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During the COVID-19 pandemic, Sweden implemented social distancing measures to reduce infection rates. However, the recommendation meant to protect individuals particularly at risk may have had negative consequences. The aim of this study was to investigate the impact of the COVID-19 pandemic on very old Swedish peoples' mental health and factors associated with a decline in mental health. We conducted a cross-sectional study among previous participants of the SilverMONICA (MONItoring of Trends and Determinants of CArdiovascular disease) study. Of 394 eligible participants, 257 (65.2%) agreed to participate. Of these, 250 individuals reported mental health impact from COVID-19. Structured telephone interviews were carried out during the spring of 2021. Data were analysed using the χ2 test, t-test, and binary logistic regression. Of 250 individuals (mean age: 85.5 ± 3.3 years, 54.0% women), 75 (30.0%) reported a negative impact on mental health, while 175 (70.0%) reported either a positive impact (n = 4) or no impact at all (n = 171). In the binary logistic regression model, factors associated with a decline in mental health included loneliness (odds ratio [95% confidence interval]) (3.87 [1.83-8.17]) and difficulty adhering to social distancing recommendations (5.10 [1.92-13.53]). High morale was associated with positive or no impact on mental health (0.37 [0.17-0.82]). A high percentage of very old people reported a negative impact on mental health from the COVID-19 pandemic, primarily from loneliness and difficulty adhering to social distancing measures, while high morale seemed to be a protective factor.

Background Hip fracture (HF) is a significant cause of mortality among older people. Almost half of the patients with HF have dementia, which increases the mortality risk further. Cognitive impairment is associated with depressive disorders (DDs) and both dementia and DDs are independent risk factors for poor outcome after HF. However, most studies that evaluate mortality risk after HF separate these conditions. Aims To investigate whether dementia with depressive disorders (DDwD) affects the mortality risk at 12, 24, and 36 months after HF among older people. Methods Patients with acute HF ( n  = 404) were included in this retrospective analysis of two randomized controlled trials performed in orthopedic and geriatric departments. Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive function was assessed using the Mini-Mental State Examination. A consultant geriatrician made final depressive disorder and dementia diagnoses using the Diagnostic and Statistical Manual of Mental Disorders criteria, with support from assessments and medical records. The 12-, 24- and 36-month mortality after HF was analyzed using logistic regression models adjusted for covariates. Results In analyses adjusted for age, sex, comorbidity, pre-fracture walking ability, and fracture type, patients with DDwD had increased mortality risks at 12 [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.75–12.51], 24 (OR 3.61, 95% CI 1.71–7.60), and 36 (OR 4.53, 95% CI 2.24–9.14) months. Similar results were obtained for patients with dementia, but not depressive disorders, alone. Conclusion DDwD is an important risk factor for increased mortality at 12, 24, and 36 months after HF among older people. Routinely assessments after HF for cognitive- and depressive disorders could identify patients at risk for increased mortality, and enable early interventions. Trial registration RCT2: International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN15738119.

Background The Geriatric Depression Scale (GDS) has shown good validity and reliability, but few studies have examined the GDS among very old adults or the Swedish translation. Objectives Evaluate the validity and reliability of the Swedish version of GDS-15 among very old adults. Methods In the Umeå85 + /GErontological Regional DAtabase (GERDA) study, 387 participants were assessed with both the GDS-15 and the Montgomery-Åsberg Depression Rating Scale (MADRS). The mean age was 91 years. Concurrent validity between the scales was calculated using Spearman's correlation. We used the Diagnostic and Statistical Manual of Mental Disorders (DSM) V symptom criteria for depression based on MADRS item scores to define depression. We calculated the Area Under the Curve (AUC) and found an optimal cut-off. A convenience sample with 60 individuals was used to calculate test–retest reliability with Cohen’s kappa and Intraclass Correlation Coefficient (ICC). Results Spearman's correlation coefficients between total scores for GDS-15 and MADRS were 0.60. Cronbach's alpha for the whole scale was 0.73. The AUC was 0.90 for distinguishing major depression, and the recommended cut-off of ≥ 5 showed a sensitivity of 95.2% and specificity of 65.8%. The test–retest showed that Cohen’s kappa was substantial (0.71) and the ICC was excellent (0.95). Conclusions The Swedish version of the GDS-15 showed good validity and reliability among very old adults. The generally recommended cut-off of ≥ 5 seems reasonable to use with the Swedish version and among very old adults.

