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Article ; Online: Trajectories of Long-term Care after Stroke in Sweden: Nationwide Study Exploring Patterns and Determinants.

Meyer, Anna C / Ebeling, Marcus / Modig, Karin

Journal of the American Medical Directors Association

2024 Volume 25, Issue 4, Page(s) 599–605.e5

Abstract: Objectives: Stroke is a leading cause of mortality and disability worldwide. Although studies have primarily focused on health and functioning among stroke survivors, there is limited research on longitudinal patterns of long-term care use among older ... ...

Abstract	Objectives: Stroke is a leading cause of mortality and disability worldwide. Although studies have primarily focused on health and functioning among stroke survivors, there is limited research on longitudinal patterns of long-term care use among older adults with stroke. This study explores long-term care trajectories among older men and women with stroke in the Swedish population. Design: Nationwide prospective cohort study. Setting and participants: All individuals aged ≥70 years hospitalized with a first stroke in 2015-2017 followed in the Swedish population registers for 3 years. Methods: Care trajectories among patients with strokes were visualized and compared to trajectories in 2 control groups: (1) same-aged peers randomly drawn from the general population and (2) older adults with health and sociodemographic characteristics similar to patients with strokes but without stroke identified through propensity score matching. Multivariable Cox regression and multistate models were used to identify determinants of mortality and care trajectories among patients with strokes. Results: We identified 31,560 individuals with stroke (mean age 82.9 years). Already before the stroke, these individuals had a higher comorbidity burden and received more long-term care than their same-aged peers. Compared with both control groups, patients with strokes were also more likely to enter long-term care. However, 38% of patients with strokes survived for 3 years without taking up long-term care. Sex, income, cohabitation, and comorbidities were associated with care trajectories. Care status was a more robust predictor of mortality after stroke than the established Charlson comorbidity index. Conclusions and implications: Experiencing a stroke increases both mortality and long-term care utilization, and once formal long-term care is provided, exceedingly few patients with strokes return to living without care. However, a considerable part of care utilization and mortality after stroke is concentrated among those with preexisting care needs. Prestroke care utilization should thus be considered in future studies exploring stroke prognosis.
MeSH term(s)	Male ; Humans ; Female ; Aged ; Aged, 80 and over ; Sweden/epidemiology ; Long-Term Care ; Prospective Studies ; Stroke/epidemiology ; Stroke/therapy ; Prognosis
Language	English
Publishing date	2024-01-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2023.11.024
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Article ; Online: Variation in End-of-Life Trajectories in Persons Aged 70 Years and Older, Sweden, 2018‒2020.

Ebeling, Marcus / Meyer, Anna C / Modig, Karin

American journal of public health

2023 Volume 113, Issue 7, Page(s) 786–794

Abstract: Objectives. ...

Abstract	Objectives.
MeSH term(s)	Humans ; Aged ; Aged, 80 and over ; Sweden ; Aging ; Death
Language	English
Publishing date	2023-04-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	121100-6
ISSN	1541-0048 ; 0090-0036 ; 0002-9572
ISSN (online)	1541-0048
ISSN	0090-0036 ; 0002-9572
DOI	10.2105/AJPH.2023.307281
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Un I Zs.279: Show issues

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Article ; Online: Låg förskrivning av läkemedel för osteoporos inom Sverige.

Modig, Karin / Meyer, Anna / Ek, Stin / Sääf, Maria / Hedström, Margareta

Lakartidningen

2024 Volume 121

Abstract: In Sweden, secondary prevention of fragility fractures through osteoporosis medication is directed by national guidelines. According to these, postmenopausal women and men who have suffered a fragility fracture should be assessed and pharmaceutical ... ...

