Bettina Meinow | Karolinska Institutet (original) (raw)
Papers by Bettina Meinow
PLOS ONE, Oct 23, 2023
The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecar... more The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors (age, gender, education, cohabitation status) and time with a dementia diagnosis. Methods This retrospective cohort study included all people who died in November 2019 aged 70 years and older (n = 6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use. Results Results showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in residential care close to death. Women who lived alone, with or without dementia, used residential care to a higher degree compared to married or cohabiting women. Conclusions Among people without a dementia diagnosis, as well as those who were newly diagnosed, it was common to have no LTC at all, or use LTC only for a brief period close to death. During the last five years of life, PlwD and those living alone more often entered LTC early and
International Journal of Integrated Care, Dec 27, 2023
Co-designing collaborative health deterioration prevention together with older people, civic soci... more Co-designing collaborative health deterioration prevention together with older people, civic society, and community health and social care
Scandinavian Journal of Public Health, Aug 3, 2023
Aims: There is substantial evidence that previous working conditions influence post-retirement he... more Aims: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions’ association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care. Methods: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up ( n = 931,819). Results: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19–1.27; physical demands: HR 1.36, 95% CI 1.31–1.40, and hazardous work: HR 1.35, 95% CI 1.30–1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency. Conclusions: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.
European Journal of Ageing, Jul 1, 2023
There is a gap in knowledge about factors associated with the duration of late life dependency. I... more There is a gap in knowledge about factors associated with the duration of late life dependency. In this study, we measured how the age at onset of late life dependency relates to the time spent with late life dependency. Using Swedish register data, we identified people 70 + who entered the period of late life dependency (measured by entering long-term care for help with PADLs) between June and December 2008. We followed this cohort (n = 17,515) for 7 years, or until death. We used Laplace regression models to estimate the median number of months with late life dependency by age group, gender, level of education and country of birth. We also calculated the crude percentiles (p10, p25, p50, p75 and p90) of month with late life dependency, by age group, gender and cohabitation status. Results show that the majority spent a rather long period with dependency, the median number of months were 40.0 (3.3 years) for women and 22.6 (1.9 year) for men. A higher age at entry was associated with a shorter duration of dependency, an association that was robust to adjustment for cohabiting at baseline, gender, education and country of birth. Our results suggest that older adults who postpone the start of dependency also compress the time with dependency, this lends support to the ambitions of public health initiatives and interventions targeting maintained independence in older adults.
Innovation in Aging, Nov 1, 2022
of cognitive aging, it does not account for the impact of micro-level measures of neighborhood st... more of cognitive aging, it does not account for the impact of micro-level measures of neighborhood stressors on cognitive function. Therefore, the purpose of the current study was to determine whether violent crime incident proximity (VCIP) contributes to later-life cognitive function above and beyond ADI in older African Americans. Participants (N=147; M= 68.34) from an ongoing study, Pathways to Healthy Aging in African Americans-a Rutgers University-Newark community partnership fostered over 16 years of community engagement, health education, and public service-responded to measures of cognitive ability, SDOH, and demographic details. The results show that VCIP is a trending predictor of cognitive performance, when adjusting for age, gender, education, depression, and ADI. The result aligns with our hypothesis that individuals living in areas with greater VCIP will have poorer performance on cognitive tasks. Our findings suggest that for African Americans in an urban setting, hyper-local VCIP appears to be more useful at capturing the impact of neighborhood disadvantage on cognitive decline and Alzheimer's disease risk. Therefore, for later-life cognitive health in African Americans, it is important to consider micro-level measures of neighborhood stressors such as VCIP.
BMC Public Health, Apr 14, 2022
Background: Due to population aging, it is essential to examine to what extent rises in life expe... more Background: Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. Methods: CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n≈2000), was used to estimate the prevalence of CHP. Age-and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP. Results: Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%). Conclusions: The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.
