M. Raivio - Academia.edu (original) (raw)
Papers by M. Raivio
Surgery and Pathology of the Middle Ear, 1985
The indications for a second-look operation after closed and obliterative techniques are: postope... more The indications for a second-look operation after closed and obliterative techniques are: postoperative cholesteatoma, planned second-stage reconstruction of the ossicular chain, inadequate closure of the air-bone gap, and postoperative infection of the obliteration material. With the canal wall down technique used by the author, the frequency of the postoperative cholesteatoma is relatively low compared with experiences of the intact canal wall technique, but this harm cannot be completely avoided. In a long-term follow-up Ojala and Palva have shown how these few cholesteatomas grew in the meso- and epitympanum only, but none primarily in the obliterated mastoid. This can only be understood on the basis of complete radicalism of the surgery in the mastoid, with sufficient concern to every possible projection of the cholesteatoma within any little cell as well as into the Haversian canals in the bone. A golden rule to be kept in mind is therefore: “Never obliterate the mastoid without full reliability of your radicalism!” One ear with previous inadequate surgery in another hospital, reoperated on by the author, showed clearly the serious consequences forgetting this rule can have. A residual cholesteatoma on top of the labyrinthine massive advanced quickly resulting in a large fistula on the lateral semicircular canal. In the middle ear the radicalism of the primary surgery remains more or less questionable due to other demands. In order to improve the risk evaluation concerning the postoperative cholesteatoma, the author routinely takes specimens for histological examination from the hideaways of the middle ear, and from the mucosal borderlines when removing parts of the middle ear mucosa. However, keratinizing squamous cell epithelium is seen in these specimens far more frequently than the postoperative cholesteatoma which is to be expected, and the author does not consider such a finding as an indication for a second look. Due to the use of lyophilized dura on the bare bone surfaces in the middle ear the author waits nine to twelve months before the second look, due to persistent air-bone gap, or the second-stage reconstruction of the ossicular chain is performed. During this time the lyodura disappears as completely at it will do, and the regrowth of the middle ear mucosa can take place undisturbed.
European Geriatric Medicine, 2013
Pitkälä K, Savikko N, Pöysti M, Laakkonen M-L, Kautiainen H, Strandberg T, Tilvis R. Effectivenes... more Pitkälä K, Savikko N, Pöysti M, Laakkonen M-L, Kautiainen H, Strandberg T, Tilvis R. Effectiveness of physical rehabilitation for older people with memor y disorder. Randomized controlled trial. Helsinki: The Social Insurance Institution of Finland, Studies in social security and health 125, 2013. 193 s. ISBN 978-951 669-909-0 (nid.), ISBN 978-951-669-910-6 (pdf ). The objective of the study was to determine with a randomized, controlled trial design whether exercise program has beneficial effects on different aspects of home-dwelling Alzheimer patients functioning, their spousal caregivers’ quality of life and effects on use and costs of patients’ and spousal caregivers’ social and health care services during 2008–2011. Participants were 210 caregiver-patient dyads, who were randomized in three equally large groups 1) group-based rehabilitation (exercise for four hours twice a week in day centre for one year), 2) home-delivered rehabilitation (exercise for one hour twice a week fo...
Age and Ageing
Background Dementia is a condition which results in a high cost of care, a significant proportion... more Background Dementia is a condition which results in a high cost of care, a significant proportion of which is the cost associated with informal care. In previous studies, informal caregiving has been challenging to assess due to difficulties in estimating the true time spent on caregiving work and how to value caregivers’ time. The aim of this study was to compare the costs of dementia among patients living alone and among those living with a caregiver to show the monetary value of informal caregiving from a societal perspective. Methods Data from our four dementia trials using the same measures were combined, allowing the inclusion of 604 participants. Participants were followed up for 2 years or until death for their use of health and social services. Use of all services was retrieved from medical/social records. We also included the costs of lost productivity of those caregivers who were not retired. Results The total mean cost of services and lost productivity was €22,068/person...
