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  • 1.
    Edlund, Agneta
    et al.
    Piteå River Valley Hospital, Department of Rehabilitation.
    Lundström, Maria
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Brännström, Benny
    Bucht, Gösta
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Delirium before and after operation for femoral neck fracture2001In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 49, no 10, p. 1335-40Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to investigate the differences between preoperative and postoperative delirium regarding predisposing, precipitating factors and outcome in older patients admitted to hospital with femoral neck fractures. DESIGN: A prospective clinical assessment of patients treated for femoral neck fractures. SETTING: Department of orthopedic surgery at Umea University Hospital, Sweden. PARTICIPANTS: One hundred one patients, age 65 and older admitted to the hospital for treatment of femoral neck fractures. MEASUREMENTS: The Organic Brain Syndrome (OBS) Scale. RESULTS: Thirty patients (29.7%) were delirious before surgery and another 19 (18.8%) developed delirium postoperatively. Of those who were delirious preoperatively, all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, had been treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium, and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and had more postoperative complications such as infections. Male patients were more often delirious both preoperatively and postoperatively. Patients with preoperative delirium were more often discharged to institutional care and had poorer walking ability both on discharge and after 6 months than did patients with postoperative delirium only. CONCLUSIONS: Because preoperative and postoperative delirium are associated with different risk factors it is necessary to devise different strategies for their prevention

  • 2.
    Gustafson, Yngve
    et al.
    Umeå University, Department of Geriatric Medicine.
    Berggren, Diana
    Umeå University, Department of Anesthesia and Intensive Care.
    Brännström, Benny
    Bucht, Gösta
    Umeå University, Department of Geriatric Medicine.
    Norberg, Astrid
    University of Umeå, Department of Advanced Nursing.
    Hansson, L-I
    Umeå University Hospital, Department of Orthopaedics.
    Winblad, Bengt
    Umeå University, Department of Geriatric Medicine.
    Acute confusional states in elderly patients treated for femoral neck fracture1988In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 36, no 6, p. 525-30Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to estimate the incidence of acute confusional state (ACS), its predisposing factors and consequences in 111 consecutive patients operated for fractured neck of the femur. The incidence of ACS was 61 percent and the predicting factors were old age and dementia. Drugs with anticholinergic effect, depression, and previous stroke were factors that seemed to be associated with the development of ACS. Ninety-two percent of the patients who had severe perioperative blood pressure drops developed ACS. The consequences of ACS were prolonged ward-stay at the orthopedic department, a greater need for long-term care after discharge, and poor walking ability at discharge and six months after surgery. The confused patients also had more complications, such as urinary problems, feeding problems and decubital ulcers, as compared with the nonconfused patients.

  • 3.
    Gustafson, Yngve
    et al.
    Umeå University, Department of Geriatric Medicine.
    Brännström, Benny
    Berggren, Diana
    Umeå University, Department of Anesthesia and Intensive Care.
    Ragnarsson, Jon Ingvar
    Umeå University Hospital, Department of Orthopaedics.
    Siggard, Jarl
    Umeå University, Department of Anesthesia and Intensive Care.
    Bucht, Gösta
    Umeå University, Department of Geriatric Medicine.
    Reiz, Sebastian
    Umeå University, Department of Anesthesia and Intensive Care.
    Norberg, Astrid
    University of Umeå, Department of Advanced Nursing.
    Winblad, Bengt
    Karolinska institutet, Department of Geriatric Medicine.
    A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures1991In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 39, no 7, p. 655-62Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the effect of a geriatric-anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre- and post-operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri-operative blood pressure falls and treatment of post-operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P less than 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post-operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P less than 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay

