Using a life-course approach to better understand depression in older age

This doctoral thesis aimed to explore the prevalence of depression, and to identify risk factors, secular changes, and consequences of depression in late adulthood from a life-course perspective. The four studies in this thesis were based on data from the H-70 study, the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), and the Kungsholmen Project (KP). The major findings of these studies are summarized below. Study I: This study used five-year follow-up data from the H-70 study to examine whether the association between social factors and depression has changed between the 1970s and 2000s in two birth cohorts of septuagenarians. Feelings of loneliness were related to higher depression risk in both of the cohorts. However, infrequent visits with others than children or neighbors (once per month or less), and the perception of having too little contact with others, were related to an increased risk of depression in 75-year-olds examined in the 1970s, but not in those examined in the 2000s. Study II: This study used SNAC-K data to examine to what extent the prevalence of depression varies when using different depression definitions and sub-samples of the population of adults aged 60−104 years. The prevalence of any depression ranged between 4.2% to 9.3% according to the diagnostic criteria (DSM-IV-TR and ICD-10); 9.2% to 10.6% for the rating scales (MADRS and GDS15); and was 9.1% for self-report. Depression prevalence was lower when excluding those having dementia, as compared to the total population. Moreover, being physically dependent or not having a partner were related to higher depression prevalence across the majority of the depression definitions. Study III: This study used nine-year follow-up data from SNAC-K and KP to explore whether low mood was related to an increased risk of dementia in two birth cohorts of adults above 70 years of age, and whether marital status and living situation modify this relationship. Those having low mood at baseline were at an increased risk of dementia in both cohorts combined (hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.0-1.4), compared to those without low mood. However, the higher risk was detected only in those who did not have a partner (HR 1.5, 95% CI 1.2-1.9), or lived alone (HR 1.5, 95% CI 1.2-1.9), but not among those who had a partner or lived with someone (HR 0.8, 95% CI 0.5-1.2). Study IV: This study used six-year follow-up data from SNAC-K to explore whether the experience of negative life events across the life span was related to an increased depression risk later in life. The total number of negative life events was associated with an increased risk of any depression. When further examining timing of the events, the experience of negative events (≥90th percentile) in early- (0−18 years, odds ratio [OR] 2.4, 95% CI 1.2-5.0) or late-life (>65 years, OR 2.1, 95% CI 1.1-4.4) were associated with an increased risk of any depression, but not those occurring in early-adulthood (19−40 years, OR 1.4, 95% CI 0.7-2.7) or middle-adulthood (41−65 years, OR 1.3, 95% CI 0.6-3.1). Conclusions: Depression prevalence was similar independent of the depression definitions used, except for ICD-10, showing much lower prevalence. Moreover, the quantity and quality of social contacts with others were related to depression in older adults examined in the 1970s, but not in those examined 30 years later. In addition, marital status and living situation have the possibility to buffer the detrimental effects of low mood on dementia onset. Finally, there are critical time periods in early-life (0−18 years) and late-life (>65 years), when the experience of negative life events exacerbates depression risk in later life

