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  • 1.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Analys och handläggning av äldres multisjuklighet måste samordnas [Analysis and management of comorbidity among the elderly must be coordinated]: med DBU-metod tillämpad vid äldrevårdscentral kan behandling utvärderas [Treatment can be evaluated with the DBU method implemented at community centers for the aged]2005In: Läkartidningen, ISSN 0023-7205, Vol. 102, no 10, 758-765 p.Article in journal (Refereed)
  • 2.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Analysis of multimorbidity in individual elderly nursing home residents: development of a multimorbidity matrix2009In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 49, no 3, 413-419 p.Article in journal (Refereed)
    Abstract [en]

    The chronic multimorbidity in individual elderly people is rarely documented in its entirety in present medical records, neither as cross-sectional overview nor as longitudinal time-course of various health problems. This obviously hampers an integrated clinical analysis. This work was aimed at evaluating the chronic multimorbidity in individual elderly patients and developing a method to map, quantify and grade the prevalence of the multimorbidity. An explorative study in 70 nursing home residents (55 women), mean age 85 was performed. Information on health problems was obtained through history, clinical examination and medical records. A 19-item multimorbidity matrix that maps, quantifies and grades the chronic morbidity in individual patients is presented. The 70 residents exhibited 275 different health problems; the top 3 items being neuropsychiatric, cardiovascular and gastrointestinal ones. The residents had a mean of 17 different chronic health problems and were prescribed a mean of 6.6 continuous medications per day. There was a significant correlation between the number of continuous drug prescriptions and both quantitative and graded multimorbidity-scores. The presented multimorbidity matrix provides a useful taxonomic overview over the health situation in individual multimorbid elderly and constitutes the basis for ongoing work to develop and renew the electronic health record into an "interactive health analysis system".

  • 3.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Arbetsmetod2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 45-50 p.Chapter in book (Other academic)
  • 4.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Background2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 23-42 p.Chapter in book (Other academic)
  • 5.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Bakgrund2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 25-44 p.Chapter in book (Other academic)
  • 6.
    Akner, Gunnar
    Geriatriska kliniken, Universitetssjukhuset, Örebro, Sweden.
    Bräcklighet och multisjuklighet: nödvändigt att flytta fokus från handläggning av isolerade sjukdomar till multipla hälsoproblem inom en individualiserad, integrerad och målstyrd process över tid2012In: Svensk Geriatrik, ISSN 2001-2047, Vol. 1, no 1, 7-12 p.Article in journal (Other academic)
  • 7.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Bräckligt åldrande och multisjuklighet drabbar allt fler [Frail aging and multimorbidity affect more and more]: fokus måste flyttas från isolerade sjukdomar till komplexa hälsoproblem : klinisk översikt [Focus must be moved from isolated diseases to complex health problems]2010In: Läkartidningen, ISSN 0023-7205, Vol. 107, no 44, 2707-2711 p.Article in journal (Refereed)
  • 8.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Evidensbaserad behandling behövs inom äldrevården  [Evidence-based treatment is necessary in geriatric health care]: multibehandling av multisjuka äldre ställer stora krav på samordning [Multitreatment of elderly with multiple illness puts great demands on cooperation]2003In: Läkartidningen, ISSN 0023-7205, Vol. 100, no 34, 2592-2596 p.Article in journal (Other academic)
  • 9.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget2003Collection (editor) (Other academic)
  • 10.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Geriatric care and treatment: a systematic compilation of existing scientific literature2003Collection (editor) (Other academic)
  • 11.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Geriatric care in Sweden2014In: Current Diagnosis & Treatment: Geriatrics / [ed] Williams B, Chang A, Ahalt C, Conant R, Richie C, Chen H, Landefeld S, Yukawa M, USA: McGraw-Hill, 2014, 539-542 p.Chapter in book (Refereed)
  • 12.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Geriatric medicine in Sweden: a study of the organisation, staffing and care production in 2000-20012004In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 33, no 4, 338-341 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: the organisation of long-term medicine and geriatric medicine has undergone many changes during the last 15 years. The aim of this study is to gain an overall perspective of the present organisation of geriatric medicine in Sweden.

