Elderly Finns Research Articles

Adherence to Life's simple 7 is associated with better carotid properties

Background and aimsCardiovascular health scores have emerged as a simple way to assess the risk to suffer from a cardiovascular disease. The American Heart Association's Life's Simple 7 constitutes of modifiable lifestyle factors to reduce cardiovascular risk. Its association with carotid properties is yet inconclusive. The aim of this study is to determine the association between the adherence to Life's Simple 7 and carotid properties in middle-aged to elderly Finns. MethodsA representative sample of Finnish men and women aged 55–74 years was included in the present study. Carotid intima-media thickness (cIMT), lumen diameter (cLD), and carotid distensibility were measured by transcutaneous ultrasound using state-of-the-art wall contour detection techniques. The Life's Simple 7 cardiovascular health score was calculated using seven categories (body mass index, cholesterol, systolic blood pressure, fasting plasma glucose, smoking status, physical activity, and diet). In accordance to the American Heart Association, for each category, an ideal score was given 2 points, intermediate scores 1 point, and poor scores 0 points. ResultsIn total, 1400 (49.4% male) subjects were included in the analyses. After adjusting for age and sex, we found that subjects with a an ideal cardiovascular health score had lower cLD than those with an intermediate score (−0.21 mm, 95% CI: 0.37 to −0.05 mm, p=0.005) and a poor score (−0.39 mm, 95% CI: 0.65 to −0.12 mm, p=0.001). Similarly, subjects with an ideal health score had higher carotid distensibility than those with an intermediate score (0.0032 1/kPa, 95% CI: 0.009–0.0055 1/kPa, p=0.002) and a poor score (0.0018 1/kPa, 95% CI: 0.0005–0.0032 1/kPa, p=0.004). We found no differences regarding cIMT. ConclusionsIn middle-aged to elderly Finns, higher adherence to the Life's Simple 7 is associated with lower cLD and higher distensibility, but not with cIMT. Adherence to healthy lifestyle habits is therefore associated with better carotid structure and carotid function in middle-aged to elderly Finns.

PIH17 Drivers of Service Use, Costs, and Feasibility for a Potential Social IMPACT Bond (SIB) Among Elderly Finns with Assisted Living Services

To use multivariate analyses to i] examine factors that affect functionality, use of services, and costs of care, and ii] assess whether a SIB would be a feasible financing instrument for a preventive intervention that aims to maintain the functionality of the elderly. The study was part of functional capacity of the elderly SIB project. PICOSTEPS (Patients-Intervention-Comparator-Outcomes-Setting-Time-Effects-Perspective-Sensitivity) framework was applied. Data from two regions of Finland (Pohjanmaa, Etelä-Savo) consisting of 1,107 elderly people using assisted living services was managed, instrumented, and analysed. The dependent variables in the models were the amount of used services, the expected annually cumulative costs during years 2019-2024, and the expected yearly costs. The models included multilevel linear and Poisson regressions and generalized estimating equations. The costs were presented in year 2019 real value without discounting. First, mobility and health challenges, social challenges, poverty and losses, technological challenges, and cognitive impairment significantly increased whereas informal care decreased the amount of services used and care costs. Second, SIBs might be suitable financial instruments for preventive interventions that aim to maintain the functionality of the elderly especially, if the intervention focuses on mobility, health, or social challenges. However, the SIB approach requires careful planning, predictive analyses, implementation, and assessment. In general, when the SIB is applied, indicators, outcomes, patient perspectives, potential for cost savings and other health economic value is essential for the knowledge management of SIB-based services. We assessed factors and feasibility of a SIB and found important drivers of resources and costs. We recommend tying SIB-associated costs and outcomes to a general functionality meter. A topic for follow-up research is prediction of costs of care with a functionality meter, including determining the natural regression of functionality over time and estimation of the changes in costs of care due to changes in functionality.

Yard vegetation is associated with gut microbiota composition

Gut microbes play an essential role in the development and functioning of the human immune system. A disturbed gut microbiota composition is often associated with a number of health disorders including immune-mediated diseases. Differences in host characteristics such as ethnicity, living habit and diet have been used to explain differences in the gut microbiota composition in inter-continental comparison studies. As our previous studies imply that daily skin contact with organic gardening materials modify gut microflora, here we investigated the association between living environment and gut microbiota in a homogenous western population along an urban-rural gradient. We obtained stool samples from 48 native elderly Finns in province Häme in August and November 2015 and identified the bacterial phylotypes using 16S rRNA Illumina MiSeq sequencing. We assumed that yard vegetation and land cover classes surrounding homes explain the stool bacterial community in generalized linear mixed models. Diverse yard vegetation was associated with a reduced abundance of Clostridium sensu stricto and an increased abundance of Faecalibacterium and Prevotellaceae. The abundance of Bacteroides was positively and strongly associated with the built environment. Exclusion of animal owners did not alter the main associations. These results suggest that diverse vegetation around homes is associated with health-related changes in gut microbiota composition. Manipulation of the garden diversity, possibly jointly with urban planning, is a promising candidate for future intervention studies that aim to maintain gut homeostasis.