Purpose The aim of this study was to describe a population of very old people with heart failure (HF), to analyse the use of cardiovascular drugs over time, and to explore factors influencing cardiovascular drug treatment for this group. Methods All participants with information regarding HF diagnosis were selected from the Umeå 85+/Gerontological Regional Database (GERDA). The people in GERDA are all ≥85 years old. Trained investigators performed structured interviews and assessments. Information regarding medications and diagnoses was obtained from the participants and from medical records. Medical diagnoses were reviewed and confirmed by an experienced geriatrician. Results In this very old population, the prevalence of HF was 29.6% among women and 30.7% among men. Between 2000 and 2017, there was an increase in the use of renin-angiotensin (RAS) inhibitors (odds ratio [OR] 1.107, 95% confidence interval [CI] 1.072–1.144) and beta-blockers (BBs) (OR 1.123, 95% CI 1.086–1.161) among persons with HF, whereas the prevalence of loop diuretics (OR 0.899, 95% CI 0.868–0.931) and digitalis (OR 0.864, 95% CI 0.828–0.901) decreased ( p  < 0.001 for all drug classes). Higher age was associated with lower use of RAS inhibitors and BBs. Conclusion In this HF population, the use of evidence-based medications for HF increased over time. This may be a sign of better awareness among prescribers regarding the under-prescribing of guidelines-recommended treatment to old people. Higher age associated with a lower prevalence of RAS inhibitors and BBs. This might indicate that further improvement is possible but could also represent a more cautious prescribing among frail very old individuals.

Background To investigate the associations between the body mass index (BMI), Mini Nutritional Assessment–Short Form (MNA-SF) scores, and 2-year mortality. Methods A nationwide cohort study using data from a national quality register of older (age ≥ 65 years) nursing home residents ( N  = 47,686). Individuals were categorized according to BMI as underweight (< 18.5 kg/m 2 ), normal-weight (18.5–24.9 kg/m 2 ), overweight (25.0–29.9 kg/m 2 ), and obese (class I, 30.0–34.9 kg/m 2 ; class II, 35.0–39.9 kg/m 2 ; class III, ≥ 40.0 kg/m 2 ). Participants’ nutritional status were categorized as good (MNA-SF score 12–14), at risk of malnutrition (MNA-SF score 8–11), or malnutrition (MNA-SF score 0–7). Associations with mortality were analysed using Cox proportional-hazards models. Results At baseline, 16.0% had obesity, and 14.6% were malnourished. During 2 years of follow-up, 23,335 (48.9%) individuals died. Compared with normal-weight individuals, mortality was greater among underweight individuals [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.55–1.69] and lesser among individuals with class I (HR 0.63, 95% CI 0.60–0.66), class II (HR 0.62, 95% CI 0.56–0.68), and class III (HR 0.80, 95% CI 0.69–0.94) obesity. Compared with individuals with good nutritional status, mortality was increased for those with malnutrition (HR 2.98,95% CI 2.87–3.10). Lower mortality among obese individuals was also seen in subgroups defined according to MNA-SF scores. Conclusions Among older nursing home residents, obesity, including severe obesity, was associated with lower 2-year mortality. Higher BMIs were associated with better survival, regardless of nutritional status according to MNA-SF.