European Geriatric Medicine
BackgroundThere are scarce studies exploring effectiveness and feasibility of intensive and long-... more BackgroundThere are scarce studies exploring effectiveness and feasibility of intensive and long-lasting exercise among patients with dementia.
European Geriatric Medicine
ABSTRACT Objective To explore feelings and psychological well-being of spousal caregivers of pers... more ABSTRACT Objective To explore feelings and psychological well-being of spousal caregivers of persons with Alzheimer's disease related to caregiving and experiences with the service system and associated factors. Methods A cross-sectional survey of Alzheimer patients’ spouses included items on caregiving and the Psychological Well-being Scale (PWB). An open-ended question: “What kind of problems have you faced with the services?” was included. Those responding to the question (n = 728) were analyzed combining both quantitative and qualitative responses. Results According to PWB, 10.8% had poor well-being. They had poorer subjective health, their care recipient had poorer functioning and they more often felt that their closest ones did not understand caregiving situation than those with better PWB. No difference existed between these groups in proportions satisfied with the services. In the responses of the open-ended question, the caregivers described both positive and negative feelings related to everyday caregiving as well as problems related to using services. Positive feelings were associated with being satisfied with services and caregivers’ good subjective health. Negative feelings included bitterness, feeling of being isolated and distress. Bitterness was associated with being dissatisfied with services, the relationship with the spouse or closest ones and poor PWB. Feeling isolated was associated with the view that the closest ones do not understand their situation. Conclusions Caregivers’ feelings are intertwined with their personal characteristics and life situation with their spousal relationship and closest ones. Traditional home service may not be equipped to deal with the complexity of these feelings. A more psychological approach is needed.
Dementia and geriatric cognitive disorders extra
People with dementia are at high risk for falls. However, little is known of the features causing... more People with dementia are at high risk for falls. However, little is known of the features causing falls in Alzheimer disease (AD). Our aim was to investigate how participants with AD fall. In the FINALEX (Finnish Alzheimer Disease Exercise Trial) study, participants' (n = 194) falls were followed up for 1 year by diaries kept by their spouses. The most common reason for falls (n = 355) was stumbling (n = 61). Of the falls, 123 led to injuries, 50 to emergency department visits, and 13 to fractures. The participants without falls (n = 103) were younger and had milder dementia than those with 1 (n = 34) or ≥2 falls (n = 57). Participants with a Mini Mental State Examination score of around 10 points were most prone to fall. In adjusted regression models, good nutritional status, good physical functioning, and use of antihypertensive medication (incident rate ratio [IRR] 0.68, 95% confidence interval [CI] 0.54-0.85) protected against falls, whereas fall history (IRR 2.71, 95% CI 2....
Drugs Aging, Feb 1, 2006
Although the Beers criteria have been frequently utilised to describe the use of inappropriate me... more Although the Beers criteria have been frequently utilised to describe the use of inappropriate medications in various elderly populations, less is known about the use of such medications among patients with dementia, and nor have many studies dealt with their impact on mortality or use of healthcare services. This study examines the use of inappropriate drugs and their impact on mortality and use of health services among Finnish elderly nursing home and hospital patients. Patients with dementia were studied as a special subgroup. A total of 425 patients consecutively admitted to seven Finnish nursing homes and two hospitals in 1999-2000 were examined. Details of all medications prescribed and administered were retrieved from medical records and coded according to the Beers 1997 criteria. Mortality data as well as days in acute hospital were obtained from central registers and all area hospitals during 2 years of follow-up. The entire population was old and frail (mean age 86 years, 82% females), 60% had dementia and 36.2% received at least one potentially inappropriate drug (PID). No differences existed in the proportion of users of PIDs among those 60% of patients with dementia compared with those without. The most common PID was temazepam, with 14% of all patients on high doses. Other commonly used PIDs were oxybutynin and dipyridamole. Amitriptyline was more commonly used among patients without dementia (4.7%) compared with those with dementia (0.8%). Nevertheless, in this very old and frail study population, use of inappropriate drugs did not predict mortality or use of health services. Use of PIDs is common in nursing homes and hospitals in Finland but has no impact on mortality or hospital admissions. Use of high-dose temazepam as a hypnotic accounted for most of the high use of PIDs.