  • 4.
    Gustafson, Yngve
    et al.
    Umeå University, Department of Geriatric Medicine.
    Brännström, Benny
    Norberg, Astrid
    University of Umeå, Department of Advanced Nursing.
    Bucht, Gösta
    Umeå University, Department of Geriatric Medicine.
    Winblad, Bengt
    Karolinska institutet, Department of Geriatric Medicine.
    Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients1991In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 39, no 8, p. 760-5Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: To determine the accuracy of diagnosis and documentation of acute confusional states (ACS) in the medical records of patients with hip fracture. DESIGN: The diagnosis of ACS in two prospective clinical studies was compared to its diagnosis in the medical records of the same patients on the same hospitalization. In order to determine if the simultaneous prospective study influences the diagnostic and documentary practices evidenced in the medical records, a further comparison was done by reviewing medical records of two series of patients seen some years prior to the prospective studies. SETTING: Patients with femoral neck fractures treated at a department of orthopedic surgery in a university hospital and one retrospective control sample from a department of general surgery in a county hospital. SUBJECTS: Two prospective samples of patients 65 years and older treated for femoral neck fractures (n = 111 and n = 57, respectively) and two earlier retrospective samples (n = 66 and n = 68, respectively). MEASUREMENTS AND MAIN RESULTS: All comparisons showed that both physicians and nurses diagnosed ACS unsatisfactorily and documented the patients' mental status poorly. The analysis of the two retrospective medical record control samples gave the same results. Neither the physicians nor the nurses used any kind of diagnostic instrument to detect cognitive disorders in the patients. CONCLUSIONS: ACS is a common and severe complication in elderly people treated for femoral neck fractures. Acute confusional states have, by definition, one or more causes that can often be identified and treated. Poor assessment and documentation is a threat to the patients as a correct diagnosis of ACS is a prerequisite for further assessment of its underlying causes and the consequent necessary medical and nursing care.

  • 5.
    Hansson, Patrik
    et al.
    Umeå universitet, Institutionen för psykologi.
    Eriksson Sörman, Daniel
    Umeå universitet, Institutionen för psykologi.
    Bergdahl, Jan
    Umeå universitet, Institutionen för psykologi.
    Bergdahl, Maud
    Nyberg, Lars
    Umeå universitet, Diagnostisk radiologi.
    Adolfsson, Rolf
    Umeå universitet, Psykiatri.
    Nilsson, Lars-Goran
    Dental status is unrelated to risk of dementia: a 20-year prospective study2014In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 62, no 5, p. 979-981Article in journal (Refereed)
  • 6.
    Jensen, Jane
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Fall and injury prevention in residential care: effects in residents with higher and lower levels of cognition2003In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 51, no 5, p. 627-35Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition. DESIGN: A preplanned subgroup comparison of the effectiveness of a cluster-randomized, nonblinded, usual-care, controlled trial.SETTING: Nine residential facilities in Umea, Sweden. PARTICIPANTS: All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini-Mental State Examination (MMSE; n = 378).An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean +/- standard deviation = 83.9 +/- 5.8 vs 82.2 +/- 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6-15) vs 17 (13-18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group. INTERVENTION: A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem-solving conferences. MEASUREMENTS: The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group. RESULTS: A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls P =.016 and P =.121 and adjusted hazard ratio P <.001 and P =.420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group (P =.006). CONCLUSION: The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group

  • 7. Lexell, Jan
    et al.
    Robertsson, E
    Umeå universitet.
    Stenström, E
    Umeå universitet.
    Effects of strength training in elderly women1992In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 40, no 2, p. 190-191Article in journal (Refereed)
  • 8.
    Littbrand, Håkan
    et al.
    Divisions of Geriatric Medicine and Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University.
    Lundin-Olsson, Lillemor
    Divisions of Geriatric Medicine and Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University.
    Gustafson, Yngve
    Divisions of Geriatric Medicine and Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    The effect of a high-intensity functional exercise program on activities of daily living: a randomized controlled trial in residential care facilities2009In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 57, no 10, p. 1741-1749Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia. DESIGN: Randomized, controlled trial. SETTING: Nine residential care facilities. PARTICIPANTS: One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia. INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months. MEASUREMENTS: The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses. RESULTS: There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months. CONCLUSION: A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect.

