-based usability test of the SMART4MD app model in a clinical environment, followed by four-week testing of the app in the home environment. By employing a user-centered design approach, the SMART4MD application proved to be an adequate and feasible interface for an eHealth intervention. In the final usability test, a score of 81% satisfied users was obtained. The possibility to test the application in all the procedures included in the study generated important information on how to present the technology to the users and how to improve these procedures

Associations Between Mobile Health Technology Use and Self-rated Quality of Life: A Cross-sectional Study on Older Adults with Cognitive Impairment

Background: Quality of life (QoL) is affected even at early stages in older adults with cognitive impairment. The use of mobile health (mHealth) technology can offer support in daily life and improve the physical and mental health of older adults. However, a clarification of how mHealth technology can be used to support the QoL of older adults with cognitive impairment is needed. Objective: To investigate factors affecting mHealth technology use in relation to self-rated QoL among older adults with cognitive impairment. Methods: A cross-sectional research design was used to analyse mHealth technology use and QoL in 1082 older participants. Baseline data were used from a multi-centred randomised controlled trial including QoL, measured by the Quality of Life in Alzheimer’s Disease (QoL-AD) Scale, as the outcome variable. Data were analysed using logistic regression models. Results: Having moderately or high technical skills in using mHealth technology and using the internet via mHealth technology on a daily or weekly basis was associated with good to excellent QoL in older adults with cognitive impairment. Conclusions: The variation in technical skills and internet use among the participants can be interpreted as an obstacle for mHealth technology to support QoL

Antibodies against Porphyromonas gingivalis in serum and saliva and their association with rheumatoid arthritis and periodontitis. Data from two rheumatoid arthritis cohorts in Sweden

BackgroundPeriodontitis and oral pathogenic bacteria can contribute to the development of rheumatoid arthritis (RA). A connection between serum antibodies to Porphyromonas gingivalis (P. gingivalis) and RA has been established, but data on saliva antibodies to P. gingivalis in RA are lacking. We evaluated antibodies to P. gingivalis in serum and saliva in two Swedish RA studies as well as their association with RA, periodontitis, antibodies to citrullinated proteins (ACPA), and RA disease activity.MethodsThe SARA (secretory antibodies in RA) study includes 196 patients with RA and 101 healthy controls. The Karlskrona RA study includes 132 patients with RA ≥ 61 years of age, who underwent dental examination. Serum Immunoglobulin G (IgG) and Immunoglobulin A (IgA) antibodies and saliva IgA antibodies to the P. gingivalis–specific Arg-specific gingipain B (RgpB) were measured in patients with RA and controls.ResultsThe level of saliva IgA anti-RgpB antibodies was significantly higher among patients with RA than among healthy controls in multivariate analysis adjusted for age, gender, smoking, and IgG ACPA (p = 0.022). Saliva IgA anti-RgpB antibodies were associated with RA disease activity in multivariate analysis (p = 0.036). Anti-RgpB antibodies were not associated with periodontitis or serum IgG ACPA.ConclusionPatients with RA had higher levels of saliva IgA anti-RgpB antibodies than healthy controls. Saliva IgA anti-RgpB antibodies may be associated with RA disease activity but were not associated with periodontitis or serum IgG ACPA. Our results indicate a local production of IgA anti-RgpB in the salivary glands that is not accompanied by systemic antibody production

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

The Swedish National study on Aging and Care in Blekinge (SNAC-B)