AimsThe aims of this study were to compare the patterns of long-term care (LTC) use (no care, hom... more AimsThe aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors and time with a dementia diagnosis.MethodsThis retrospective cohort study included all people who died in November 2019 aged 70 years and older (n=6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use and predicted proportions were calculated from the margins command.ResultsResults showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in resi...
BMC Geriatrics
Background Although many people with dementia need progressive support during their last years of... more Background Although many people with dementia need progressive support during their last years of life little is known to what extent they use formal long-term care (LTC). This study investigates the use of LTC, including residential care and homecare, in the month preceding death, as well as the number of months spent in residential care, among Swedish older decedents with a dementia diagnosis, compared with those without a dementia diagnosis. Methodology This retrospective cohort study identified all people who died in November 2019 in Sweden aged 70 years and older (n = 6294). Dementia diagnoses were collected from the National Patient Register (before death) and the National Cause of Death Register (death certificate). The use of LTC was based on the Social Services Register and sociodemographic factors were provided by Statistics Sweden. We performed regression models (multinomial and linear logistic regression models) to examine the association between the utilization of LTC a...
Innovation in Aging, 2018
For nursing home residents, positive interactions with staff and engagement in activity contribut... more For nursing home residents, positive interactions with staff and engagement in activity contribute meaningfully to quality of life. We sought to improve interactions between staff and residents, with the ultimate aim of enhancing resident engagement. We used an opportunistic, snowball sample of 6 Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs). Our staff-based behavior-change intervention involved staff using a set of evidence-based practices for implementing quality improvement: frontline huddles, rapid-cycle structured observations, a strengths-based approach, and the importance of brevity coupled with regularity. CLC staff facilitated the intervention, with some assistance from researchers. Research data comprised validated resident and staff surveys, researcherconducted structured pre-and post-intervention observations, and semi-structured post-intervention staff interviews. 62 CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations and 66 interviews. In generalized linear models using observation and survey data, intervention implementation was associated with increased staff-resident communication during the provision of direct care activities (β = 0.083, 95% CI: 0.04-0.126, adjusted P=.0012) and decreased negative staff interactions with residents (β =-0.035, 95% CI:-0.062-0.009, adjusted P=0.0288). In interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) improve the quality of their interactions with residents. Overall, the intervention proved feasible. The combination of rapid-cycle observations, huddles, and a focus on identified strengths influenced staff to make simple enhancements to their behaviors that improved staff-resident interactions and staff-assessed resident engagement.
European Journal of Ageing, 2006
Most studies on health trends in the elderly population focus on specific conditions, studied one... more Most studies on health trends in the elderly population focus on specific conditions, studied one at a time. However, health problems are often interrelated and exist simultaneously in late life. Individuals with health problems in several domains present special challenges to care services. To estimate future needs for care it may be relevant to study trends of complex health problems as well as single health items. This study identified serious problems in three domains (diseases/ symptoms, mobility, cognition/communication) in two representative samples of the Swedish population aged 77 and older (1992: n=537; 2002: n=561). People with serious problems in two or three domains were considered to have complex health problems. Changes between 1992 and 2002 in the prevalence of persons having serious problems in no, one and two/three domains were analyzed with logistic regressions. When examining each domain separately all three showed a significant increase of serious problems. For diseases/symptoms the increase remained significant after controlling for different age and gender distributions in the two surveys. Results showed a significant increase in the prevalence of having problems in one domain, as well as having problems in two or three domains (complex problems). Results persisted when adjusting for different distributions in age, gender and education between 1992 and 2002. Results suggest a worsening of health during the 10-year period and an increase of complex problems. This emphasizes the necessity of cooperation and collaboration between different kinds of medical and social services for elderly people.