Title translation	Prescription of osteoporosis drugs and secondary fracture prevention still at low levels and with large regional variation.
Abstract	In Sweden, secondary prevention of fragility fractures through osteoporosis medication is directed by national guidelines. According to these, postmenopausal women and men who have suffered a fragility fracture should be assessed and pharmaceutical treatment of osteoporosis should always be considered. For the most serious fractures (hip and vertebral fractures), treatment can be initiated immediately. Despite this, previous studies have shown that the level of pharmaceutical treatment is low. In Sweden, osteoporosis drugs are predominantly administered by prescription, but about one-third of drugs are nowadays administered on-site in the health care system, which is not recorded in national registers. We have estimated the total amount of osteoporosis drugs through aggregated sales statistics. Our results show that medical treatment with osteoporosis drugs is still at low levels, covering approximately 5 percent of the population aged 70 or older, with clear differences between regions.
MeSH term(s)	Male ; Female ; Humans ; Secondary Prevention/methods ; Osteoporosis/complications ; Osteoporosis/drug therapy ; Fractures, Bone/complications ; Prescriptions ; Pharmaceutical Preparations ; Osteoporotic Fractures/prevention & control ; Osteoporotic Fractures/complications ; Osteoporotic Fractures/drug therapy ; Bone Density Conservation Agents/therapeutic use ; Hip Fractures/complications ; Hip Fractures/epidemiology ; Hip Fractures/prevention & control
Chemical Substances	Pharmaceutical Preparations ; Bone Density Conservation Agents
Language	Swedish
Publishing date	2024-01-30
Publishing country	Sweden
Document type	English Abstract ; Journal Article
ZDB-ID	391010-6
ISSN	1652-7518 ; 0023-7205
ISSN (online)	1652-7518
ISSN	0023-7205
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Ua VI Zs.411: Show issues

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Article ; Online: Continued decline in the incidence of myocardial infarction beyond the COVID-19 pandemic: a nationwide study of the Swedish population aged 60 and older during 2015-2022.

Meyer, Anna C / Ebeling, Marcus / Acosta, Enrique / Modig, Karin

European journal of epidemiology

2024

Abstract: The number of myocardial infarctions declined during the early COVID-19 pandemic but mechanisms behind these declines are poorly understood. COVID-19 infection is also associated with an increased risk of myocardial infarction which could lead to higher ... ...

Abstract	The number of myocardial infarctions declined during the early COVID-19 pandemic but mechanisms behind these declines are poorly understood. COVID-19 infection is also associated with an increased risk of myocardial infarction which could lead to higher incidence rates in the population. This study aims to shed light on the seemingly paradoxical relationship between COVID-19 and myocardial infarction occurrence on the population level by exploring long-term trends in incidence rates, case fatality, and proportion of patients dying before reaching a hospital. Our work is based on a linkage of administrative registers covering the entire population aged 60 + in Sweden. Considering both long-term trends since 2015 and seasonal variability, we compared observed incidence, case fatality, and proportions of patients hospitalized to expected values during 2020-2022. Despite more than 200 laboratory-confirmed COVID-19 cases per 1000 inhabitants by the end of 2022, incidence rates of myocardial infarction continued to decline, thus following the long-term trend observed already before 2020. During the first pandemic wave there was an additional incidence decline corresponding to 13% fewer myocardial infarctions than expected. This decline was neither accompanied by increasing case fatality nor by lower shares of patients being hospitalized. We found no increase in the population-level incidence of myocardial infarction despite large-scale exposure to COVID-19, which suggests that the effect of COVID-19 on myocardial infarction risk is not substantial. Increased pressure on the Swedish health care system has not led to increased risks or poorer outcomes for patients presenting with acute myocardial infarction.
Language	English
Publishing date	2024-04-23
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	632614-6
ISSN	1573-7284 ; 0393-2990
ISSN (online)	1573-7284
ISSN	0393-2990
DOI	10.1007/s10654-024-01118-4
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Zs.A 2090: Show issues

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Article ; Online: Population frailty trends by education and income levels over a period of 30 years: findings from Swedish registry data.

Wennberg, Alexandra / Tao, Yining / Ek, Stina / Modig, Karin

Journal of epidemiology and community health

2023

Abstract: Background: Frailty is an age-related health condition affecting an estimated 18% of older adults in Europe and past evidence has shown a relationship between socioeconomic factors and frailty. We examined population frailty trends and the association ... ...