The national study SNAC - The Swedish National Study on Aging and Care, includes four participating areas: SNAC-Blekinge, SNAC Kungsholmen, SNAC Nordanstig and SNAC Skåne (GÅS). In all four areas, a research centre conducts a population study and a health care system study. (Metadata related to the main study SNAC and the other participating areas can be found under the Related studies tab). SNAC- Blekinge is headed by a steering group of researchers with Professor Johan Sanmartin Berglund as principal investigator. The project is supported by the Ministry of Health and Social Affairs, Blekinge Institute of Technology, Kristianstad University and Linnaeus University in Växjö. Blekinge County Council is cooperating with the municipality of Karlskrona. ´ In addition to the national design and objectives a number of separate research questions have been of special interest to the research team in Blekinge. These are as follows: - Dental health and care - a general assessment of elderly between 60 and 96 years of age with a particular focus on identifying osteoporosis using dental X-ray examination. - Multi-morbidity - developing an instrument for estimating incidence and prevalence of diseases in the general population. - Occupation and retirement - the purpose being to study the differences between those working and those being retired or pre-retired at the ages between 60 and 66. - Cardiovascular and cognitive diseases - does patients being treated in primary care know about incipient heart? Also is studied the relation between heart and cardiovascular diseases and diabetes mellitus and cognitive function. - Quality in the care of the elderly - a study about how social contextual and structural factors relate to the need of care and services. - OTC´s and non prescription drugs - the significance of lifestyle and psychological factors for the use of OTC and prescription medication. - Functional performance and stress-reactivity - examining how variability in functional performance in a homogenous age group relate to experimental induces stress testing the stress hypothesis on ageing. Population study: The aim of the population study is to find out how among other things social environment, lifestyle and earlier diseases effect health and wellbeing in old age. The design is longitudinal and interdisciplinary and the study examines elderly between 60 and 96 years of age. Medical examinations, interviews, psychological tests and distributed of questionnaires are repeated every third or sixth year. The baseline examination was conducted during the period 2001 to 2003. When closed in spring 2003 examination had been made on 1402 subjects out of 2312 (aged 60-96 years old) that was invited to take part in the study. The participation rate was fully (slightly above) 60% for the whole age range from 60 to 96 years of age. Several follow-ups have been conducted. Health care system study: Karlskrona municipality Mature Management has a need to raise awareness of aging and the care of the elderly in the future to improve care for older people. During the autumn of 2009 begins, therefore, SNAC, in cooperation with BTH, on behalf of the Mature Management, a research in Karlskrona on the municipality's elderly care is tailored to the needs of the elderly. The same type of study is done simultaneously in a number of other municipalities in the country. The survey covers all persons aged 65 years and benefiting the elderly of Mature Management in Karlskrona and / or have a lasting home care / rehabilitation. Data collection have been conducted at several occasions. Purpose: The aim is to provide information about how social environment, lifestyle and earlier diseases effect health and wellbeing in old age. One of the special interests to the research team in Blekinge is dental health and the impact to general health.Den nationella äldrestudien SNAC - The Swedish National Study on Aging and Care, innefattar fyra deltagande områden: SNAC-Blekinge, SNAC-Kungsholmen, SNAC-Nordanstig och SNAC-Skåne (GÅS). Vid samtliga fyra områden finns ett forskningscentrum som bedriver dels en befolkningsstudie och dels en vårdsystemstudie. Under 'Relaterade studier' finns beskrivning om huvudstudien SNAC, samt specifik studiebeskrivning för respektive delstudie inom SNAC. SNAC- Blekinge I Blekinge bedrivs forskning inom ett flertal områden baserat på data från SNAC. Exempel på några av dessa områden är: Tandhälsa hos äldre samt munhälsans betydelse för allmänhälsa, Multisjuklighet - utveckla instrument för beräkning av befolknings sjuklighet och varför vi åldras olika, Livsstilens betydelse för hälsan och välbefinnandet, Arbetsvetenskap med inriktning att studera de som arbetar respektive inte arbetar i åldern 60-65 år, Studier om hjärt- och kärlsjukdomar, diabetes och kognitiv funktion. SNAC- Blekinge leds av en styrgrupp av forskare med professor Johan Sanmartin Berglund som huvudansvarig. Projektet stöds av Socialdepartementet, Blekinge Tekniska Högskola, Högskolan i Kristianstad och Linnéuniversitet i Växjö. Samarbete finns med Landstinget Blekinge och med Karlskrona kommun. Befolkningsdel: Befolkningsstudien avser att ge information om vilken betydelse bland annat omgivning, livsstil och tidigare sjukdomar har för hälsa och välbefinnande på äldre dagar. Genom tvärvetenskapliga undersökningar, intervjuer och enkäter som upprepas med tre eller sex års intervall kartläggs förändringar över tiden av såväl ohälsa, funktionsförmåga, psykiskt tillstånd, upplevd livskvalitet som sociala förhållanden och kontakter med vård- och omsorgssystemet. Under 2001-2003 genomfördes den första datainsamlingen inom befolkningsdelen i Blekinge, utifrån ett sampel om totalt 2312 individer. Då denna baslinjeundersökning slutförts hade 1402 personer i åldrarna 60-96 år genomgått undersökningen. I samplet avböjde 870 deltagande och 40 personer avled innan de var kallade till undersökning vilket motsvarande en total deltagarfrekvens på 61%. Flertal uppföljningar har därefter skett. Vårdsystemdel: Karlskrona kommuns Äldreförvaltning har ett behov av att öka kunskaperna om åldrandet och vården av de äldre för att inför framtiden kunna förbättra vård och omsorg för äldre personer. Under hösten 2009 startar därför SNAC, i samarbete med BTH, på uppdrag av Äldreförvaltningen, en forskningsstudie i Karlskrona om hur kommunens äldreomsorg är anpassad för de äldres behov. Undersökningen omfattar alla personer som har fyllt 65 år och som beviljats äldreomsorg av Äldreförvaltningen i Karlskrona eller har varaktig hemsjukvård eller rehabilitering. Datainsamling har genomförts vid flertal tillfällen. Syfte: Syftet är att ge information om vilken betydelse bland annat omgivning, livsstil och tidigare sjukdomar har för hälsa och välbefinnande på äldre personer. Inom ramen för SNAC har SNAC-B bla speciellt inriktats på munhälsans betydelse för allmänhäls