    DESIGN: questionnaire survey.

    METHODS: The Swedish Society for Geriatric Medicine and Gerontology, in collaboration with the Federation of County Councils and the Swedish Association of Local Authorities, sent out a survey to people in all county councils in Sweden. The subject of the survey was the speciality of geriatric medicine in the Swedish healthcare system, with regard to healthcare organisation, staffing and care production in 2000/2001.

    RESULTS: there were 52 separate geriatric units, 41 independent 'clinics' and 11 'sections' within other departments. There were a total of 3,101 geriatric inpatient beds. On average, there was one geriatric bed for every 799 individuals within the local population aged 65 years and over, with a 10-fold variation between counties. Four counties had no geriatric provision. The 'geriatric clinics' were mainly located in university towns and averaged 85 beds per clinic, again with a 10-fold variation. There were 604 established positions for doctors within geriatrics, of which 63% were at geriatric clinics. On average, the clinics had 16 positions each (of which 75% were filled with geriatric specialists) with 7 beds per doctor. The corresponding averages for nurses and paramedics could not be summarised due to organisational differences between the county councils. In general, there were very few nurses with specialist training in geriatric medicine.

    CONCLUSIONS: the field of geriatric medicine in Sweden is very heterogeneous regarding terminology, designations, structure, staffing and care production. There is no overall structural plan for the role of geriatric medicine in Swedish healthcare, with the desired close connection between content and dimensioning of geriatric specialist training and the practical organisation of the activities. The county councils designate geriatric medicine so differently that it is hardly possible to compare different geriatric facilities today. Considering how many patients at hospitals today are elderly and suffer from multiple illnesses, it is a major quality issue to ensure that these patients have access to geriatric specialists.