Fall-induced hospital-treated traumatic brain injuries among elderly Finns in 1970–2017

BackgroundFall-induced traumatic brain injuries (TBI) of elderly adults are a major public health concern. MethodsWe determined the current trends in the absolute number and incidence (per 100,000 persons) of severe fall-induced TBI among 80-year-old or older Finns by taking into account all persons who were admitted to Finnish hospitals for primary treatment of such injury between 1970 and 2017. ResultsThe total number of hospitalized older Finns with a fall-induced TBI increased considerably between the years 1970 and 2017, from 60 (women) and 25 (men) in 1970 to 1622 (women) and 991 (men) in 2017. The age-adjusted incidence of TBI (per 100,000 persons) also showed a clear increase from 1970 to 2017: from 167.9 to 800.4 in women (377% increase), and from 176.8 to 927.3 in men (424% increase). If this trend in the age-adjusted incidence of hospital-treated TBI continues, and the size of the 80-year-old or older Finnish population increases as predicted (from 0.29 million in 2017 to 0.49 million in 2030), the number of these severe injuries among 80-year-old or older Finns will be approximately 1.8 times higher in 2030 (4811 injuries) compared with 2613 injuries in 2017. ConclusionsThe number and age-adjusted incidence of fall-induced hospital-treated TBI among elderly Finns increased considerably between 1970 and 2017. Wide-scale fall and injury prevention measures are urgently needed, because further aging of the population is likely to worsen the problem in the near future.

Listeria monocytogenes risk assessment on cold smoked and salt-cured fishery products in Finland - A repeated exposure model

Listeria monocytogenes causes severe consequences especially for persons belonging to risk groups. Finland is among the countries with highest number of listeriosis cases in the European Union. Although most reported cases appear to be sporadic and the maximum bacterial concentration of 100 cfu/g is not usually exceeded at retail, cold smoked and salt-cured fish products have been noted as those products with great risk especially for the elderly.In order to investigate the listeriosis risk more carefully, an exposure assessment was developed, and laboratory results for cold smoked and salt-cured salmon products were exploited. L. monocytogenes exposure was modeled for consumers in two age groups, the elderly population as a risk group and the working-age population as a reference. Incidence was assessed by estimating bacterial growth in the food products at three temperatures. Bayesian estimation of the risk was based on bacterial occurrence and product consumption data and epidemiological population data.The model builds on a two-state Markov chain describing repeated consumption on consecutive days. The cumulative exposure is probabilistically governed by the daily decreasing likelihood of continued consumption and the increasing bacterial concentrations due to growth. The population risk was then predicted with a Poisson distribution accounting for the daily probabilities of purchasing a contaminated product and the cumulative total probability of infection from its use.According to the model presented in this article, elderly Finns are at a greater risk of acquiring listeriosis than healthy adults. The risk for the elderly does not fully diminish even if the products have been stored at the recommended temperature (between 0 and 3 °C). It can be concluded that the stage after retail, i.e. food handling and storage by consumer or professional kitchens, is essential to protection against listeriosis. The estimation model provides means for assessing the joint impacts of these effects.