Use of a powered toothbrush to improve oral health in individuals with mild cognitive impairment

Objectives: The aim of the study is to investigate whether the use of a powered toothbrush could maintain oral health by reducing the dental plaque (PI), bleeding on probing (BOP), and periodontal pocket depth (PPD) ≥4 mm in a group of individuals with MCI and also if changes in oral health affect various aspects of quality of life. Background: People with cognitive impairment tend to have poor oral hygiene and poorer Quality of life. In the present study, the participants were asked to use a powered toothbrush for at least 2 min morning and evening and no restrictions were given against the use of other oral care products. The participant survey conducted at each examination demonstrated that 61.2% of participants at baseline claimed to have experience of using a powered toothbrush, 95.4% at 6 months and 95% after 12 months. At the same time, the use of manual toothbrushes dropped from 73.3% to 44.7% from baseline to the 12-month check-up. This shows that several participants continue to use the manual toothbrush in parallel with the powered toothbrush, but that there is a shift towards increased use of the powered toothbrush. Removal of dental biofilm is essential for maintaining good oral health. We investigated whether using a powered toothbrush reduces the presence of dental plaque, bleeding on probing and periodontal pockets ≥4 mm in a group of older individuals with mild cognitive impairment. Materials and methods: Two hundred and thirteen individuals with the mean age of 75.3 years living without official home care and with a Mini-Mental State Examination (MMSE) score between 20 and 28 and a history of memory problems in the previous six months were recruited from the Swedish site of a multicenter project, Support Monitoring And Reminder Technology for Mild Dementia (SMART4MD) and screened for the study. The individuals received a powered toothbrush and thorough instructions on how to use it. Clinical oral examinations and MMSE tests were conducted at baseline, 6 and 12 months. Results: One hundred seventy participants, 36.5% women and 63.5% men, completed a 12-month follow-up. The use of a powered toothbrush resulted, for the entire group, in a significant decrease in plaque index from 41% at baseline to 31.5% after 12 months (P &lt;.000). Within the same time frame, the values for bleeding on probing changed from 15.1% to 9.9% (P &lt;.000) and the percentage of probing pocket depths ≥4 mm from 11.5% to 8.2% (P &lt;.004). The observed improvements in the Oral Health Impact Profile 14 correlate with the clinical improvements of oral health. Conclusion: The use of a powered toothbrush was associated with a reduction of PI, BOP and PPD over 12 months even among individuals with low or declining MMSE score. An adequately used powered toothbrush maintain factors that affect oral health and oral health-related Quality of Life in people with mild cognitive impairment. CC BY-NC-ND 4.0© 2022 The Authors. Gerodontology published by Gerodontology Association and John Wiley &amp; Sons Ltd.First published: 22 January 2022</p