... Gummerus Kirjapaino Oy, Vaajakoski 2007 This book is available at: tarina@kirjakauppatarina P... more ... Gummerus Kirjapaino Oy, Vaajakoski 2007 This book is available at: tarina@kirjakauppatarina Page 3. To my dear children Ronja, Tuuli, Ilpo and Heini Page 4. Journey Make haste with care, the never-ending sky above embraces dreams. To our feet it lowers its white stars, ...
Journal of the American Geriatrics Society, 2016
To examine whether a regular, long-term exercise program performed by individuals with Alzheimer&... more To examine whether a regular, long-term exercise program performed by individuals with Alzheimer's disease (AD) at home or as group-based exercise at an adult daycare center has beneficial effects on cognition; to examine secondary outcomes of a trial that has been published earlier. Randomized, controlled trial. Community. Community-dwelling dyads (N = 210) of individuals with AD and their spousal caregivers randomized into three groups. Two types of intervention comprising customized home-based exercise (HE) and group-based exercise (GE), each twice a week for 1 year, were compared with a control group (CG) receiving usual community care. Cognitive function was measured using the Clock Drawing Test (CDT), Verbal Fluency (VF), Clinical Dementia Rating (CDR), and Mini-Mental State Examination (MMSE) at baseline and 3, 6, and 12 months of follow-up. Executive function, measured using CDT, improved in the HE group, and changes in the score were significantly better than those of the CG at 12 months (adjusted for age, sex, and CDR, P = .03). All groups deteriorated in VF and MMSE score during the intervention, and no significant differences between the groups were detected at 12-month follow-up when analyses were adjusted for age, sex, and CDR. Regular, long-term, customized HE improved the executive function of community-dwelling older people with memory disorders, but the effects were mild and were not observed in other domains of cognition.
European Geriatric Medicine, 2016
European Geriatric Medicine, 2015
European Geriatric Medicine, 2015
The American Journal of Geriatric Psychiatry, 2007
The journal of nutrition, health & aging, 2014
Alzheimer patients (AD) are known to be at risk for malnutrition and their older spouses may also... more Alzheimer patients (AD) are known to be at risk for malnutrition and their older spouses may also have nutritional problems. The aim of our study was to clarify the association of caregivers' sex on the nutrient intake of AD couples. Our study uses the baseline data of a randomized nutritional trial exploring the effectiveness of nutrition intervention among home-dwelling AD patients. The central AD register in Finland was used to recruit AD patients living with a spousal caregiver, 99 couples participated in our study. Nutritional status was assessed using the Mini-Nutritional Assessment (MNA). Nutrient intakes for both AD patients and their spouses were calculated from 3-day food diaries. The mean age of caregivers and AD spouses was 75.2 (SD 7.0) and 77.4 years (SD 5.6), respectively. According to the MNA, 40% of male and 52% of female AD spouses were at risk for malnutrition. Among male caregivers, the mean energy and protein intakes were 1605 kcal (SD 458) and 0.93 g/body k...
JAMA internal medicine, Jan 27, 2013
Few rigorous clinical trials have investigated the effectiveness of exercise on the physical func... more Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD). To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services. A randomized controlled trial. A total of 210 home-dwelling patients with AD living with their spousal caregiver. The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care. The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services. All groups deteriorated in functioning during the year after randomization, but deterioration was signi...