Social Science & Medicine, 2011
In Sweden and other countries, the benefits of user choice and market forces are often voiced in ... more In Sweden and other countries, the benefits of user choice and market forces are often voiced in relation to the provision of medical care and social services. Policy makers increasingly view people as customers and consumers of care services. Among very old peopledthe most frequent care usersdhow many have the capacity necessary to find information and make decisions concerning providers of medical and social services? Using a nationally representative sample of Swedes aged 77þ (SWEOLD) in 2002 this study describes the prevalence of cognitive, physical and sensory resources associated with the capacity to make and carry out informed choices concerning medical and social care providers. Results showed that one third of a nationally representative sample of persons aged 77þ scored low on a cognitive test or they were so cognitively impaired that they could not be interviewed directly. Another 22% scored poorly on a test of the ability to find and process information. A further 32% had adequate cognition but had limitations in sensory function or mental vitality or were unable to go outside on their own. A total of 10% did not report any of the measured problems. In general, care utilisation increases with age. As health problems increase, physical and cognitive abilities decline. Results suggest that those elderly people who are most dependent on care services and who could benefit most from a "good choice", are also those who have the highest prevalence of cognitive and physical limitations associated with the capacity to act as a rational consumer of care services.
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2004
Objectives. Racial differences in self-rated health at older ages are well documented. African Am... more Objectives. Racial differences in self-rated health at older ages are well documented. African Americans consistently report poorer health, even when education, income, and other health status indicators are controlled. The extent to which neighborhood-level characteristics mediate this association remains largely unexplored. We ask whether neighborhood social and economic resources help to explain the self-reported health differential between African Americans and Whites.
Associations between work-related stress in late midlife, educational attainment, and serious hea... more Associations between work-related stress in late midlife, educational attainment, and serious health problems in old age: a longitudinal study before and after retirement.
Are work conditions more than 20 year earlier associated to complex and severe health problems af... more Are work conditions more than 20 year earlier associated to complex and severe health problems after retirement age?
Background Due to population aging, it is essential to examine to what extent rises in life expec... more Background Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. Methods CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n ≈ 2000), was used to es...
This thesis investigates health trends among very old people and the allocation of public home-he... more This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sou ...
Increased survival among people with multiple health problems - A challenge for care provision
PLOS ONE, Oct 23, 2023
The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecar... more The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors (age, gender, education, cohabitation status) and time with a dementia diagnosis. Methods This retrospective cohort study included all people who died in November 2019 aged 70 years and older (n = 6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use. Results Results showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in residential care close to death. Women who lived alone, with or without dementia, used residential care to a higher degree compared to married or cohabiting women. Conclusions Among people without a dementia diagnosis, as well as those who were newly diagnosed, it was common to have no LTC at all, or use LTC only for a brief period close to death. During the last five years of life, PlwD and those living alone more often entered LTC early and
International Journal of Integrated Care, Dec 27, 2023
Co-designing collaborative health deterioration prevention together with older people, civic soci... more Co-designing collaborative health deterioration prevention together with older people, civic society, and community health and social care
Scandinavian Journal of Public Health, Aug 3, 2023
Aims: There is substantial evidence that previous working conditions influence post-retirement he... more Aims: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions’ association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care. Methods: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up ( n = 931,819). Results: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19–1.27; physical demands: HR 1.36, 95% CI 1.31–1.40, and hazardous work: HR 1.35, 95% CI 1.30–1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency. Conclusions: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.
European Journal of Ageing, Jul 1, 2023
There is a gap in knowledge about factors associated with the duration of late life dependency. I... more There is a gap in knowledge about factors associated with the duration of late life dependency. In this study, we measured how the age at onset of late life dependency relates to the time spent with late life dependency. Using Swedish register data, we identified people 70 + who entered the period of late life dependency (measured by entering long-term care for help with PADLs) between June and December 2008. We followed this cohort (n = 17,515) for 7 years, or until death. We used Laplace regression models to estimate the median number of months with late life dependency by age group, gender, level of education and country of birth. We also calculated the crude percentiles (p10, p25, p50, p75 and p90) of month with late life dependency, by age group, gender and cohabitation status. Results show that the majority spent a rather long period with dependency, the median number of months were 40.0 (3.3 years) for women and 22.6 (1.9 year) for men. A higher age at entry was associated with a shorter duration of dependency, an association that was robust to adjustment for cohabiting at baseline, gender, education and country of birth. Our results suggest that older adults who postpone the start of dependency also compress the time with dependency, this lends support to the ambitions of public health initiatives and interventions targeting maintained independence in older adults.