Abstract	Background: Frailty is an age-related health condition affecting an estimated 18% of older adults in Europe and past evidence has shown a relationship between socioeconomic factors and frailty. We examined population frailty trends and the association between frailty and 5-year mortality by education tertiles and income quartiles at ages 75, 85 and 95 in Swedish registry data. Methods: All Swedish residents born in 1895-1945 and in the Total Population Register from 1990 to 2020 were included. Frailty was assessed with the Hospital Frailty Risk Score (HFRS), which sums 109 weighted International Classification of Diseases (ICD codes), collected from the National Patient Register. Results: Regardless of education and income, frailty increased over time, though the association between frailty and 5-year mortality remained stable. Particularly in earlier birth cohorts, although the highest education and income levels had the highest mean HFRS scores, the lowest education and income levels accounted for greater proportions among the frail. These trends varied slightly by sex and age. Men and women had similar levels of frailty, but frailty was more strongly associated with mortality among men. Conclusion: Over time, education and income levels were more equally represented among the frail population in more recent years. More equitable distribution over time may suggest improvement in health disparities, though more work is needed. The overall increase in frailty and unchanged association with mortality indicates that additional research is needed to better understand how to best support the growing ageing population. This would then support the long-term viability of the healthcare system.
Language	English
Publishing date	2023-10-03
Publishing country	England
Document type	Journal Article
ZDB-ID	391868-3
ISSN	1470-2738 ; 0142-467X ; 0141-7681 ; 0143-005X
ISSN (online)	1470-2738
ISSN	0142-467X ; 0141-7681 ; 0143-005X
DOI	10.1136/jech-2023-221060
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Zs.A 186: Show issues

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Article: Risk of All-Cause Dementia, Alzheimer Disease, and Vascular Dementia in Breast Cancer Survivors: A Longitudinal Register-Based Study.

Wennberg, Alexandra / Ding, Mozhu / Feychting, Maria / Modig, Karin

Neurology. Clinical practice

2023 Volume 13, Issue 4, Page(s) e200173

Abstract: Background and objectives: Now more than two-thirds of cancer survivors are aged 65 years or older, but evidence about their long-term health is thin. Cancer and its treatments have been linked to accelerated aging, so there is a concern that aging ... ...

Abstract	Background and objectives: Now more than two-thirds of cancer survivors are aged 65 years or older, but evidence about their long-term health is thin. Cancer and its treatments have been linked to accelerated aging, so there is a concern that aging cancer survivors have an increased risk of age-related diseases, including dementia. Methods: We examined the risk of dementia among 5-year breast cancer survivors using a matched cohort study design. We included breast cancer survivors aged 50 years and older at diagnosis (n = 26,741) and cancer-free comparison participants (n = 249,540). Women eligible for inclusion in the study were those born 1935-1975 and registered in the Swedish Total Population Register between January 1, 1991, and December 31, 2015. We defined breast cancer survivors as women with an initial breast cancer diagnosis between 1991 and 2005 who survived 5 or more years after their first diagnosis. We assessed all-cause dementia, Alzheimer disease (AD), and vascular dementia (VaD) using Results: We did not observe an association between breast cancer survivorship and risk of all-cause dementia, AD, or VaD. However, in models stratified by age at cancer diagnosis, women diagnosed with cancer after age 65 years had a higher risk of all-cause dementia (subdistribution hazard ratio [SHR] = 1.30, 95% CI 1.07-1.58), AD (SHR = 1.35, 95% CI 1.05-1.75), and VaD (SHR = 1.64, 95% CI 1.11-2.43) in models adjusted for age, education, and country of origin. Discussion: Older breast cancer survivors who survive cancer have a higher risk for dementia than their peers without a cancer diagnosis, in contrast to earlier studies showing that prevalent or incident cancer is associated with a lower risk of dementia. With the older adult population growing rapidly and because cancer and dementia are 2 of the most common and debilitating diseases among older adults, it is critical that we understand the link between the 2.
Language	English
Publishing date	2023-05-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2645818-4
ISSN	2163-0933 ; 2163-0402
ISSN (online)	2163-0933
ISSN	2163-0402
DOI	10.1212/CPJ.0000000000200173
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Article ; Online: The role of having children for the incidence of and survival after hip fracture - A nationwide cohort study.

Meyer, Anna C / Modig, Karin

Bone

2021 Volume 145, Page(s) 115873

Abstract: Background: Childless older women have a higher risk of sustaining a hip fracture than mothers. Several biological mechanisms linking parity to bone health among women have been proposed but it remains unclear whether a similar association exists among ... ...