International journal of Alzheimer's disease, 2012
The proportion of male caregivers is rapidly increasing. However, there are few large scale studi... more The proportion of male caregivers is rapidly increasing. However, there are few large scale studies exploring gender differences in the burden or coping with caregiving. We investigated this among caregivers of patients with dementia. The study cohort consisted of 335 dyads of wife-husband couples from two studies including dementia patients and their spousal caregivers. Baseline mini-mental state examination (MMSE), clinical dementia rating scale (CDR), neuropsychiatric inventory (NPI), cornell depression scale and charlson comorbidity index (CCI) were used to describe patients with dementia, Zarit burden scale and geriatric depression scale were used to measure experienced burden and depression of caregivers. Mean age of caregivers was 78 years. There were no differences in depression, satisfaction with life, or loneliness according to caregivers' gender. Male caregivers had more comorbidities than females (CCI 1.9 versus 1.1, P < 0.001), and the wives of male caregivers ha...
Dementia and geriatric cognitive disorders extra, 2011
To investigate the use of drugs with anticholinergic properties (DAPs) and their associations wit... more To investigate the use of drugs with anticholinergic properties (DAPs) and their associations with delirium and mortality among elderly patients with comorbidities. 425 patients (≥70 years of age) in geriatric wards and nursing homes were assessed. The use of DAPs was retrieved from their medical records. Delirium was diagnosed according to the DSM-IV criteria. Of the 341 patients (80.2%) treated with multiple DAPs (≥2), 92 patients (27.0%) suffered from delirium, whereas 14 of 84 patients (16.7%) without DAP treatment had delirium (p = 0.050). In a logistic regression analysis with age, gender, and Charlson Comorbidity Index as covariates, DAP treatment did not predict delirium (odds ratio 1.67, 95% confidence interval 0.87-3.21). The 2-year mortality was 49.3% (n = 168) in DAP users and 35.7% (n = 30) in non-users, respectively (p = 0.026). In the Cox proportional hazard model adjusted for age, gender, and comorbidity, DAPs did not predict mortality (hazard ratio 1.12, 95% confide...
Surgery and Pathology of the Middle Ear, 1985
The indications for a second-look operation after closed and obliterative techniques are: postope... more The indications for a second-look operation after closed and obliterative techniques are: postoperative cholesteatoma, planned second-stage reconstruction of the ossicular chain, inadequate closure of the air-bone gap, and postoperative infection of the obliteration material. With the canal wall down technique used by the author, the frequency of the postoperative cholesteatoma is relatively low compared with experiences of the intact canal wall technique, but this harm cannot be completely avoided. In a long-term follow-up Ojala and Palva have shown how these few cholesteatomas grew in the meso- and epitympanum only, but none primarily in the obliterated mastoid. This can only be understood on the basis of complete radicalism of the surgery in the mastoid, with sufficient concern to every possible projection of the cholesteatoma within any little cell as well as into the Haversian canals in the bone. A golden rule to be kept in mind is therefore: “Never obliterate the mastoid without full reliability of your radicalism!” One ear with previous inadequate surgery in another hospital, reoperated on by the author, showed clearly the serious consequences forgetting this rule can have. A residual cholesteatoma on top of the labyrinthine massive advanced quickly resulting in a large fistula on the lateral semicircular canal. In the middle ear the radicalism of the primary surgery remains more or less questionable due to other demands. In order to improve the risk evaluation concerning the postoperative cholesteatoma, the author routinely takes specimens for histological examination from the hideaways of the middle ear, and from the mucosal borderlines when removing parts of the middle ear mucosa. However, keratinizing squamous cell epithelium is seen in these specimens far more frequently than the postoperative cholesteatoma which is to be expected, and the author does not consider such a finding as an indication for a second look. Due to the use of lyophilized dura on the bare bone surfaces in the middle ear the author waits nine to twelve months before the second look, due to persistent air-bone gap, or the second-stage reconstruction of the ossicular chain is performed. During this time the lyodura disappears as completely at it will do, and the regrowth of the middle ear mucosa can take place undisturbed.