This issue of Acta Sept 2018

The cover illustration shows a macular haemorrhage, as described by Schargus from Dusseldorf in the electronic part of this issue. Vaes et al in the Netherlands and Belgium point to microvascular changes in retina of patients with chronic obstructive pulmonary disease. Ramdas in Maastricht reviews the literature on dietary influences in glaucoma. Iron and selenium may increase risk, and leafy vegetables decrease risk of glaucoma. However, the data are limited. Bengtsson et al and Lindén et al in Sweden describe the ongoing GLAUCOMA INTENSIVE TREATMENT STUDY and show that intensive treatment lowers IOP more than monotherapy. The study will determine the effect of intensive glaucoma therapy on visual field progression and predict vision loss at life's end. Willekens et al in Belgium and Portugal found that some glaucoma patients have posterior vitreous detachment at an older age than healthy controls. Farhoudi et al in Sweden demonstrate that patients benefit from new spectacle following cataract surgery. Stolk-Vos et al in the Netherlands emphasize the advantage of recording patient-reported visual function and recommend the Catquest-9SF questionnaire. Grimfors et al in Sweden use the Swedish National Cataract Register to demonstrate a correlation between patient-reported improvement and visual function on the one hand and surgical complications, comorbidities, age, gender and visual acuity on the other. Næser et al in Denmark and Italy show that corneal astigmatism is stable until age 50 and changes by 0.25 dioptres every 10 years thereafter. Frimmel et al in the Netherlands and Switzerland report significant eye trauma from fireworks on new Year′s Eve. Sahraravand et al in Helsinki found falls at home to cause most eye injuries in elderly Finns. Bro and Lindblom in Sweden point out that visual requirement for driving are variable in Nordic countries. Mourits et al in the Netherlands looked at cosmetic outcomes following enucleation or radiation for retinoblastoma. Orbital implant complications were manageable, whereas external beam radiation gave less favourable cosmetic outcomes. Scheerlink et al in the Netherlands found better foveal sensitivity on microperimetry with gas compared with silicone oil tamponade for retinal detachment. Leinonen et al in Helsinki used intravitreal steroid implants to treat uveitis-related macular oedema. Pérez-Trullén et al in Spain propose that Goya had age-related cataract and this influenced his late paintings. The following articles are published electronically and are accessible on www.actaophthalmologica.com, as are all articles in Acta for the last century. Leal et al in Portugal and UK conclude that intravitreal injection of anti-TNF antibodies is a possible but not proven treatment for noninfectious uveitis. Zhu et al in China provide a comprehensive review on exercise and glaucoma, including the possible effect on IOP, blood flow and neuroprotection. Kang et al in United States and Australia found that total flavonoid intake does not influence glaucoma risk. Mataki et al in Japan correlated beta peripapillary atrophy with age, lower IOP and disc-fovea distance. Rabensteiner et al in Austria found Meibomian gland dysfunction to play a major role in dry eye, often in combination with reduces aqueous tear secretion. Klingensteiner et al in Munchen recommend PET scanning for orbital adnexal lymphomas. Liu et al in China influence angiotensin pathways in retina with microRNA. This affects proliferation and apoptosis in retinal endothelial cells in diabetic rats. Rose et al in Canada and Australia measure changes in retinal perfusion and oxygen metabolism in radiation retinopathy. Hanhart et al in Israel suggest that bevacizumab intravitreal injections may increase mortality in patients who have recently suffered TIA or stroke. Blixt et al in Denmark and Sweden found that endothelin-1 induced vasoconstriction in retina can be suppressed and this may offer treatment possibilities in retinal ischaemia. Subhi and Sörensen in Denmark view pigment epithelial detachment in 3D and measure volume. They suggest that such analysis may be superior to current practice. Shargus in Dusseldorf supplied the cover illustration of a picturesque retinal haemorrhage. Ferreira et al in Portugal used infrared pupillometry to demonstrate transient pupil changes following laser iridotomy. Diederen et al in the Netherlands recommend Baerveldt implants in uveitis glaucoma in young patients. Vohra et al in Denmark found vision loss in a patient with cerebral amyloid angiopathy. Grzybowski and Nowak in Poland found similar rate of myopia in Polish children as in other Caucasian cohorts. Schrader et al in Germany present a plastic compressed collagen device, which they transplanted onto the corneal surface of a patient with corneal ulcer. Krohn et al in Norway describe a slowly progressive RPE dysgenesis with severe visual loss. I hope this issue of Acta provides pleasant and informative reading in the cool and dark evenings ahead.

An exploratory study on the attitudes of elderly Finns towards Russian-speaking minorities

ABSTRACTResearch has shown Russian speakers in Finland are often victims of prejudice and discrimination. Utilizing integrated threat theory, this study investigated the extent to which threats are significant predictors of prejudice towards Russian speakers in Finland among a highly neglected research population – the elderly. This study also aimed at finding out which threat (realistic threat, symbolic threat, and negative stereotyping) was the most significant predictor of attitudes towards members of the Russian-speaking minority, and the extent to which men and women differed. In a sample of 90 participants, aged 65 and above, results indicated realistic threat and symbolic threat were not significant predictors of prejudicial attitudes towards members of the Russian-speaking community. Negative stereotyping however had a negative effect on prejudice. Moreover, contrary to previous research on prejudice, there were no significant differences between men and women on threat.

Low-trauma knee fractures in older Finnish women between 1970 and 2013.

Fresh information on various low-trauma fractures of elderly adults is sparse. We aimed to assess the current trends in the low-trauma knee fractures among older adults in Finland, an EU country with a well-defined white population of 5.4million. The rates of elderly Finns' low-trauma fractures of the knee (distal femur, patella, and proximal tibia) were assessed by taking into account 60-year-old or older persons who were admitted to Finnish hospitals for primary treatment of such injury in 1970-2013. The incidence of low-trauma knee fractures among 60-year-old or older Finnish women sharply rose between 1970 and 1997, from 55 fractures (per 100,000 persons) in 1970 to 124 fractures in 1997. Thereafter, the incidence continuously declined so that the fracture incidence was 91 in 2013. The corresponding age-adjusted fracture incidences were 60 (1970), 119 (1997), and 83 (2013). In older men, the fracture incidence was rather steady over time: the age-adjusted incidence was 30 in 1970 vs. 28 in 2013. The rise in the incidence of low-trauma knee fractures in Finnish older women from early 1970s until late 1990s has been followed by a continuous decline in the fracture rate. Reasons for the decline are unknown, but a cohort effect toward a healthier aging female population with improved functionality and decreased risk of injurious slips, trips, and falls could partly explain the observation.