Strategies for cooler cities : how to create cool spots in a warmer climate

Klimatförändringarna till följd av den stigande temperaturen har de senaste åren blivit allt mer påtaglig, inte minst under värmeböljan sommaren 2018 som varade i nästan en hel månad och drabbade många platser runt om i Europa. Värmeböljor drabbar städer hårdare än landsbygd då städer genom sin uppbyggnad är extra sårbara för höga temperaturer på grund av den urbana värmeöeffekten. Det gör att nya krav behöver ställas på utformningen av och materialvalet i framtidens städer för att upprätthålla en god levnadsmiljö för människor även under en värmebölja och i ett framtida varmare klimat. I detta arbete, som grundas i en litteraturstudie presenteras hur form, material och vegetation inverkar på temperaturen i staden. Resultatet kan sammanfattas i att mörka material på mark och byggnader i solexponerade lägen leder till högre temperaturer. Grönska, vatten och ljusa material på mark och byggnader kan i stället verka svalkande, både genom att faktiskt sänka temperaturen på ytor och luft, men verkar även svalkande på den upplevda temperaturen. Beroende av form och placering inverkar, hårda material och vegetation olika mycket på temperaturen i staden. Utifrån detta resultat presenteras i arbetets nästa del tolv huvudsakliga strategier som landskapsarkitekten kan arbeta med för att skapa förutsättningar för svalka i staden under en värmebölja och varma sommardagar. Strategierna delas in i kategorierna gröna, blå och grå strategier utefter vilka byggstenar strategin använder sig av. I de gröna strategierna är grönska det huvudsakliga verktyget, i de blå är vatten huvudsakligt verktyg och i de grå strategierna är det stadens hårda material som utgör det huvudsakliga verktyget för att skapa svalka i staden. För att illustrera strategierna och hur de kan se ut och fungera på en plats presenteras därefter nio exempelplatser som utvärderas utefter hur väl strategierna fungerar på platsen. Övergripande slutsatser som dras utifrån arbetets resultat är att de gröna strategierna är de mest effektiva utifrån ett temperaturperspektiv, samt att grönska även för med sig många andra fördelar i staden i form av ekosystemtjänster såsom dagvattenhantering, estetiska värden, biologisk mångfald et cetera. Då fördelarna med stadsgrönska redan är välkänd bland landskapsarkitekter vill vi dock betona de grå strategierna som vi bedömer inte är lika välkända. En andra viktig slutsats är därför att det trots att grönska har störst effekt är viktigt att inte glömma de andra strategierna som kan användas tillsammans med gröna strategier eller på platser där gröna strategier inte passar eller fungerar. Genom att studera Sveriges fyra största kommuners översiktsplaner ser vi även luckor i flera av kommunernas övergripande planering vad gäller beredskap för och hantering av höga temperaturer och framtida värmeböljor.Climate change due to rising temperatures has become more detactable in the last few years. Not least, this was the case during the 2018 heatwave which lasted almost a month and impacted several locations across Europe. Owing to the urban heat island effect, the way cities are constructed makes urban areas more affected by heatwaves than rural areas. Thus, modern cities must meet new requirements when it comes design and building materials. Meeting these requirements will be necessary to maintain an adequate living standard in an ever-warmer climate and during heatwaves. The following study is based on a literature review and presents how form, material and vegetation affects the temperature of cities. It is found that dark materials on buildings and on the ground, result in higher temperatures when located in areas which are exposed to sunlight. In contrast, greenery, water and light materials can have a cooling effect both by lowering the actual air temperature and by affecting the thermal comfort. Depending on their form and placement, building materials and vegetation affect the temperature to a varying extent. Following these findings, the study presents 12 strategies for how landscape architects can create better conditions for keeping temperatures down in urban areas during heatwaves and warm summer days. Based on their respective building blocks, the strategies are divided into the following three categories. Green strategies in which vegetation serves as the main architectural tool, blue strategies which utilizes water, and grey strategies which are based on the hard building materials of the city. Subsequently, 9 example locations are presented to illustrate how the strategies may be realized in a location. The strategies are then evaluated based on how well they work in the different locations. The result of the study suggests that the green strategies are the most effective for keeping temperatures down. Moreover, the green strategies tend to bring other advantages to the urban landscape such as biodiversity, aesthetic value, better stormwater management et cetera. Yet, because the positive effects of urban greenery are already well known, the study wishes to highlight the grey strategies which have so far received less attention. The second important takeaway is therefore that while greenery has the biggest effects, one should not disregard the other strategies. The blue and grey strategies may be used in combination with green strategies or in locations where greenery is not possible or suitable. By examining the comprehensive plans of the four biggest Swedish municipalities, the study also finds that several gaps exist in the municipal planning with regards to the preparedness for and management of high temperatures and heatwaves

Sleep disturbances and the speed of multimorbidity development in old age : results from a longitudinal population-based study

Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The aim of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N = 3363). The study included a subsample (n = 1189) without multimorbidity at baseline (< 2 chronic diseases). Baseline sleep disturbances were derived from the Comprehensive Psychiatric Rating Scale and categorized as none, mild, and moderate-severe. The number of chronic conditions throughout the 9-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic disease accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, or musculoskeletal diseases as the outcome. Moderate-severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß /year = 0.142, p = 0.008), regardless of potential confounders. Significant positive associations were also found between moderate-severe sleep disturbances and neuropsychiatric (ß /year = 0.041, p = 0.016) and musculoskeletal (ß /year = 0.038, p = 0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults. The online version contains supplementary material available at 10.1186/s12916-020-01846-w

Sleep disturbances and change in multiple cognitive domains among older adults : a multicenter study of five Nordic cohorts

Study Objectives: We examined and compared cross-sectional and longitudinal associations between self-reported sleep disturbances and various cognitive domains in five separate Nordic European longitudinal aging studies (baseline N = 5631, mean age = 77.7, mean follow-up = 4.16 years). Methods: Comparable sleep parameters across studies included reduced sleep duration/quality, insomnia symptoms (sleep latency, waking up at night, and early awakenings), short and long sleep duration, and daytime napping. The cognitive domains were episodic memory, verbal fluency, perceptual speed, executive functioning, and global cognition (aggregated measure). A series of mixed linear models were run separately in each study and then compared to assess the level and rate of change in cognitive functioning across each sleep disturbance parameter. Models were adjusted for age, sex, education, hypnotic usage, depressive symptoms, lifestyle factors, cardiovascular, and metabolic conditions. By using a coordinated analytic approach, comparable construct-level measurements were generated, and results from identical statistical models were qualitatively compared across studies. Results: While the pattern of statistically significant results varied across studies, subjective sleep disturbances were consistently associated with worse cognition and steeper cognitive decline. Insomnia symptoms were associated with poorer episodic memory and participants sleeping less or more than 7–8 hours had a steeper decline in perceptual speed. In addition, daytime napping (>2 hours) was cross-sectionally and longitudinally associated with all examined cognitive domains. Most observed associations were study-specific (except for daytime napping), and a majority of association estimates remained significant after adjusting for covariates. Conclusion: This rigorous multicenter investigation further supports the importance of sleep disturbance, including insomnia, long and short sleep duration, and daytime napping on baseline cognitive functioning and rate of change among older adults. These sleep factors may be targeted in future lifestyle interventions to reduce cognitive decline.Peer reviewe