  • 13.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Malnutrition2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, 257-264 p.Chapter in book (Other academic)
  • 14.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Methods2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 43-48 p.Chapter in book (Other academic)
  • 15.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Multisjuklighet hos äldre: analys, handläggning och förslag om äldrevårdscentral2004 (ed. 1)Book (Other (popular science, discussion, etc.))
  • 16.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Multisjuklighet hos äldre personer2012In: Äldres hälsa: ett sjukgymnastiskt perspektiv / [ed] Elisabeth Rydwik, Lund: Studentlitteratur AB, 2012, 1, 367-382 p.Chapter in book (Other academic)
  • 17.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Mår de allra äldsta verkligen sämre idag? [Is the health of the elderly really worse nowadays?]: medicinsk kommentar2004In: Läkartidningen, ISSN 0023-7205, Vol. 101, no 17, 1470-1471 p.Article in journal (Other academic)
  • 18.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Orsaker till mat- och nutritionsproblem inom äldrevården samt förslag till utveckling och förbättringsarbete2006In: Nordisk Geriatrik, no 4, 36-41 p.Article in journal (Other academic)
  • 19.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Sammanfattning2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, 9-24 p.Chapter in book (Other academic)
  • 20.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Summary2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, 9-22 p.Chapter in book (Other academic)
  • 21.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    SWOT-analys av geriatriken i Sverige2006In: Nordisk Geriatrik, no 2, 42-43 p.Article in journal (Other academic)
  • 22.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Undernutritionstillstånd vid KOL2014In: KOL: Kroniskt obstruktiv lungsjukdom / [ed] Kjell Larsson, Stockholm: Studentlitteratur AB, 2014, 3, 497-508 p.Chapter in book (Other academic)
  • 23.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Undernäringstillstånd2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, 257-264 p.Chapter in book (Other academic)
  • 24.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Vilka evidens finns för dagens styrning av äldrevården?2014In: Sjukhusläkaren, ISSN 1651-2715, no 4, 34- p.Article in journal (Other academic)
  • 25.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Vilka evidens finns och används för dagens styrning av äldrevården?2014In: Sjukhusläkaren, ISSN 1651-2715, no 4, 34-34 p.Article in journal (Other (popular science, discussion, etc.))
  • 26.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Visualization of evaluation and management of the 'nutrition process' in individual elderly, multimorbid patients2010In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 14, no 6, 502-502 p.Article in journal (Refereed)
  • 27.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Äldrevård måste grundas på etik [Health services for the aged must be based on ethical foundations]: den enskilde patientens bästa skall alltid stå i fokus : medicinsk kommentar [Focused on the best for the individual patient]2006In: Läkartidningen, ISSN 0023-7205, Vol. 103, no 41, 3068-3069 p.Article in journal (Other (popular science, discussion, etc.))
  • 28.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Äldrevården måste bli mer proaktiv och personinriktad2014In: Sjukhusläkaren, ISSN 1651-2715, no 6, 17-17 p.Article in journal (Other (popular science, discussion, etc.))
  • 29.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences.
    Boréus, Lars
    Drug treatment2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, 1, 233-256 p.Chapter in book (Other academic)
  • 30.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences.
    Boréus, Lars
    Läkemedelsbehandling2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: SBU , 2003, 1, 233-256 p.Chapter in book (Other academic)
  • 31.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Boström, Anne-Marie
    Inst. NVS, sektionen för omvårdnad, Karolinska Institutet, Stockholm, Sverige.
    Krachler, Benno
    Medicinkliniken, Kalix sjukhus, Kalix, Sverige.
    Orrevall, Ylva
    Dietistkliniken, Karolinska Universitetssjukhuset, Huddinge, Sverige.
    Rundgren, Åke
    Enheten för geriatrik Sahlgrenska akademin, Göteborgs universitet, Göteborg, Sverige.
    Sahlin, Nils-Eric
    Avd. för medicinsk etik, Lunds universitet, Lund, Sverige.
    Gyllensvärd, Harald
    Statens beredning för medicinsk utvärdering, Stockholm, Sverige.
    Kosttillägg för undernärda äldre: en systematisk litteraturöversikt.2014Report (Other academic)
  • 32.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences.
    Engelheart, Stina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Inventering av särskilt boende Backagården i Örebro kommun hösten 2010: Mat – måltider – hälsotillstånd2011Report (Other academic)
  • 33.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafson, Yngve
    Avd. för geriatrik, Umeå Universitet, Umeå.
    Geriatriken behöver skifta fokus: från sjukdom till person2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 31-32, 1290-1290 p., CYICArticle in journal (Other (popular science, discussion, etc.))
  • 34.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gustafson, Yngve
    Umeå Universitet, Umeå, sverige.
    Personalized Geriatric Medicine2014In: European Geriatric Medicine, ISSN 1878-7649, Vol. 5, 145-146 p.Article in journal (Refereed)
  • 35.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rothenberg, Elisabet
    Högskolan i Kristianstad.
    Multisjuka och bräckliga äldre2015In: Mat och hälsa: En klinisk handbok / [ed] Tommy Cederholm, Elisabet Rothenberg, Stockholm: Studentlitteratur AB, 2015, 1, 105-108 p.Chapter in book (Other academic)
  • 36.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rundgren, Åke
    Göteborg Universitet, Göteborg.
    Gustafson, Yngve
    Umeå universitet, Umeå.
    Inrätta ett geriatriskt centrum som utvecklar vården2012In: Dagens medicin, ISSN 1104-7488, no 8, 18-19 p.Article in journal (Other (popular science, discussion, etc.))
  • 37.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Stina, Engelheart
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Vanligt att kommunalt bistånd till äldre rör nutrition2013In: Läkartidningen, ISSN 0023-7205, Vol. 110, CHUE- p.Article in journal (Other academic)
  • 38.
    Algilani, Samal
    et al.
    Örebro University, School of Health Sciences.
    Östlund-Lagerström, Lina
    Örebro University, School of Medical Sciences.
    Schoultz, Ida
    Örebro University, School of Medical Sciences.
    Brummer, Robert J.
    Örebro University, School of Health Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Increasing the qualitative understanding of optimal functionality in older adults: a focus group based study2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, 70Article in journal (Refereed)
    Abstract [en]

    Background: Decreased independence and loss of functional ability are issues regarded as inevitably connected to old age. This ageism may have negative influences on older adults' beliefs about aging, making it difficult for them to focus on their current ability to maintain a good health. It is therefore important to change focus towards promoting Optimal Functionality (OF). OF is a concept putting the older adult's perspective on health and function in focus, however, the concept is still under development. Hence, the aim was to extend the concept of optimal functionality in various groups of older adults.