Variation in food quality and abundance requires animals to decide whether to stay on a poor food patch or leave in search of better food. An important question in behavioral ecology asks when is it optimal for an animal to leave a food patch it is depleting. Although optimal foraging is central to evolutionary success, the neural and molecular mechanisms underlying it are poorly understood. Here we investigate the neuronal basis for adaptive food-leaving behavior in response to resource depletion in Caenorhabditis elegans, and identify several of the signaling pathways involved. The ASE neurons, previously implicated in salt chemoattraction, promote food-leaving behavior via a cGMP pathway as food becomes limited. High ambient O2 promotes food-leaving via the O2-sensing neurons AQR, PQR, and URX. Ectopic activation of these neurons using channelrhodopsin is sufficient to induce high food-leaving behavior. In contrast, the neuropeptide receptor NPR-1, which regulates social behavior on food, acts in the ASE neurons, the nociceptive ASH neurons, and in the RMG interneuron to repress food-leaving. Finally, we show that neuroendocrine signaling by TGF-β/DAF-7 and neuronal insulin signaling are necessary for adaptive food-leaving behavior. We suggest that animals integrate information about their nutritional state with ambient oxygen and gustatory stimuli to formulate optimal foraging strategies.

Background In order to improve quality of care and recovery after hip fracture we need to include the perspectives of the individual older adults when evaluating different rehabilitation interventions. The aim of this study was therefore to explore older adults’ experiences of their rehabilitation after a hip fracture and of the recovery process during the 12 months following the fracture. Methods Qualitative interviews were conducted with 20 older adults (70–91 years of age) who had participated in a randomised controlled trial evaluating the effects of early discharge followed by geriatric interdisciplinary home rehabilitation compared to in-hospital care according to a multifactorial rehabilitation program. Ten participants from each group were interviewed shortly after the one-year follow-up when the study was completed. Data were analysed with qualitative content analysis. Results The analysis resulted in four themes: Moving towards recovery with the help of others; Getting to know a new me; Striving for independence despite obstacles; and Adapting to an altered but acceptable life . The participants emphasised the importance of having access to rehabilitation that was provided by skilled staff, and support from family members and friends for well-being and recovery. They experienced a change in their self-image but strove for independence despite struggling with complications and functional limitations and used adaptive strategies to find contentment in their lives. Conclusions Rehabilitation interventions provided by competent health care professionals, as well as support from family members and friends, were emphasised as crucial for satisfactory recovery. Participants’ experiences further highlight the importance of targeting both physical and psychological impacts after a hip fracture. To improve recovery, rehabilitation providers should customise future interventions to suit each individual´s wishes and needs and provide rehabilitation in various settings throughout the recovery process. Trial registration The trial is registered at Current Controlled Trials Ltd, ICRCTN 15738119 . Date of registration 16/06/2008, retrospectively registered.

Background The World Health Organization claims that rehabilitation is important to meet the needs of persons with dementia. Rehabilitation programmes, however, are not routinely available. Person-centred, multidimensional, and interdisciplinary rehabilitation can increase the opportunities for older adults with dementia and their informal primary caregivers to continue to live an active life and participate in society. To our knowledge, staff team experiences of such rehabilitation programmes, involving older adults with dementia and their informal caregivers has not been previously explored. Methods The aim of this qualitative focus group study was to explore the experiences of a comprehensive staff team providing person-centred multidimensional, interdisciplinary rehabilitation to community-dwelling older adults with dementia, including education and support for informal primary caregivers. The 13 staff team members comprised 10 professions who, during a 16-week intervention period, provided individualised interventions while involving the rehabilitation participants. After the rehabilitation period the staff team members were divided in two focus groups who met on three occasions each (in total six focus groups) and discussed their experiences. The Grounded Theory method was used for data collection and analysis. Results The analysis resulted in four categories: Achieving involvement in rehabilitation is challenging, Considering various realities by acting as a link, Offering time and continuity create added value , and Creating a holistic view through knowledge exchange , and the core category: Refining a co-creative process towards making a difference. The core category resembles the collaboration that the staff had within their teams, which included participants with dementia and caregivers, and with the goal that the intervention should make a difference for the participants. This was conducted with flexibility in a collaborative and creative process. Conclusions The staff team perceived that by working in comprehensive teams they could provide individualised rehabilitation in creative collaboration with the participants through interaction, knowledge exchange, time and continuity, coordination and flexibility, and a holistic view. Challenges to overcome were the involvement of the person with dementia in goal setting and the mediating role of the staff team members. The staff pointed out that by refinement they could achieve well-functioning, competence-enhancing and timesaving teamwork.

