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  • 1.
    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, p. 338-341Article 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.

  • 2.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    PEG treatment: an increasing dilemma2005In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 34, no 4, p. 320-321Article in journal (Refereed)
  • 3.
    El-Sharkawy, Ahmed M.
    et al.
    Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, UK.
    Watson, Phillip
    School of Exercise and Health Sciences, Loughborough University, Loughborough, UK.
    Neal, Keith R.
    Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden.
    Maughan, Ron J.
    School of Exercise and Health Sciences, Loughborough University, Loughborough, UK.
    Sahota, Opinder
    Department of Elderly Medicine, Nottingham University Hospitals, Queen’s Medical Centre, Nottingham, UK.
    Lobo, Dileep N.
    Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, UK.
    Hydration and outcome in older patients admitted to hospital (The HOOP prospective cohort study)2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 6, p. 943-947Article in journal (Refereed)
    Abstract [en]

    Background: older adults are susceptible to dehydration due to age-related pathophysiological changes. We aimed to investigate the prevalence of hyperosmolar dehydration (HD) in hospitalised older adults, aged >= 65 years, admitted as an emergency and to assess the impact on short-term and long-term outcome.

    Methods: this prospective cohort study was performed on older adult participants who were admitted acutely to a large UK teaching hospital. Data collected included the Charlson comorbidity index (CCI), national early warning score (NEWS), Canadian Study of Health and Aging (CSHA) clinical frailty scale and Nutrition Risk Screening Tool (NRS) 2002. Admission bloods were used to measure serum osmolality. HD was defined as serum osmolality > 300 mOsmol/kg. Participants who were still in hospital 48 h after admission were reviewed, and the same measurements were repeated.

    Results: a total of 200 participants were recruited at admission to hospital, 37% of whom were dehydrated. Of those dehydrated, 62% were still dehydrated when reviewed at 48 h after admission. Overall, 7% of the participants died in hospital, 79% of whom were dehydrated at admission (P = 0.001). Cox regression analysis adjusted for age, gender, CCI, NEWS, CSHA and NRS demonstrated that participants dehydrated at admission were 6 times more likely to die in hospital than those euhydrated, hazards ratio (HR) 6.04 (1.64-22.25); P = 0.007.

    Conclusions: HD is common in hospitalised older adults and is associated with poor outcome. Coordinated efforts are necessary to develop comprehensive hydration assessment tools to implement and monitor a real change in culture and attitude towards hydration in hospitalised older adults.

  • 4. Rydwik, Elisabeth
    et al.
    Frändin, Kerstin
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Effects of physical training on physical performance in institutionalised elderly patients (70+) with multiple diagnoses2004In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 33, no 1, p. 13-23Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: the positive effect of physical training in healthy elderly people is well documented. The aim of this systematic review was to describe the effect of physical training on physical performance in institutionalised elderly patients with multiple diagnoses.

    DESIGN: systematic literature review of randomised controlled trials regarding effects of physical training of elderly (70+) subjects.

    METHODS: the randomised controlled trials were evaluated using a modified version of an evaluation form originally developed by the Cochrane Collaboration. It is based on a weighted scale of 0-100 points, and ranks the studies as high, moderate or low methodological quality. A total of 16 randomised controlled trials were included in the review.

    RESULTS: six studies scored as high quality, eight as moderate and two as low. There was a large heterogeneity in the studies concerning sample size, types of interventions and types of assessments. There is strong evidence for a positive effect of physical training on muscle strength and mobility; moderate evidence for an effect on range of motion; and contradictory evidence regarding gait, activities of daily living, balance and endurance.

    CONCLUSION: more studies are required, with larger sample sizes, higher specificity as to the types of interventions and assessments, greater focus on clinically relevant outcomes such as endurance and activities of daily living, and also, for example, quality of life and mortality.

  • 5.
    Stenzelius, Karin
    et al.
    Faculty of Health and Society, Malmö University, Skåne University Hospital, Malmö, Sweden.
    Molander, Ulla
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Odeberg, Jenny
    SBU-The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Hammarström, Margareta
    Department of Gynecology and Obstetrics, Childrens and Youth Hospital of Queen Silvia, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Franzen, Karin M.
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Gynecology and Obstetrics, Örebro University Hospital, Örebro, Sweden.
    Midlöv, Patrik
    Clinical Research Centre (CRC), Skåne University Hospital, Malmö, Sweden.
    Samuelsson, Eva
    Family Medicine, Department of Public Health and Clinical medicine, Umeå University, Umeå, Sweden.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 5, p. 736-744Article in journal (Refereed)
    Abstract [en]

    Background: urinary incontinence (UI) is a common symptom among older people, with a higher prevalence among frail older persons living in nursing homes. Despite consequences such as reduced health and quality of life, many older people do not seek help for their symptoms, resulting in missed opportunity for treatment.

    Objective: the aim of this study was to investigate the evidence and the effect of conservative treatment of UI and the quality of life among older and frail older persons.

    Methods: a systematic review of randomised controlled studies and prospective, non-randomised studies was conducted, evaluating interventions of conservative treatment of UI in an older population (65 years or older). A total of 23 studies fulfilled the inclusion criteria and 9 were of high or moderate quality. Fourteen studies were of low quality and were therefore excluded from the analysis.

    Results: documented and effective conservative treatments are available even for older persons with UI. Pelvic muscle exercise, physical training in combination with ADL, prompted voiding and attention training, and help to toilet are important treatments. In some studies, however, the evidence of effectiveness is limited.

    Conclusions: this systematic review concludes that there are conservative treatments for UI for older and frail older persons that reduce leakage and increase quality of life. There is however a need for further high-quality studies.

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