    Methods: A qualitative study was conducted based on focus group discussions (FGD). In total 6 FGDs were performed, including 37 older adults from three different groups: group 1) senior athletes, group 2) free living older adults, group 3) older adults living in senior living homes. All data was transcribed verbatim and analyzed following the process of deductive content analysis.

    Results: The principal outcome of the analysis was "to function as optimally as you possibly can", which was perceived as the core of the concept. Further, the concept of OF was described as multifactorial and several new factors could be added to the original model of OF. Additionally the findings of the study support that all three cornerstones comprising OF have to occur simultaneously in order for the older adult to function as optimal as possible.

    Conclusions: OF is a multifaceted and subjective concept, which should be individually defined by the older adult. This study further makes evident that older adults as a group are heterogeneous in terms of their preferences and views on health and should thus be approached as such in the health care setting. Therefore it is important to promote an individualized approach as a base when caring for older adults.

  • 39. Andersson, Christin
    et al.
    Blennow, Kaj
    Johansson, Sven-Erik
    Almkvist, Ove
    Engfeldt, Peter
    Örebro University, School of Health and Medical Sciences.
    Lindau, Maria
    Eriksdotter-Jönhagen, Maria
    Differential CSF biomarker levels in APOE-epsilon4-positive and -negative patients with memory impairment2007In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 23, no 2, 87-95 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the relationships between episodic memory, APOE genotype, CSF markers (total tau, T-tau; phospho-tau, P-tau; beta-amyloid, Abeta42) and longitudinal cognitive decline. METHODS: 124 memory clinic patients were retrospectively divided into 6 groups based on (i) episodic memory function (Rey Auditory Verbal Learning Test, RAVLT): severe, moderate or no impairment (SIM, MIM or NIM), and (ii) APOE genotype (epsilon4+ or epsilon4-). CSF marker levels and cognitive decline were compared across groups. RESULTS: Episodic memory function, according to RAVLT scores, was significantly correlated with CSF marker levels only among epsilon4+ subjects and not among epsilon4- subjects. When comparing the 6 subgroups, SIM epsilon4+ and MIM epsilon4+ groups showed significantly lower Abeta42 levels than the other groups. T-tau and P-tau levels were significantly increased in SIM epsilon4+ when compared to all the other groups, including the SIM epsilon4- group. However, both SIM epsilon4+ and SIM epsilon4- declined cognitively during the follow-up. CONCLUSION: It remains to be determined whether APOE genotype affects the expression of biomarkers in CSF, or whether the different biomarker patterns reflect different types of disease processes in patients with progressive cognitive dysfunction.

  • 40. Andersson, Christin
    et al.
    Lindau, Maria
    Almkvist, Ove
    Engfeldt, Peter
    Örebro University, Department of Clinical Medicine.
    Johansson, Sven-Erik
    Eriksdotter Jonhagen, Maria
    Identifying patients at high and low risk of cognitive decline using Rey Auditory Verbal Learning Test among middle-aged memory clinic outpatients2006In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 21, no 4, 251-259 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate whether application of cutoff levels in an episodic memory test (Rey Auditory Verbal Learning Test, RAVLT) is a useful method for identifying patients at high and low risk of cognitive decline and subsequent dementia. METHODS: 224 patients with memory complaints (mean age = 60.7 years, mean MMSE = 28.2) followed-up at a memory clinic over approximately 3 years were assigned retrospectively to one of three memory groups from their baseline results in RAVLT [severe (SIM), moderate (MIM) or no impairment (NIM)]. These groups were investigated regarding cognitive decline. RESULTS: Patients assigned to SIM showed significant cognitive decline and progressed to dementia at a high rate, while a normal performance in RAVLT at baseline (NIM) predicted normal cognition after 3 years. Patients with MIM constituted a heterogeneous group; some patients deteriorated cognitively, while the majority remained stable or improved. CONCLUSIONS: The application of cutoff levels in RAVLT at baseline showed that patients with severely impaired RAVLT performance were at a high risk of cognitive decline and progression to dementia, while patients with normal RAVLT results did not show cognitive decline during 3 years. Furthermore, the initial degree of memory impairment was decisive in the cognitive prognosis 3 years later.