Abstract	Background: Childless older women have a higher risk of sustaining a hip fracture than mothers. Several biological mechanisms linking parity to bone health among women have been proposed but it remains unclear whether a similar association exists among men. Adult children may also support their ageing parents with hip fracture, thereby potentially increasing survival chances. Aim: To investigate how having children is related to the incidence of and survival after hip fracture among Swedish men and women over the age of 70. Methods: This nation-wide cohort study is based on data from several administrative population registers and a clinical hip fracture register. During 2013 to 2017, we estimated multivariable-adjusted incidence rate ratios to examine the association between number of children and incidence of first hip fracture and hazard ratios to examine survival after first hip fracture. Results: More than two million individuals were followed for hip fracture incidence and 45,991 patients for survival. Women had a higher risk of sustaining a hip fracture, but men had substantially higher mortality than women. Adjusting for education, comorbidity level, and further covariates, having children was associated with a lower risk of sustaining a hip fracture and a longer survival after hip fracture. Conclusions: Older childless individuals may constitute risk groups for both the incidence of and mortality after hip fracture. Mechanisms linking parity to hip fracture risk are likely complex and not limited to biological mechanisms related to pregnancy, childbirth, or breastfeeding among women.
MeSH term(s)	Adult ; Aged ; Child ; Cohort Studies ; Comorbidity ; Female ; Hip Fractures/epidemiology ; Humans ; Incidence ; Male ; Pregnancy ; Risk Factors ; Sweden/epidemiology
Language	English
Publishing date	2021-02-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632515-4
ISSN	1873-2763 ; 8756-3282
ISSN (online)	1873-2763
ISSN	8756-3282
DOI	10.1016/j.bone.2021.115873
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Zs.A 1571: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Homecare workers - an untapped resource in preventing emergency department visits among older individuals? A qualitative interview study from Sweden.

Bastholm-Rahmner, Pia / Bergqvist, Monica / Modig, Karin / Gustafsson, Lars L / Schmidt-Mende, Katharina

BMC geriatrics

2024 Volume 24, Issue 1, Page(s) 350

Abstract: Background: Older individuals with functional decline and homecare are frequent visitors to emergency departments (ED). Homecare workers (HCWs) interact regularly with their clients and may play a crucial role in their well-being. Therefore, this study ... ...

Abstract	Background: Older individuals with functional decline and homecare are frequent visitors to emergency departments (ED). Homecare workers (HCWs) interact regularly with their clients and may play a crucial role in their well-being. Therefore, this study explores if and how HCWs perceive they may contribute to the prevention of ED visits among their clients. Methods: In this qualitative study, 12 semi-structured interviews were conducted with HCWs from Sweden between July and November 2022. Inductive thematic analysis was used to identify barriers and facilitators to prevent ED visits in older home-dwelling individuals. Results: HCWs want to actively contribute to the prevention of ED visits among clients but observe many barriers that hinder them from doing so. Barriers refer to care organisation such as availability to primary care staff and information transfer; perceived attitudes towards HCWs as co-workers; and client-related factors. Participants suggest that improved communication and collaboration with primary care and discharge information from the ED to homecare services could overcome barriers. Furthermore, they ask for support and geriatric education from primary care nurses which may result in increased respect towards them as competent staff members. Conclusions: HCWs feel that they have an important role in the health management of older individuals living at home. Still, they feel as an untapped resource in the prevention of ED visits. They deem that improved coordination and communication between primary care, ED, and homecare organisations as well as proactive care would enable them to add significantly to the prevention of ED visits.
MeSH term(s)	Humans ; Aged ; Sweden/epidemiology ; Emergency Room Visits ; Emergency Service, Hospital ; Qualitative Research ; Palliative Care
Language	English
Publishing date	2024-04-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-024-04906-5
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Article ; Online: Profiling chronic diseases and hospitalizations in older home care recipients: a nationwide cohort study in Sweden.

Schmidt-Mende, Katharina / Arvinge, Cecilia / Cioffi, Giovanni / Gustafsson, Lars Lennart / Modig, Karin / Meyer, Anna Carina

BMC geriatrics

2024 Volume 24, Issue 1, Page(s) 312

Abstract: Background: Older adults with home care (HC) often have complex disease patterns and use healthcare extensively. Increased understanding is necessary to tailor their care. To our knowledge, this is the first study to describe patterns of morbidity and ... ...