Innovation in Aging, Nov 1, 2022
of cognitive aging, it does not account for the impact of micro-level measures of neighborhood st... more of cognitive aging, it does not account for the impact of micro-level measures of neighborhood stressors on cognitive function. Therefore, the purpose of the current study was to determine whether violent crime incident proximity (VCIP) contributes to later-life cognitive function above and beyond ADI in older African Americans. Participants (N=147; M= 68.34) from an ongoing study, Pathways to Healthy Aging in African Americans-a Rutgers University-Newark community partnership fostered over 16 years of community engagement, health education, and public service-responded to measures of cognitive ability, SDOH, and demographic details. The results show that VCIP is a trending predictor of cognitive performance, when adjusting for age, gender, education, depression, and ADI. The result aligns with our hypothesis that individuals living in areas with greater VCIP will have poorer performance on cognitive tasks. Our findings suggest that for African Americans in an urban setting, hyper-local VCIP appears to be more useful at capturing the impact of neighborhood disadvantage on cognitive decline and Alzheimer's disease risk. Therefore, for later-life cognitive health in African Americans, it is important to consider micro-level measures of neighborhood stressors such as VCIP.
BMC Public Health, Apr 14, 2022
Background: Due to population aging, it is essential to examine to what extent rises in life expe... more Background: Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. Methods: CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n≈2000), was used to estimate the prevalence of CHP. Age-and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP. Results: Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%). Conclusions: The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.
AimsThe aims of this study were to compare the patterns of long-term care (LTC) use (no care, hom... more AimsThe aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors and time with a dementia diagnosis.MethodsThis retrospective cohort study included all people who died in November 2019 aged 70 years and older (n=6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use and predicted proportions were calculated from the margins command.ResultsResults showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in resi...
BMC Geriatrics
Background Although many people with dementia need progressive support during their last years of... more Background Although many people with dementia need progressive support during their last years of life little is known to what extent they use formal long-term care (LTC). This study investigates the use of LTC, including residential care and homecare, in the month preceding death, as well as the number of months spent in residential care, among Swedish older decedents with a dementia diagnosis, compared with those without a dementia diagnosis. Methodology This retrospective cohort study identified all people who died in November 2019 in Sweden aged 70 years and older (n = 6294). Dementia diagnoses were collected from the National Patient Register (before death) and the National Cause of Death Register (death certificate). The use of LTC was based on the Social Services Register and sociodemographic factors were provided by Statistics Sweden. We performed regression models (multinomial and linear logistic regression models) to examine the association between the utilization of LTC a...
Innovation in Aging, 2018
For nursing home residents, positive interactions with staff and engagement in activity contribut... more For nursing home residents, positive interactions with staff and engagement in activity contribute meaningfully to quality of life. We sought to improve interactions between staff and residents, with the ultimate aim of enhancing resident engagement. We used an opportunistic, snowball sample of 6 Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs). Our staff-based behavior-change intervention involved staff using a set of evidence-based practices for implementing quality improvement: frontline huddles, rapid-cycle structured observations, a strengths-based approach, and the importance of brevity coupled with regularity. CLC staff facilitated the intervention, with some assistance from researchers. Research data comprised validated resident and staff surveys, researcherconducted structured pre-and post-intervention observations, and semi-structured post-intervention staff interviews. 62 CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations and 66 interviews. In generalized linear models using observation and survey data, intervention implementation was associated with increased staff-resident communication during the provision of direct care activities (β = 0.083, 95% CI: 0.04-0.126, adjusted P=.0012) and decreased negative staff interactions with residents (β =-0.035, 95% CI:-0.062-0.009, adjusted P=0.0288). In interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) improve the quality of their interactions with residents. Overall, the intervention proved feasible. The combination of rapid-cycle observations, huddles, and a focus on identified strengths influenced staff to make simple enhancements to their behaviors that improved staff-resident interactions and staff-assessed resident engagement.