  • 41. Andersson, Åsa G.
    et al.
    Kamwendo, Kitty
    Örebro University, Department of Nursing and Caring Sciences.
    Seiger, Åke
    Appelros, Peter
    Örebro University, Department of Clinical Medicine.
    How to identify potential fallers in a stroke unit: validity indexes of 4 test methods2006In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 38, no 3, 186-191 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to describe general characteristics of patients with stroke who have a tendency to fall and to determine whether certain test instruments can identify fallers. METHODS: Patients treated in a stroke unit during a 12-month period were included. At inclusion assessments were made with Berg Balance Scale Berg Balance Scale, Stops Walking When Talking, Timed Up & Go (TUG) and diffTUG. At follow-up 6 or 12 months later, patients who had fallen were identified. RESULTS: During the time from discharge to follow-up on 159 patients, 68 patients fell and 91 did not. Fallers fell more often during their initial hospital stay, used sedatives more often and were more visually impaired, compared with non-fallers. The Berg Balance Scale, Stops Walking When Talking and TUG results differed between fallers and non-fallers. The combined results of Berg Balance Scale and Stops Walking When Talking increased the possibility of identifying fallers. CONCLUSION: Berg Balance Scale, Stops Walking When Talking and TUG can be used to evaluate which patients have a tendency to fall in order to carry out preventive measures. Berg Balance Scale can be used in all patients. Stops Walking When Talking can give additional information if the patient is able to walk. TUG is a possible choice, but fewer patients can perform it.

  • 42.
    Andersson, Åsa G
    et al.
    Örebro University Hospital. Karolinska institutet, Stockholm, Sweden.
    Seiger, Åke
    Karolinska institutet, Stockholm, Sweden.
    Appelros, Peter
    Örebro University Hospital. Karolinska institutet, Stockholm, Sweden.
    Hip fractures in persons with stroke2013In: Stroke Research and Treatment, ISSN 2090-8105, E-ISSN 2042-0056, Vol. 2013, 954279Article in journal (Refereed)
    Abstract [en]

    Background. Our aim was to determine the incidence of hip fractures within two years after stroke, to identify associated factors, to evaluate which test instruments that best could identify people at risk, and to describe the circumstances that prevailed when they sustained their hip fractures. Method. A total of 377 persons with first-ever stroke were followed up for a 24-month period. Stroke severity, cognition, and associated medical conditions were registered. The following test instruments were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Berg Balance Scale, Timed Up & Go, and Stops Walking When Talking. Result. Sixteen of the persons fractured their hip within the study period, which corresponds to an incidence of 32 hip fractures per 1000 person-years. Persons with fractures more often had impaired vision and cognitive impairment and more had had previous fractures. Of the investigated test instruments, Timed Up & Go was the best test to predict fractures. Conclusion. The incidence of hip fractures in persons with stroke was high in this study. Persons with previous fractures, and visual and cognitive defects are at the greatest risk. Certain test instruments could be used in order to find people at risk, which should be targeted for fall preventive measures.