European Geriatric Medicine, 2013
Pitkälä K, Savikko N, Pöysti M, Laakkonen M-L, Kautiainen H, Strandberg T, Tilvis R. Effectivenes... more Pitkälä K, Savikko N, Pöysti M, Laakkonen M-L, Kautiainen H, Strandberg T, Tilvis R. Effectiveness of physical rehabilitation for older people with memor y disorder. Randomized controlled trial. Helsinki: The Social Insurance Institution of Finland, Studies in social security and health 125, 2013. 193 s. ISBN 978-951 669-909-0 (nid.), ISBN 978-951-669-910-6 (pdf ). The objective of the study was to determine with a randomized, controlled trial design whether exercise program has beneficial effects on different aspects of home-dwelling Alzheimer patients functioning, their spousal caregivers’ quality of life and effects on use and costs of patients’ and spousal caregivers’ social and health care services during 2008–2011. Participants were 210 caregiver-patient dyads, who were randomized in three equally large groups 1) group-based rehabilitation (exercise for four hours twice a week in day centre for one year), 2) home-delivered rehabilitation (exercise for one hour twice a week fo...
Age and Ageing
Background Dementia is a condition which results in a high cost of care, a significant proportion... more Background Dementia is a condition which results in a high cost of care, a significant proportion of which is the cost associated with informal care. In previous studies, informal caregiving has been challenging to assess due to difficulties in estimating the true time spent on caregiving work and how to value caregivers’ time. The aim of this study was to compare the costs of dementia among patients living alone and among those living with a caregiver to show the monetary value of informal caregiving from a societal perspective. Methods Data from our four dementia trials using the same measures were combined, allowing the inclusion of 604 participants. Participants were followed up for 2 years or until death for their use of health and social services. Use of all services was retrieved from medical/social records. We also included the costs of lost productivity of those caregivers who were not retired. Results The total mean cost of services and lost productivity was €22,068/person...
European Geriatric Medicine
BackgroundThere are scarce studies exploring effectiveness and feasibility of intensive and long-... more BackgroundThere are scarce studies exploring effectiveness and feasibility of intensive and long-lasting exercise among patients with dementia.
European Geriatric Medicine
ABSTRACT Objective To explore feelings and psychological well-being of spousal caregivers of pers... more ABSTRACT Objective To explore feelings and psychological well-being of spousal caregivers of persons with Alzheimer's disease related to caregiving and experiences with the service system and associated factors. Methods A cross-sectional survey of Alzheimer patients’ spouses included items on caregiving and the Psychological Well-being Scale (PWB). An open-ended question: “What kind of problems have you faced with the services?” was included. Those responding to the question (n = 728) were analyzed combining both quantitative and qualitative responses. Results According to PWB, 10.8% had poor well-being. They had poorer subjective health, their care recipient had poorer functioning and they more often felt that their closest ones did not understand caregiving situation than those with better PWB. No difference existed between these groups in proportions satisfied with the services. In the responses of the open-ended question, the caregivers described both positive and negative feelings related to everyday caregiving as well as problems related to using services. Positive feelings were associated with being satisfied with services and caregivers’ good subjective health. Negative feelings included bitterness, feeling of being isolated and distress. Bitterness was associated with being dissatisfied with services, the relationship with the spouse or closest ones and poor PWB. Feeling isolated was associated with the view that the closest ones do not understand their situation. Conclusions Caregivers’ feelings are intertwined with their personal characteristics and life situation with their spousal relationship and closest ones. Traditional home service may not be equipped to deal with the complexity of these feelings. A more psychological approach is needed.