Background Delirium is a common neurological complication after cardiac surgery. The purpose of the present study was to analyze the association between hemodynamic fluctuations during cardiopulmonary bypass (CPB) and the incidence of postoperative delirium (POD) in patients undergoing cardiac surgery with CPB. Methods This post hoc analysis included one-hundred-ninety-five ( n  = 195) patients aged ≥ 65 years of whom seventy ( n  = 70) patients developed POD. Intraoperative hemodynamic variables specifically related to the conduct of CPB were digitally recorded at 1-minute intervals. Variables outside the presumed safe boundaries for mean arterial pressure (MAP), systemic perfusion flow index– L/min/BSA (QBSA I ), systemic venous oxygen saturation (S V O 2 ) and arterial oxygen delivery– ml/min/BSA (DO 2 ) were defined and analyzed with reference to indices of area under the curve (AUC) and the relative proportion of registrations related to POD. POD was diagnosed according to DSM-5 criteria based on a test battery performed preoperatively and repeated twice postoperatively. Statistical tests used to verify observations outside the predefined norm included the Mann-Whitney U test and the chi-squared test. Results Markers of hemodynamic control during CPB showed significant associations with POD. Both DO 2 ( P  = 0.02) and QBSA I ( P  < 0.001) identified POD patients outside the predefined upper and lower safety limits. S V O 2 values > 84% ( P  < 0.001) werealso associated with the development of POD. The number of S V O 2 registrations below the lower safety limit was negligible, why statistical analysis seemed not useful. No association between MAP and POD registrations was identified. Conclusions This study revealed a clear association between markers of hemodynamic control and POD. These associations were most pronounced for DO 2 and QBSA I . The detected association between high S V O 2 and POD warrants further insight.

Background A team-based, individualised rehabilitation approach may be required to meet the complex needs of people with dementia. This randomised controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme for community-dwelling older people with dementia and their informal primary caregivers. Methods Participants with dementia were randomised to an intervention group ( n  = 31, mean age (SD) 78.4 (6.0) years) or usual care ( n  = 30, mean age 79.0 (7.1)). The rehabilitation programme consisted of a 20-week rehabilitation period containing assessments and interventions based on each individual’s goals, and group-based physical exercise plus social interaction twice a week for 16 weeks at a rehabilitation unit. After 5 and 14 months, the interdisciplinary team followed up participants over two four-week periods. For both groups, dates of deaths and decision to move to nursing home over three years, as well as interventions for the relevant periods, were collected. Blinded assessors measured physical functions, physical activity, activities of daily living, cognitive functions, nutritional status, and neuropsychiatric symptoms at baseline and at 5, 12, 24, and 36 months. Results Participants in the intervention group received a mean of 70.7 (20.1) interventions during the 20-week rehabilitation period, delivered by all ten team professions. The corresponding figures for the control group were 5.8 (5.9). In the intervention group, all but one participated in rehabilitation planning, including goal setting, and attendance in the exercise and social interaction groups was 74.8%. None of the adverse events ( n  = 19) led to any manifest injury or disease. Cox proportional hazard regression showed a non-significant lower relative risk (HR = 0.620, 95% CI 0.27–1.44) in favour of the intervention for moving to nursing home or mortality during the 36-month follow-up period. Linear mixed-effect models showed non-significant but potentially clinically meaningful between-group differences in gait, physical activity, and neuropsychological symptoms in favour of the intervention. Conclusions The rehabilitation programme seems feasible among community-dwelling older people with dementia. The overall results merit proceeding to a future definitive randomised controlled trial, exploring effects and cost-effectiveness. One could consider to conduct the programme earlier in the course of dementia, adding cognitive training and a control attention activity. Trial registration The study protocol, ISRCTN59155421 , was registered online 4/11/2015.