  • 43.
    Appelros, Peter
    Örebro University, Department of Clinical Medicine.
    Heart failure and stroke2006In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 37, no 7, 1637-1637 p.Article in journal (Refereed)
  • 44.
    Appelros, Peter
    Örebro University, Department of Clinical Medicine.
    Prevalence and predictors of pain and fatigue after stroke: a population-based study2006In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 29, no 4, 329-333 p.Article in journal (Refereed)
    Abstract [en]

    Pain and fatigue are two often overlooked symptoms after stroke. Their prevalence and determinants are not well understood. In this study patients with first-ever stroke (n=377) were examined at baseline and after 1 year. General characteristics of the patients, as well as stroke type, stroke severity and risk factors were registered at baseline. After 1 year survivors (n=253) were examined with respect to residual impairment, disability, cognition and depression. They were asked whether they had experienced pain and/or fatigue which had started after the stroke, and which the patient felt to be stroke related. Twenty-eight patients (11%) had stroke-associated pain and 135 (53%) had stroke-associated fatigue. Pain was associated with depression and different manifestations of stroke severity, especially degree of paresis at baseline. Fatigue was more associated with physical disability. In univariate analysis, fatigue was also associated with sleep disturbances. In conclusion, it is important to be aware of the occurrence of pain and fatigue after stroke, because these symptoms are common, they impair quality of life and they are potentially treatable. Post-stroke depression may coexist with pain and fatigue. The detection of one symptom should lead to consideration of the others. Follow-up and individual assessment of stroke patients is crucial.

  • 45.
    Appelros, Peter
    et al.
    Örebro University, Department of Clinical Medicine.
    Andersson, A. G.
    Changes in mini mental state examination score after stroke: lacunar infarction predicts cognitive decline2006In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 13, no 5, 491-495 p.Article in journal (Refereed)
    Abstract [en]

    Stroke and cognitive impairment are inter-related. The purpose of this study was to show the natural evolution of cognitive performance during the first year after a stroke, and to show which factors that predict cognitive decline. Subjects were patients with a first-ever stroke who were treated in a stroke unit. A total of 160 patients were included. At baseline patients were evaluated with regard to stroke type, stroke severity, pre-stroke dementia and other risk factors. Mini Mental State Examinations (MMSE) were performed after 1 week and after 1 year. Patients had a median increase of 1 point (range -8 to +9) on the MMSE. Thirty-two pre cent of the patients deteriorated, 13% were unchanged, and 55% improved. Lacunar infarction (LI) and left-sided stroke were associated with a failure to exhibit improvement. Patients with LI had an average decline of 1.7 points, whilst patients with other stroke types had an average increase of 1.8 points. Most stroke survivors improve cognitively during the first year after the event. The outcome for LI patients is worse, which suggests that LI may serve as a marker for concomitant processes that cause cognitive decline.

  • 46.
    Appelros, Peter
    et al.
    Örebro University, Department of Clinical Medicine.
    Nydevik, Ingegerd
    Terént, Andreas
    Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 1, 43-49 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences. METHODS: One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated. RESULTS: Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing. CONCLUSIONS: In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.

  • 47.
    Asplund, R.
    et al.
    Family Medicine Stockholm, Karolinska Institute, Huddinge, Sweden; Research and Development Unit, Jämtland County Council, Östersund, Sweden.
    Lindblad, Birgitta Ejdervik
    Department of Ophthalmology, Sundsvall Hospital, Sundsvall, Sweden.
    Sleep and sleepiness 1 and 9 months after cataract surgery2004In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 38, no 1, 69-75 p.Article in journal (Refereed)
    Abstract [en]

    This study was undertaken to analyze sleep development in a group of patients during the first 9 months after cataract extraction. Men and women (n=407) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during two periods in 2000-2002 were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 and 9 months after the operation. The response rate was 90.8%. The mean ages of the participating men and women were 74.5 and 75.6 years, respectively. One week after cataract extraction the visual acuity in the treated eye was 0.67 (+/-0.31) in men and 0.69 (+/-0.28) in women (NS), and showed an inverse relationship to age in both men (P<0.01) and women (P<0.0001). One month after cataract extraction 28.3% of the men and 37.5% of the women experienced poor sleep, and after 9 months the figures were 15.8 and 31.4%, respectively. Frequent awakenings and difficulty in falling asleep after nocturnal awakenings improved correspondingly. Being well rested in the morning increased and daytime sleepiness decreased. The results indicate that in elderly persons with cataract sleep is improved 1 month after cataract extraction and further improvement during the first 9 months may be experienced.