Child studies multiple – collaborative play for thinking through theories and methods

This text is an exploration of collaborative thinking and writing through theories, methods, and experiences on the topic of the child, children, and childhood. It is a collaborative written text (with 32 authors) that sprang out of the experimental workshop Child Studies Multiple. The workshop and this text are about daring to stay with mess, “un-closure” , and uncertainty in order to investigate the (e)motions and complexities of being either a child or a researcher. The theoretical and methodological processes presented here offer an opportunity to shake the ground on which individual researchers stand by raising questions about scientific inspiration, theoretical and methodological productivity, and thinking through focusing on process, play, and collaboration. The effect of this is a questioning of the singular academic ‘I’ by exploring and showing what a plural ‘I’ can look like. It is about what the multiplicity of voice can offer research in a highly individualistic time. The article allows the reader to follow and watch the unconventional trial-and-error path of the ongoing-ness of exploring theories and methods together as a research community via methods of drama, palimpsest, and fictionary

Experiences of preventive health initiatives – a phenomenological study among elderly and their relatives

Introduktion: Fallolyckor bland äldre är ett stort folkhälsoproblem som leder till kostnader och lidanden. Det är därför viktigt att undersöka äldres upplevelser av preventiva hälsoinsatser för att kunna förebygga fallskador och öka livskvaliteten. Syfte: Att undersöka hur de äldre i Tynnered och deras anhöriga upplever de preventiva hälsoinsatserna Fixar-Tony, Förebyggande hembesök och Träffpunkten. Dessa insatser har genomförts för att motverka fallolyckor, förbättra den fysiska miljön och ge närhet till gemenskap och service. Metod: En kvalitativ induktiv studie med ett fenomenologiskt förhållningssätt genomfördes. Två semistrukturerade intervjuer med äldre som fått förebyggande hemverksamhet, brukar besöka Träffpunkten och kunnat utnyttja tjänsten fixar Tony intervjuades, samt tre anhöriga. Resultat: Vi fann tre essenser från intervjuerna med de äldre vilka var; känslor, relationer och hantering av vardag. Bland de anhöriga hittades fyra essenser: relationer, känslor, förändringar och samhället. Sociala aktiviteter och Träffpunkten visade sig vara särskilt betydelsefulla för alla informanter. Diskussion: Denna studie kan ses som en pilotstudie då samplet med fem medverkande varit relativt litet. Resultatet visar dock på att upplevelserna av verksamheterna Fixar-Tony, och Träffpunkten varit positiva hos samtliga informanter. Fortsatta studier med fler medverkande kan behövas för att styrka detta och göra resultatet mer överförbart till andra kontexter.Folkhälsovetenskapligt progra

Den ryska friheten : En studie av förändringen i massmedial frihet från 1985 till 2008

Validerat; 20110728 (anonymous

"Oj, vad många!" : Gelman och Gallistels fem principer i rutinsituationer och i den fria leken

Syftet med denna empiriska studie är att undersöka hur pedagoger och barn arbetar och använder sig av Gelman och Gallistels fem principer i förskolan. Dessa principer ligger till grund för barns taluppfattning. För att få syn på vilka principer som används samt i vilka situationer de kommer till uttryck hos de yngsta barnen i förskolan, ska vi göra observationer på två småbarnsavdelningar. Resultatet visar att samtliga principer förekommit på varierande sätt i rutinsituationer och i leken, men ett par av principerna är mer framträdande. I resultatet framkommer det även att pedagogens roll och miljöns utformning har en stor betydelse för barns matematiska lärande. I diskussionen tar vi upp vikten av att ta tillvara alla situationer som uppstår under en dag i förskolan. Pedagogerna har en viktig uppgift att lyfta fram och visa barnen den matematik som finns runt omkring. The purpose of this empirical study is to explore how teachers and children working with and use of Gelman and Gallistels five principles in preschool. These principles form the basis for the child’s number sense. To catch sight of the principles that are used and in what situations they are expressed in the youngest children in the nursery, we will make observations on two toddlers departments. The results shows that all the principles occurred in varying ways in routine situations and the play, but a few of the principles are more prominent. The results also shows that a teacher’s role and environment design has a great impact on children’s mathematical learning. In the discussion, we discuss the importance of taking advantage of all the situations that arise during a day in kindergarten. The teachers have an important role to highlight and show the kids the mathematics around them.