Dementia and geriatric cognitive disorders extra
People with dementia are at high risk for falls. However, little is known of the features causing... more People with dementia are at high risk for falls. However, little is known of the features causing falls in Alzheimer disease (AD). Our aim was to investigate how participants with AD fall. In the FINALEX (Finnish Alzheimer Disease Exercise Trial) study, participants' (n = 194) falls were followed up for 1 year by diaries kept by their spouses. The most common reason for falls (n = 355) was stumbling (n = 61). Of the falls, 123 led to injuries, 50 to emergency department visits, and 13 to fractures. The participants without falls (n = 103) were younger and had milder dementia than those with 1 (n = 34) or ≥2 falls (n = 57). Participants with a Mini Mental State Examination score of around 10 points were most prone to fall. In adjusted regression models, good nutritional status, good physical functioning, and use of antihypertensive medication (incident rate ratio [IRR] 0.68, 95% confidence interval [CI] 0.54-0.85) protected against falls, whereas fall history (IRR 2.71, 95% CI 2....
Drugs Aging, Feb 1, 2006
Although the Beers criteria have been frequently utilised to describe the use of inappropriate me... more Although the Beers criteria have been frequently utilised to describe the use of inappropriate medications in various elderly populations, less is known about the use of such medications among patients with dementia, and nor have many studies dealt with their impact on mortality or use of healthcare services. This study examines the use of inappropriate drugs and their impact on mortality and use of health services among Finnish elderly nursing home and hospital patients. Patients with dementia were studied as a special subgroup. A total of 425 patients consecutively admitted to seven Finnish nursing homes and two hospitals in 1999-2000 were examined. Details of all medications prescribed and administered were retrieved from medical records and coded according to the Beers 1997 criteria. Mortality data as well as days in acute hospital were obtained from central registers and all area hospitals during 2 years of follow-up. The entire population was old and frail (mean age 86 years, 82% females), 60% had dementia and 36.2% received at least one potentially inappropriate drug (PID). No differences existed in the proportion of users of PIDs among those 60% of patients with dementia compared with those without. The most common PID was temazepam, with 14% of all patients on high doses. Other commonly used PIDs were oxybutynin and dipyridamole. Amitriptyline was more commonly used among patients without dementia (4.7%) compared with those with dementia (0.8%). Nevertheless, in this very old and frail study population, use of inappropriate drugs did not predict mortality or use of health services. Use of PIDs is common in nursing homes and hospitals in Finland but has no impact on mortality or hospital admissions. Use of high-dose temazepam as a hypnotic accounted for most of the high use of PIDs.
... Gummerus Kirjapaino Oy, Vaajakoski 2007 This book is available at: tarina@kirjakauppatarina P... more ... Gummerus Kirjapaino Oy, Vaajakoski 2007 This book is available at: tarina@kirjakauppatarina Page 3. To my dear children Ronja, Tuuli, Ilpo and Heini Page 4. Journey Make haste with care, the never-ending sky above embraces dreams. To our feet it lowers its white stars, ...
Journal of the American Geriatrics Society, 2016
To examine whether a regular, long-term exercise program performed by individuals with Alzheimer&... more To examine whether a regular, long-term exercise program performed by individuals with Alzheimer&amp;#39;s disease (AD) at home or as group-based exercise at an adult daycare center has beneficial effects on cognition; to examine secondary outcomes of a trial that has been published earlier. Randomized, controlled trial. Community. Community-dwelling dyads (N = 210) of individuals with AD and their spousal caregivers randomized into three groups. Two types of intervention comprising customized home-based exercise (HE) and group-based exercise (GE), each twice a week for 1 year, were compared with a control group (CG) receiving usual community care. Cognitive function was measured using the Clock Drawing Test (CDT), Verbal Fluency (VF), Clinical Dementia Rating (CDR), and Mini-Mental State Examination (MMSE) at baseline and 3, 6, and 12 months of follow-up. Executive function, measured using CDT, improved in the HE group, and changes in the score were significantly better than those of the CG at 12 months (adjusted for age, sex, and CDR, P = .03). All groups deteriorated in VF and MMSE score during the intervention, and no significant differences between the groups were detected at 12-month follow-up when analyses were adjusted for age, sex, and CDR. Regular, long-term, customized HE improved the executive function of community-dwelling older people with memory disorders, but the effects were mild and were not observed in other domains of cognition.