European Journal of Ageing, 2006
Most studies on health trends in the elderly population focus on specific conditions, studied one... more Most studies on health trends in the elderly population focus on specific conditions, studied one at a time. However, health problems are often interrelated and exist simultaneously in late life. Individuals with health problems in several domains present special challenges to care services. To estimate future needs for care it may be relevant to study trends of complex health problems as well as single health items. This study identified serious problems in three domains (diseases/ symptoms, mobility, cognition/communication) in two representative samples of the Swedish population aged 77 and older (1992: n=537; 2002: n=561). People with serious problems in two or three domains were considered to have complex health problems. Changes between 1992 and 2002 in the prevalence of persons having serious problems in no, one and two/three domains were analyzed with logistic regressions. When examining each domain separately all three showed a significant increase of serious problems. For diseases/symptoms the increase remained significant after controlling for different age and gender distributions in the two surveys. Results showed a significant increase in the prevalence of having problems in one domain, as well as having problems in two or three domains (complex problems). Results persisted when adjusting for different distributions in age, gender and education between 1992 and 2002. Results suggest a worsening of health during the 10-year period and an increase of complex problems. This emphasizes the necessity of cooperation and collaboration between different kinds of medical and social services for elderly people.
Social Science & Medicine, 2011
In Sweden and other countries, the benefits of user choice and market forces are often voiced in ... more In Sweden and other countries, the benefits of user choice and market forces are often voiced in relation to the provision of medical care and social services. Policy makers increasingly view people as customers and consumers of care services. Among very old peopledthe most frequent care usersdhow many have the capacity necessary to find information and make decisions concerning providers of medical and social services? Using a nationally representative sample of Swedes aged 77þ (SWEOLD) in 2002 this study describes the prevalence of cognitive, physical and sensory resources associated with the capacity to make and carry out informed choices concerning medical and social care providers. Results showed that one third of a nationally representative sample of persons aged 77þ scored low on a cognitive test or they were so cognitively impaired that they could not be interviewed directly. Another 22% scored poorly on a test of the ability to find and process information. A further 32% had adequate cognition but had limitations in sensory function or mental vitality or were unable to go outside on their own. A total of 10% did not report any of the measured problems. In general, care utilisation increases with age. As health problems increase, physical and cognitive abilities decline. Results suggest that those elderly people who are most dependent on care services and who could benefit most from a "good choice", are also those who have the highest prevalence of cognitive and physical limitations associated with the capacity to act as a rational consumer of care services.
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2004
Objectives. Racial differences in self-rated health at older ages are well documented. African Am... more Objectives. Racial differences in self-rated health at older ages are well documented. African Americans consistently report poorer health, even when education, income, and other health status indicators are controlled. The extent to which neighborhood-level characteristics mediate this association remains largely unexplored. We ask whether neighborhood social and economic resources help to explain the self-reported health differential between African Americans and Whites.
Associations between work-related stress in late midlife, educational attainment, and serious hea... more Associations between work-related stress in late midlife, educational attainment, and serious health problems in old age: a longitudinal study before and after retirement.
Are work conditions more than 20 year earlier associated to complex and severe health problems af... more Are work conditions more than 20 year earlier associated to complex and severe health problems after retirement age?
Background Due to population aging, it is essential to examine to what extent rises in life expec... more Background Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. Methods CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n ≈ 2000), was used to es...
This thesis investigates health trends among very old people and the allocation of public home-he... more This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sou ...
Increased survival among people with multiple health problems - A challenge for care provision