Abstract	Background: Older adults with home care (HC) often have complex disease patterns and use healthcare extensively. Increased understanding is necessary to tailor their care. To our knowledge, this is the first study to describe patterns of morbidity and hospitalizations among community-dwelling older HC recipients nationwide and in subgroups defined by age, sex, and amount of HC, and to compare patterns to community-dwelling older adults without HC. Methods: Nationwide register-based cohort study in community-dwelling adults aged 70 and older receiving publicly funded HC in Sweden on January 1st 2019 and an age-and-sex matched comparison group ("non-HC recipients"). Using register data from inpatient and specialized outpatient care, we assessed the prevalence of sixty chronic diseases, frailty, multimorbidity and hospitalizations, calculated incidence rates and explored reasons for hospitalizations during two years of follow-up. Results: We identified 138,113 HC recipients (mean age 85, 66% women, 57% ≥5 chronic diseases). The most prevalent diseases were hypertension (55%) and eye conditions (48%). Compared to non-HC recipients, HC recipients had a higher prevalence of almost all diseases, with an overrepresentation of neurological (26.1 vs. 9.5%) disease and dementia (9.3 vs. 1.5%). 61% of HC recipients were hospitalized at least once during two years, which was 1.6 times as often as non-HC recipients. One third of HC recipients´ hospitalizations (37.4%) were due to injuries, infections, and heart failure. Hospitalizations for chronic obstructive pulmonary disease, confusion, infections, and breathing difficulties were 3-5 times higher among HC recipients compared to non-HC recipients. Conclusion: Compared to non-HC recipients, HC recipients more often live alone, have higher degrees of frailty, suffer from more chronic diseases, especially neurological disease, and are hospitalized almost twice as often. The results provide a thorough description of HC recipients, which might be useful for targeted healthcare interventions including closer collaboration between primary care, neurologists, and rehabilitation.
MeSH term(s)	Humans ; Female ; Aged ; Aged, 80 and over ; Male ; Cohort Studies ; Frailty/epidemiology ; Sweden/epidemiology ; Home Care Services ; Hospitalization ; Chronic Disease
Language	English
Publishing date	2024-04-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-024-04796-7
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Article ; Online: Characterizing the Individuals Who Regain or Maintain Walking Ability after a Hip Fracture: Insights Into Physical Resilience.

Ek, Stina / Wennberg, Alexandra M / Ding, Mozhu / Meyer, Anna C / Hedström, Margareta / Modig, Karin

Journal of the American Medical Directors Association

2024 Volume 25, Issue 5, Page(s) 744–750.e3

Abstract: Objectives: Maintaining walking ability is key to healthy aging. Hip fractures often lead to declined walking ability. This study investigated characteristics of individuals who regained walking ability after a hip fracture, an expression of physical ... ...

Abstract	Objectives: Maintaining walking ability is key to healthy aging. Hip fractures often lead to declined walking ability. This study investigated characteristics of individuals who regained walking ability after a hip fracture, an expression of physical resilience. Design: Register-based cohort study. Setting and participants: A total of 55,467 Swedish residents aged ≥60 years with a first hip fracture (71% women, mean age = 82.3 ± 8) included in the Swedish Hip Fracture Register. Methods: Information about diseases, medications, and socioeconomic (SES) factors came from registers. Individuals were classified by prefracture walking ability (independent or assisted walking) and whether their walking ability 4 months post-fracture was maintained (physical resilience or nonresilience). Cluster analyses were conducted among individuals who maintained their walking ability to assess different physical resilience profiles. Results: At baseline, 38,493 individuals walked independently (69%), and 16,982 were assisted walkers. Half of the independent walkers maintained their walking ability 4 months post-fracture. Among them, 3 clusters were identified: a "Low SES, Low Disease" cluster (n = 8580, mean age 81.1 ± 7.5); a "High SES, Low Disease" cluster (n = 7778, mean age 76.7 ± 7.4); and a third "High SES, High Disease" cluster (n = 4320, mean age 77.7 ± 7.4). Sixty percent of the pre-assisted walkers maintained their level of assisted walking ability. Also among them, 3 clusters were identified: a "Low SES-Independent Living" cluster (n = 3077, mean age 85.5 ± 7.1); a second "Care Home" cluster (n = 2912, mean age 87.0 ± 6.5) with a high proportion with dementia diagnosis; and a last "High SES" cluster (n = 4044, mean age 83.0 ± 7.0) with the largest proportion of men. Conclusions and implications: Physical resilience is not characterized by one typical healthy profile, and it is possible to regain walking ability after a hip fracture despite unfavorable prerequisites in 1 domain. A favorable status in one domain may compensate for an unfavorable status in another, for example, a high disease burden in combination with high SES.
MeSH term(s)	Humans ; Female ; Hip Fractures/rehabilitation ; Male ; Aged ; Walking/physiology ; Sweden ; Aged, 80 and over ; Cohort Studies ; Registries ; Middle Aged
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2023.12.011
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