European Geriatric Medicine, 2016
European Geriatric Medicine, 2015
European Geriatric Medicine, 2015
The American Journal of Geriatric Psychiatry, 2007
The journal of nutrition, health & aging, 2014
Alzheimer patients (AD) are known to be at risk for malnutrition and their older spouses may also... more Alzheimer patients (AD) are known to be at risk for malnutrition and their older spouses may also have nutritional problems. The aim of our study was to clarify the association of caregivers' sex on the nutrient intake of AD couples. Our study uses the baseline data of a randomized nutritional trial exploring the effectiveness of nutrition intervention among home-dwelling AD patients. The central AD register in Finland was used to recruit AD patients living with a spousal caregiver, 99 couples participated in our study. Nutritional status was assessed using the Mini-Nutritional Assessment (MNA). Nutrient intakes for both AD patients and their spouses were calculated from 3-day food diaries. The mean age of caregivers and AD spouses was 75.2 (SD 7.0) and 77.4 years (SD 5.6), respectively. According to the MNA, 40% of male and 52% of female AD spouses were at risk for malnutrition. Among male caregivers, the mean energy and protein intakes were 1605 kcal (SD 458) and 0.93 g/body k...
JAMA internal medicine, Jan 27, 2013
Few rigorous clinical trials have investigated the effectiveness of exercise on the physical func... more Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD). To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services. A randomized controlled trial. A total of 210 home-dwelling patients with AD living with their spousal caregiver. The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care. The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services. All groups deteriorated in functioning during the year after randomization, but deterioration was signi...
International journal of Alzheimer's disease, 2012
The proportion of male caregivers is rapidly increasing. However, there are few large scale studi... more The proportion of male caregivers is rapidly increasing. However, there are few large scale studies exploring gender differences in the burden or coping with caregiving. We investigated this among caregivers of patients with dementia. The study cohort consisted of 335 dyads of wife-husband couples from two studies including dementia patients and their spousal caregivers. Baseline mini-mental state examination (MMSE), clinical dementia rating scale (CDR), neuropsychiatric inventory (NPI), cornell depression scale and charlson comorbidity index (CCI) were used to describe patients with dementia, Zarit burden scale and geriatric depression scale were used to measure experienced burden and depression of caregivers. Mean age of caregivers was 78 years. There were no differences in depression, satisfaction with life, or loneliness according to caregivers' gender. Male caregivers had more comorbidities than females (CCI 1.9 versus 1.1, P < 0.001), and the wives of male caregivers ha...
Dementia and geriatric cognitive disorders extra, 2011
To investigate the use of drugs with anticholinergic properties (DAPs) and their associations wit... more To investigate the use of drugs with anticholinergic properties (DAPs) and their associations with delirium and mortality among elderly patients with comorbidities. 425 patients (≥70 years of age) in geriatric wards and nursing homes were assessed. The use of DAPs was retrieved from their medical records. Delirium was diagnosed according to the DSM-IV criteria. Of the 341 patients (80.2%) treated with multiple DAPs (≥2), 92 patients (27.0%) suffered from delirium, whereas 14 of 84 patients (16.7%) without DAP treatment had delirium (p = 0.050). In a logistic regression analysis with age, gender, and Charlson Comorbidity Index as covariates, DAP treatment did not predict delirium (odds ratio 1.67, 95% confidence interval 0.87-3.21). The 2-year mortality was 49.3% (n = 168) in DAP users and 35.7% (n = 30) in non-users, respectively (p = 0.026). In the Cox proportional hazard model adjusted for age, gender, and comorbidity, DAPs did not predict mortality (hazard ratio 1.12, 95% confide...