  • 48.
    Asplund, R.
    et al.
    Family Medicine Stockholm, Karolinska Institute, Huddinge, Sweden; Research and Development Unit (Forsknings- och utvecklingsenheten), Jämtland County Council, Östersund, Sweden.
    Lindblad, Birgitta Ejdervik
    Department of Ophthalmology, Sundsvall Hospital, Sundsvall, Sweden.
    The development of sleep in persons undergoing cataract surgery2002In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 35, no 2, 179-187 p.Article in journal (Refereed)
    Abstract [en]

    This study was undertaken in order to analyse sleep in a group of patients who were operated on for cataract. All patients (n=328) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during a 4-month period were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 month after the operation. Twelve persons were unable or declined to participate. The response rate was 97.2%. The mean ages of the participating men and women were 74.5 and 76.3 years, respectively. Pre-operative visual acuity in the operated eye was 0.16 in men and 0.18 in women. After cataract extraction sleep was improved in 12.0% of the men and in 26.3% of the women. Nevertheless poor sleep 1 month post-operatively was reported by 29.3% of the men and 42.6% of the women (P<0.05). There was no age-related increase in sleep complaints. The results indicate that in elderly persons with cataract sleep is impaired, and that 1 month after cataract extraction improved sleep may be experienced.

  • 49. Axelsson, Johan
    et al.
    Elmståhl, Sölve
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Geriatrik är ett försummat ämne i svensk läkarutbildning [Geriatrics neglected in Swedish medical education.]: "äldreparadoxen" kräver rejäl satsning ["The elderly paradox" requires a substantial effort]2006In: Läkartidningen, ISSN 0023-7205, Vol. 103, no 44, 3361-3365 p.Article in journal (Refereed)
  • 50.
    Böttiger, Anna K.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hagnelius, Nils-Olof
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Torbjörn K.
    Örebro University, School of Health and Medical Sciences.
    Mutations in exons 2 and 3 of the FOLR1 gene in demented and non-demented elderly subjects2007In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 20, no 5, 653-662 p.Article in journal (Refereed)
    Abstract [en]

    We have previously reported six novel mutations in the 5'-UTR of the gene for folate receptor-alpha (FOLR1). In our search for additional mutations we screened patients, referred for investigation of suspected dementia (DGM subgroup) by SSCP and DNA sequencing from the end of exon 1 to the first bases of intron 3. We found 4 sequence variations, FOLR1 g.1314G>A, g.1816delC, g.1841G>A, and g.1928C>T. Pyrosequencing genotyping assays were developed for all of them, and 389 active seniors (AS subgroup) and the 202 DGM patients were genotyped for these mutations. The frequency q of the mutated allele was, among the AS subjects, 0.068, 0.0026, 0.0026, and 0.024 respectively, and among the DGM subjects, 0.067, 0.0076, 0.0078, and 0.023. The g.1816delC and g.1841G>A mutations thus were more frequent in the DGM than in the AS subgroup, but the difference did not reach statistical significance. The mutated alleles, FOLR1 1816(-) and 1841A, always occurred together in the same subjects, suggestive of a rare double-mutant haplotype. The two common polymorphisms, FOLR1 g. 1314G>A and g.1928C>T seemed not to raise tHcy plasma levels, whereas the double-mutated g.1816(-)-g.1841A haplotype may possibly have a slight tHcy-raising effect. Thus, so far 8 novel rare FOLR1 mutations with a combined prevalence of approximately 1.3% in Whites as well as two common polymorphisms with 5% and 13%, respectively, have been demonstrated. Only a few of the rare mutations may potentially be associated with raised plasma tHcy concentrations. No association with dementia was found.

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