  • 9.
    Lundin-Olsson, Lillemor
    et al.
    Umeå University, Department of Geriatric Medicine.
    Nyberg, Lars
    Gustafson, Yngve
    Umeå University, Department of Geriatric Medicine.
    Attention, frailty, and falls: the effect of a manual task on basic mobility1998In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 46, no 6, p. 758-61Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the effect of a second task on balance and gait maneuvers used in everyday life. Our hypothesis was that those who were more distracted by a familiar manual task performed concurrently with functional maneuvers were more frail and more prone to falls. DESIGN: A cross-sectional design with prospective follow-up for falls. SETTING: Sheltered accommodation in Umea, Sweden. PARTICIPANTS: Forty-two residents (30 women, 12 men; mean age +/- SD = 79.7 +/- 6.1 years), ambulant with or without a walking aid, able to follow simple instructions and able to carry a tumbler. MEASUREMENTS: Timed Up & Go (TUG), i.e., the time taken to rise from an armchair, walk 3 meters, turn round, and sit down again. TUG was repeated with an added manual task (TUGmanual), which was to carry a glass of water while walking. The Montgomery-Asberg Depression Rating Scale, Barthel Index, Functional Reach, Mini-Mental State Examination, and Line Bisection test were used to assess for frailty. The subjects were followed-up prospectively regarding falls indoors for a period of 6-months. RESULTS: Subjects with a time difference (diffTUG) between TUGmanual and TUG of > or = 4.5 seconds were considered to be distracted by the second task. Ten subjects had a difference in time of > or = 4.5 seconds. These subjects were more frail, and seven of them fell indoors during the follow-up period (odds ratio 4.7, 95%Confidence Interval (CI) 1.5-14.2). CONCLUSION: The time difference between the TUGmanual and the TUG appears to be a valid marker of frailty and a useful tool for identifying older persons prone to falling.

  • 10.
    Lundström, Maria
    et al.
    Umeå University, Department of Community Medicine and Rehabilitation.
    Edlund, Agneta
    Piteå River Valley Hospital, Department of Medicine and Rehabilitation.
    Karlsson, Stig
    Umeå University, Department of Community Medicine and Rehabilitation.
    Brännström, Benny
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Bucht, Gösta
    Umeå University, Department of Community Medicine and Rehabilitation.
    Gustafson, Yngve
    Umeå University, Department of Community Medicine and Rehabilitation.
    A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients2005In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 53, no 4, p. 622-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate whether an education program and a reorganization of nursing and medical care improved the outcome for older delirious patients. DESIGN: Prospective intervention study. SETTING: Department of General Internal Medicine, Sundsvall Hospital, Sweden. PARTICIPANTS: Four hundred patients, aged 70 and older, consecutively admitted to an intervention or a control ward. INTERVENTION: The intervention consisted of staff education focusing on the assessment, prevention, and treatment of delirium and on caregiver-patient interaction. Reorganization from a task-allocation care system to a patient-allocation system with individualized care. MEASUREMENTS: The patients were assessed using the Organic Brain Syndrome Scale and the Mini-Mental State Examination on Days 1, 3, and 7 after admission. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: Delirium was equally common on the day of admission at the two wards, but fewer patients remained delirious on Day 7 on the intervention ward (n=19/63, 30.2% vs 37/62, 59.7%, P=.001). The mean length of hospital stay+/-standard deviation was significantly lower on the intervention ward then on the control ward (9.4+/-8.2 vs 13.4+/-12.3 days, P<.001) especially for the delirious patients (10.8+/-8.3 vs 20.5+/-17.2 days, P<.001). Two deliriouspatients in the intervention ward and nine in the control ward died during hospitalization (P=.03). CONCLUSION: This study shows that a multifactorial intervention program reduces the duration of delirium, length of hospital stay, and mortality in delirious patients.