An Instrument for Measuring Social Participation to Examine Older Adults' Use of the Internet as a Social Platform : Development and Validation Study

BACKGROUND: Older people's use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people's internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. OBJECTIVE: The aim of this study was to create an instrument to measure an older person's perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. METHODS: A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193). RESULTS: A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach α coefficient was .92. The 1-factor solution explained 55% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model (χ26=13.985; χ2/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025). CONCLUSIONS: The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected.CC BY 4.0</p

Longitudinal evaluation of periodontitis and development of cognitive decline among older adults.

Aim: to determine whether having periodontitis is associated with cognitive decline among older adults. Material and Methods: A prospective population study of older adults, Swedish National Study on Ageing and Care, (SNAC) provided repeated registrations of cognitive functions. Cognitive decline was defined as ≥ 3-points deterioration from a predetermined level at baseline, using the Mini-Mental State Examination (MMSE). Between 2001 and 2003, 715 individuals had a medical as well as a clinical and radiographic dental examination. The individuals were re-examined after 6 years. Periodontitis was defined as ≥ 4mm bone loss at ≥ 30 % of tooth sites. Social variables were captured from questionnaires. Results: The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of periodontitis and cognitive decline after adjustments of confounding factors of importance. Conclusions: A history of periodontitis may be of importance for cognitive functions among older adults

Sleep disturbance predicts worse cognitive performance in subsequent years : A longitudinal population-based cohort study

Background: Poor sleep is a potential modifiable risk factor for later life development cognitive impairment. The aim of this study is to examine if subjective measures of sleep duration and sleep disturbance predict future cognitive decline in a population-based cohort of 60, 66, 72 and 78-year-olds with a maximal follow up time of 18 years. Methods: This study included participants from the Swedish National Study on Ageing and Care – Blekinge, with assessments 2001–2021. A cohort of 60 (n = 478), 66 (n = 623), 72 (n = 662) and 78 (n = 548) year-olds, were assessed at baseline and every 6 years until 78 years of age. Longitudinal associations between sleep disturbance (sleep scale), self-reported sleep duration and cognitive tests (Mini Mental State Examination and the Clock drawing test) were examined together with typical confounders (sex, education level, hypertension, hyperlipidemia, smoking status, physical inactivity and depression). Results: There was an association between sleep disturbance at age 60 and worse cognitive function at ages 60, 66 and 72 years in fully adjusted models. The association was attenuated after bootstrap-analysis for the 72-year-olds. The items of the sleep scale most predictive of later life cognition regarded nightly awakenings, pain and itching and daytime naps. Long sleep was predictive of future worse cognitive function. Conclusion: Sleep disturbance was associated with worse future cognitive performance for the 60-year-olds, which suggests poor sleep being a risk factor for later life cognitive decline. Questions regarding long sleep, waking during the night, pain and itching and daytime naps should be further explored in future research and may be targets for intervention. CC BY 4.0© 2022 The AuthorsCorresponding author at: Department of Health, Blekinge Institute of Technology, Valhallavägen 1, 371 41 Karlskrona, Sweden. E-mail address: [email protected] (A. Behrens). SNAC is financially supported by the Ministry of Health and Social Affairs, Sweden, and the participating county councils, municipalities, and university departments.</p