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Johnell K.,Karolinska Institutet | Johnell K.,Stockholm Gerontology Research Center | Fastbom J.,Karolinska Institutet | Fastbom J.,Stockholm Gerontology Research Center
Drugs and Aging | Year: 2012

Background: Most previous studies about drug use in the elderly population have either investigated drug use in institutions or in the community-dwelling setting. Hence, very few studies have compared drug use in institutionalized and community-dwelling elderly, maybe because of a lack of sufficiently large databases. Objective: The aim of the study was to investigate differences in drug use patterns between community-dwelling and institutionalized elderly, after adjustment for age, gender and number of other drugs (used as a proxy for overall co-morbidity). Methods: We analysed data from individuals aged ≥65 years who filled at least one drug prescription between July and September 2008 and were consequently registered in the Swedish Prescribed Drug Register (n = 1,347,564; 1,260,843 community-dwelling and 86,721 institutionalized elderly). A list of current prescriptions was constructed for every individual on the arbitrarily chosen date 30 September 2008. Outcome measures were the 20 most common drug classes and the 20 most common individual drugs. Logistic regression analysis was used to investigate whether institutionalization was associated with use of these drugs, after adjustment for age, gender and number of other drugs. Results: Institutionalized elderly were more likely than community-dwelling elderly to use antidepressants, laxatives, minor analgesics, opioids and hypnotics/sedatives, after adjustment for age, gender and number of other drugs. On the contrary, institutionalization was negatively associated with use of lipid modifying agents, angiotensin II antagonists, selective calcium channel blockers, β-blocking agents and ACE inhibitors, after adjustment for age, gender and number of other drugs. Conclusions: Our results indicate that institutionalized elderly are more likely than community-dwelling elderly to use psychotropics, analgesics and laxatives, but less likely to receive recommended cardiovascular drug therapy, which may indicate a need for implementation of evidence-based guidelines for drug treatment in this vulnerable group of elderly patients. Further research is needed to elucidate to what extent the differences in drug use between community-dwelling and institutionalized elderly are explained by different underlying disease patterns and by different prescribing traditions in the different settings. © 2012 Springer International Publishing Switzerland. Source


Rizzuto D.,Karolinska Institutet | Fratiglioni L.,Karolinska Institutet | Fratiglioni L.,Stockholm Gerontology Research Center
Gerontology | Year: 2014

As the world's population ages, elderly people are becoming an increasingly important group that merits special attention with regard to health and social issues. Lifestyles affect health and survival at all ages, but the consequences of poor lifestyle behaviors may be different for elderly people than for younger adults. They can also be heavily dependent on exposure earlier in life. Our current state of knowledge is based predominantly on studies conducted among middle-aged adults or young elderly people. Moreover, studies are sparse throughout the entire older age spectrum, from 65 to 90 years. This article summarizes the evidence regarding the impact of lifestyle behaviors on mortality among elderly people. It focuses on behaviors modifiable by individual actions and public health interventions, such as smoking, obesity and sedentary behavior, which predispose numerous people to diseases that rank among the leading causes of death, including heart disease, cancer, stroke, diabetes and dementia. These factors not only shorten life but, when they occur together, also have a major impact on survival beyond that associated with each single lifestyle factor. We propose an integrated life course model to guide research on longevity to answer questions that remain open and to find new strategies to ensure a longer and healthier life for future generations. © 2014 S. Karger AG, Basel. Source


Lovden M.,Karolinska Institutet | Lovden M.,Max Planck Institute for Human Development | Kohncke Y.,Karolinska Institutet | Laukka E.J.,Karolinska Institutet | And 7 more authors.
NeuroImage | Year: 2014

The integrity of the brain's white matter is important for neural processing and displays age-related differences, but the contribution of changes in white matter to cognitive aging is unclear. We used latent change modeling to investigate this issue in a sample of very old adults (aged 81-103. years) assessed twice with a retest interval of 2.3. years. Using diffusion-tensor imaging, we probed white matter microstructure by quantifying mean fractional anisotropy and mean diffusivity of six major white matter tracts. Measures of perceptual speed, episodic memory, letter fluency, category fluency, and semantic memory were collected. Across time, alterations of white matter microstructure in the corticospinal tract were associated with decreases of perceptual speed. This association remained significant after statistically controlling for changes in white matter microstructure in the entire brain, in the other demarcated tracts, and in the other cognitive abilities. Changes in brain volume also did not account for the association. We conclude that white matter microstructure is a potent correlate of changes in sensorimotor aspects of behavior in very old age, but that it is unclear whether its impact extends to higher-order cognition. © 2014 Elsevier Inc. Source


Qiu C.,Karolinska Institutet | Xu W.,Karolinska Institutet | Fratiglioni L.,Karolinska Institutet | Fratiglioni L.,Stockholm Gerontology Research Center
Journal of Alzheimer's Disease | Year: 2010

Alzheimer's disease (AD), the most common cause of dementia, is posing serious threat to public health and health care system in both developed and developing nations due to a rapid increase in the aging population. Identification of etiological factors for AD and active implementation of interventions targeting those modifiable factors that may prevent or postpone clinical onset of the dementing disorder will provide an opportunity to cope with this challenge. Multidisciplinary research involving epidemiology, neuropathology, and neuroimaging has provided moderately strong evidence supporting the role of vascular factors and related disorders (e.g., midlife high blood pressure and obesity, diabetes, cerebral microvascular lesions, and smoking) as risk factors and the possible role of psychosocial factors (e.g., high educational achievements, mentally-stimulating activity, social engagement, and physical exercise) as protective factors in the development and clinical manifestation of the dementia syndrome, including AD. The implementation of long-term, multidomain interventions designed for the modification of multiple vascular risk factors and the maintenance of socially-integrated lifestyles and mentally-stimulating activities is expected to postpone the clinical onset of AD and dementia, and thus, substantially reduce the burden of the disease at both the individual and societal levels. © 2010 - IOS Press and the authors. Source


Caracciolo B.,Karolinska Institutet | Caracciolo B.,University of Stockholm | Xu W.,Karolinska Institutet | Collins S.,McMaster University | And 2 more authors.
Mechanisms of Ageing and Development | Year: 2014

Cognitive decline in elderly people often derives from the interaction between aging-related changes and age-related diseases and covers a large spectrum of clinical manifestations, from intact cognition through mild cognitive impairment and dementia. Epidemiological evidence supports the hypothesis that modifiable lifestyle-related factors are associated with cognitive decline, opening new avenues for prevention. Diet in particular has become the object of intense research in relation to cognitive aging and neurodegenerative disease. We reviewed the most recent findings in this rapidly expanding field. Some nutrients, such as vitamins and fatty acids, have been studied longer than others, but strong scientific evidence of an association is lacking even for these compounds. Specific dietary patterns, like the Mediterranean diet, may be more beneficial than a high consumption of single nutrients or specific food items. A strong link between vascular risk factors and dementia has been shown, and the association of diet with several vascular and metabolic diseases is well known. Other plausible mechanisms underlying the relationship between diet and cognitive decline, such as inflammation and oxidative stress, have been established. In addition to the traditional etiological pathways, new hypotheses, such as the role of the intestinal microbiome in cognitive function, have been suggested and warrant further investigation. © 2014 The Authors. Source

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