  • 11.
    Nyberg, Lars
    et al.
    Umeå University, Department of Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Department of Geriatric Medicine.
    Berggren, Diana
    Umeå University, Department of Anesthesia and Intensive Care.
    Brännström, Benny
    Luleå University of Technology, Department of Health Sciences.
    Bucht, Gösta
    Umeå University, Department of Community Medicine and Rehabilitation.
    Falls leading to femoral neck fractures in lucid older people1996In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 44, no 2, p. 156-60Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyze the mechanisms of falls that result in femoral neck fractures among lucid older people. DESIGN: A cross-sectional study. SETTING: An orthopedic university hospital department. PARTICIPANTS: A consecutive series of 123 lucid patients, 65 years of age or more, who were admitted for femoral neck fractures. MEASUREMENTS: On admission, the subjects were interviewed about fracture accident characteristics, and falling mechanisms were classified. An arterial blood gas sample was taken from each patient soon after admission. Based on data regarding drug consumption and social and medical characteristics, a fall-risk index was calculated for each subject. RESULTS: It was ascertained that 95% of the fractures were caused by falls and < 2% were spontaneous. Most accidents (68%) took place indoors, 47% of the falls were classified as extrinsic, 24% as intrinsic, 7% as nonbipedal, and 22% remained unclassified. Almost all outdoor falls were extrinsic; however, intrinsic falls were as common as extrinsic falls indoors (P < .001). Extrinsic fallers presented a significantly lower fall-risk index score than subjects with fractures caused by intrinsic, nonbipedal, and unclassifiable falls. A large proportion of subjects (24%) wre hypoxemic (pO2 < 8 kPa) on admission, and patients who sustained fractures at night had lower oxygen tension than that of daytime fallers (P = .006). CONCLUSIONS: Accidental falls are the primary cause of femoral neck fractures. Preventive actions should be directed toward intrinsic, as well as extrinsic, risk factors for falls. Hypoxemia might be a risk factor for falls, especially those falls that occur at night

  • 12.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Effect size underestimates the effects of interventions among older people with severe physical or cognitive impairments?2007In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 55, no 8, p. 1315-1316Article in journal (Other academic)
    Abstract [en]

    The use of effect sizes for comparison of the effects of various studies could potentially underestimate the effect among older people with severe physical or cognitive impairment. In a Cochrane Review about strength training in older adults, Standardized Mean Difference (SMD) was used to estimate the effect on lower-limb strength, calculated as the difference in means (between the intervention and the control group) of the outcome divided by the standard deviation of the outcome. Using a calculation where the effect is divided by the variation in ability between participants may underestimate the effect in studies which have broad inclusion criteria (often the case in studies on older people with severe impairments) since the same change over time in the absolute value of an outcome will produce a higher effect size in a more homogeneous group, as is to be expected if the participants are more healthy. However, this seems not to have been considered in the Cochrane Review for all included studies. Hopefully, in future, a consensus will be reached concerning how to calculate effect sizes in randomized trials. For the present, it is recommended that effect sizes are presented but the definitions in the CONSORT statement, e.g., for continuous outcome "difference in means," need to be clarified to ensure that the calculation is made in the same way in all studies.

  • 13.
    Sandberg, Olov
    et al.
    Umeå University, Department of Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Department of Geriatric Medicine.
    Brännström, Benny
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Bucht, Gösta
    Umeå University, Department of Geriatric Medicine.
    Clinical profile of delirium in older patients1999In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 47, no 11, p. 1300-6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the prevalence, psychiatric and behavior symptoms, differing symptom profiles, and diurnal variations of delirium in older patients. DESIGN: A descriptive, point prevalence study with a cross-sectional design. SETTING: One ordinary county hospital (n = 148), three nursing homes (n = 202), five old people's homes (n = 196), and home medical care patients (n = 171) in parts of a hospital catchment area in Mid-Sweden. PARTICIPANTS: A total of 717 patients 75 years of age and older were observed and assessed for the prevalence of delirium. Women accounted for 66.4% of the studied population, and the mean age for both sexes was 83.7 years. MEASUREMENTS: All patients were examined using the OBS (Organic Brain Syndrome) scale, and delirium was diagnosed according to DSM-III-R. RESULTS: Delirium was diagnosed in 315 of 717 (43.9%) patients, and 135 of 315 (42.9%) of the delirious patients had dementia. Thirty-seven percent of the patients with delirium were delirious in the afternoon, evening, or at night, and 47% of the delirious patients had morning delirium. The delirious patients presented a wide variety of psychiatric symptoms. More than half the patients exhibiting anxiety, psychomotor slowing, depressed mood, and irritability. Nearly 26% were classified as having hypoactive, 22% as having hyperactive, and 42% as having mixed delirium, whereas 11% had neither hypo- nor hyperactive delirium. Seventy-seven percent were classified as having delirium with pronounced emotional and 43% with pronounced psychotic symptoms. CONCLUSIONS: This study shows that patients with delirium have very different clinical profiles. This might indicate a need for different treatment strategies for patients with different types of delirium.

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