Vanhoista vanhimpien elämänlaatu

Tutkimuksen tarkoituksena oli arvioida 95-vuotiaiden koettua elämänlaatua sekä tyytyväisyyttä elämänlaadun fyysiseen, psyykkiseen, sosiaaliseen ja elinympäristöön liittyvään elämänlaadun ulottuvuuteen. Tutkimuksessa kohdejoukkona olivat turkulaiset kotona tai laitoshoidossa asuneet vuonna 1920 syntyneet (n=58). Elämänlaatua arvioitiin WHOQOL-Bref-mittarilla. Tulosten mukaan 52:stä (49 %) elämänlaatukyselyyn vastanneesta melkein kolme neljäsosaa (73 %) koki elämänlaatunsa hyväksi tai erittäin hyväksi ja oli melko tai erittäin tyytyväinen terveyteensä. Vastaajat kokivat elämänlaatunsa ulottuvuuksista parhaaksi elinympäristöön liittyvän ulottuvuuden (keskiarvopisteet 77,8) ja heikommaksi psyykkisen ulottuvuuden (60,9). Siitä huolimatta, että psyykkinen ulottuvuus koettiin heikoimmaksi elämänlaadun ulottuvuudeksi, yli puolet vastaajista koki nauttivansa elämästä ja kaksi kolmasosaa koki elämänsä vähintään kohtuullisen merkitykselliseksi. Tämän tutkimuksen tulokset vahvistavat tietoa siitä, että parhaiten pärjäävällä osalla hyvin iäkkäistä elämänlaatu säilyy pääsääntöisesti hyvänä korkeaan ikään saakka

Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up

ObjectivesTo assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall.DesignLongitudinal study.Setting and ParticipantsThe subjects (n = 561) were participants in fall prevention conducted in western Finland.MethodsBlood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months.ResultsThe prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment.Conclusions and ImplicationsOH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons.</p

Psychosocial resources related to survival among non-robust community-dwelling older people : an 18-year follow-up study

Purpose Psychosocial resources have been considered to be associated with survival among frail older adults but the evidence is scarce. The aim was to investigate whether psychosocial resources are related to survival among non-robust community-dwelling older people. Methods This is a prospective study with 10- and 18-year follow-ups. Participants were 909 non-robust (according to Rockwood's Frailty Index) older community-dwellers in Finland. Psychosocial resources were measured with living circumstances, education, satisfaction with friendship and life, visiting other people, being visited by other people, having someone to talk to, having someone who helps, self-rated health (SRH) and hopefulness about the future. To assess the association of psychosocial resources for survival, Cox regression analyses was used. Results Visiting other people more often than once a week compared to that of less than once a week (hazard ratio 0.61 [95% confidence interval 0.44-0.85], p = 0.003 in 10-year follow-up; 0.77 [0.62-0.95], p = 0.014 in 18-year follow-up) and good SRH compared to poor SRH (0.65 [0.44-0.97], p = 0.032; 0.68 [0.52-0.90], p = 0.007, respectively) were associated with better survival in both follow-ups. Visiting other people once a week (compared to that of less than once a week) (0.77 [0.62-0.95], p = 0.014) was only associated with better 18-year survival. Conclusions Psychosocial resources, such as regularly visiting other people and good self-rated health, seem to be associated with better survival among non-robust community-dwelling Finnish older people. This underlines the importance of focusing also on psychosocial well-being of frail older subjects to remain or promote their resilience. Key summary pointsAim To investigate whether psychosocial resources are associated with survival among non-robust community-dwelling older Finnish people during an 18-year follow-up. Findings Psychosocial resources, such as good self-rated health and regularly visiting other people, were significantly associated with better survival of non-robust older people. Message It is important to focus also on psychological well-being, together with physical activity and nutrition, of frail older people to remain or promoting their capacity.Peer reviewe

Self-detection of atrial fibrillation in an aged population: three-year follow-up of the LietoAF intervention study

BackgroundAtrial fibrillation (AF) is often asymptomatic and undiagnosed until an ischaemic stroke occurs. An irregular pulse is a key manifestation of AF. We assessed whether pulse self-palpation is feasible in screening of AF.MethodsAltogether 205 residents of Lieto municipality aged ≥75 years were randomized in 2012 to receive brief education on pulse palpation focusing on evaluating rhythm regularity. Self-detected pulse irregularity and new AF diagnoses were recorded, and the subjects’ quality of life and use of health care services were assessed during a three-year follow-up.ResultsThe subjects’ median age was 78.2 [3.8] years, and 89 (43.4%) were men. Overall, 139 (68%) subjects had initial good motivation/capability for regular palpation. At four months, 112 (80.6%) subjects with good and 26 (39.4%) with inadequate motivation/capability palpated their pulse daily. At 12 months, 120 (58.5%) and at 36 months, 69 (33.7%) subjects palpated their pulse at least weekly. During the intervention, 67 (32.7%) subjects reported pulse irregularity. New AF was found in 10 (4.9%) subjects, 7 (70%) of whom had reported pulse irregularity. Pulse irregularity independently predicted new AF, but only one (0.5%) subject with new AF sought undelayed medical attention due to pulse irregularity. Quality of life and number of outpatient clinic visits remained unchanged during follow-up.ConclusionPulse palpation can be learned also by the elderly, but it is challenging to form a continuing habit. The low persistence of pulse self-palpation limits its value in the screening of AF, and strategies to promote persistence and research on alternative screening methods are needed.         </p

Frailty, walking ability and self-rated health in predicting institutionalization : an 18-year follow-up study among Finnish community-dwelling older people

Background In clinical practice, there is a need for an instrument to screen older people at risk of institutionalization. Aims To analyze the association of frailty, walking-ability and self-rated health (SRH) with institutionalization in Finnish community-dwelling older people. Methods In this prospective study with 10- and 18-year follow-ups, frailty was assessed using FRAIL Scale (FS) (n = 1087), Frailty Index (FI) (n = 1061) and PRISMA-7 (n = 1055). Walking ability was assessed as self-reported ability to walk 400 m (n = 1101). SRH was assessed by a question of general SRH (n = 1105). Cox regression model was used to analyze the association of the explanatory variables with institutionalization. Results The mean age of the participants was 73.0 (range 64.0-97.0) years. Prevalence of institutionalization was 40.8%. In unadjusted models, frailty was associated with a higher risk of institutionalization by FS in 10-year follow-up, and FI in both follow-ups. Associations by FI persisted after age- and gender-adjustments in both follow-ups. By PRISMA-7, frailty predicted a higher risk of institutionalization in both follow-ups. In unadjusted models, inability to walk 400 m predicted a higher risk of institutionalization in both follow-ups and after adjustments in 10-year follow-up. Poor SRH predicted a higher risk of institutionalization in unadjusted models in both follow-ups and after adjustments in 10-year follow-up. Discussion Simple self-reported items of walking ability and SRH seemed to be comparable with frailty indexes in predicting institutionalization among community-dwelling older people in 10-year follow-up. Conclusions In clinical practice, self-reported walking ability and SRH could be used to screen those at risk.Peer reviewe

Effect of RNA quality to SARS-CoV-2 RT-qPCR detection from saliva

Saliva is an alternative sample material to nasopharyngeal swab in SARS- CoV- 2 diagnostics. We investigated possible aspects to improve the reliability of SARS- CoV- 2 detection from saliva. Saliva was collected from asymptomatic healthy subjects (n=133) and COVID- 19 patients (n=9). SARS- CoV- 2 detection was performed with quantitative reverse- transcriptase PCR (RT- qPCR) with two viral and one host target serving as an internal control. The use of internal control revealed that in the first RT- qPCR run 25???30 % of assays failed. The failure is associated with poor RNA quality. When the amount of RNA was cut down to half from the original amount, the performance of RT- qPCR was greatly enhanced (95 % of the assays succeeded). The quality of RNA was not affected by the use of different nucleic acid stabilizing buffers. Our study showed that saliva is suitable material for RT- qPCR based SARS- CoV- 2 diagnostics, but the use of internal control is essential to distinguish the true negative samples from failed assays.Peer reviewe