Low-Trauma Pelvic Fractures in Elderly Finns in 1970-2013.

Low-trauma fractures of elderly persons are a major public health problem. However, epidemiologic knowledge on their fresh secular trends is scarce. Trends in the number and incidence (per 100,000 persons) of low-trauma fractures of the pelvic ring among older Finns were assessed by taking into account individuals 80-year-old or older who were admitted to Finnish hospitals for primary treatment of such injury in 1970-2013. The number and age-adjusted incidence of these fractures increased considerably between 1970 and 2013, from 33 (number) and 73 (incidence) in 1970 to 1055 and 364 in 2013. The age-specific incidence of fracture also increased in all age groups (80-84, 85-89, and 90-) of women and men during the entire study period. If the fracture incidence continues to rise at the same rates as in 1970-2013 and the size of the 80-year-old or older population of Finland increases as predicted (87 % by the year 2030), the number low-trauma pelvic fractures in this population will be 2.4 times higher in the year 2030 (2550 fractures) than it was in 2013 (1055 fractures). The number of low-trauma fractures of the pelvis among Finns 80 years of age or older has risen sharply between 1970 and 2013-with a rate that cannot be explained merely by demographic changes. Further studies are urgently needed to better assess the reasons for the rise and possibilities for fracture prevention.

Genotypic characterization and historical perspective of Mycobacterium tuberculosis among older and younger Finns, 2008–2011

The Mycobacterium tuberculosis genotypes obtained from elderly Finns were assessed and compared with those obtained from younger Finns to comprehend the epidemiology of tuberculosis (TB) in Finland. From 2008 to 2011, a total of 1021 M. tuberculosis isolates were characterized by spoligotyping and 15-locus mycobacterial interspersed repetitive units–variable number tandem repeat typing. In total, 733 Finnish-born cases were included in the study, of which 466 (64%) were born before 1945 (older Finns). Of these, 63 (14%) shared an M. tuberculosis genotype with foreign-born or younger Finnish cases (born after 1945), and 59 (13%) shared a genotype with older Finnish cases. Eighty-five per cent had a unique genotypic profile while 70% belonged to T or Haarlem families, suggesting that ongoing transmission is infrequent among young and elderly Finns. Simultaneous reactivation of TB among older Finns was the most likely cause for clustering. As most isolates belonged to Haarlem or T, Finland was most likely affected by a similar TB epidemic at the beginning of the twentieth century as that seen in Sweden and Norway. Younger Finns were significantly more likely to be clustered (56% versus 27%, p <0.001), have pulmonary TB (87% versus 71%, p <0.001) and to be sputum smear positive (57% versus 48%, p <0.05) indicating that the risk of TB transmission from younger Finns is likely to be larger than from older Finns. The M. tuberculosis isolates from elderly Finns were associated with dominant lineages of the early twentieth century and differed from the heterogeneous lineages found among younger TB patients. Additionally, younger TB patients were more likely to transmit TB than elderly Finns.

Fall-induced deaths among older adults: nationwide statistics in Finland between 1971 and 2009 and prediction for the future

BackgroundFall-related injuries and deaths of elderly people are a major public health concern. MethodsUsing the Official Cause-of-Death Statistics of Finland we determined the current trends in the number and age-adjusted incidence (per 100,000 persons) of fall-induced deaths among older Finnish men and women by taking into account all persons 50 years of age or older who died because of a fall-induced injury between 1971 and 2009. ResultsAmong elderly Finnish men, the number of deaths due to falls increased considerably between the years 1971 and 2009, from 162 to 627 (a 287% increase). The age-adjusted incidence also increased from 43.4 (per 100,000 persons) in 1971 to 57.9 in 2000, but stabilized thereafter (57.3 in 2009). Among elderly Finnish women, the number of fall-induced deaths increased till the beginning of the new millennium (from 279 in 1971 to 499 in 2000) but stabilized thereafter (506 in 2009), and, in sharp contrast to men, women's age-adjusted incidence of fall-induced deaths declined during the entire study period, the incidence being 77.2 in 1971 while only 35.3 in 2009. ConclusionsBetween 1971 and 2009 the number of fall-induced deaths increased among elderly Finns. The changes were sex-specific so that men surpassed women in both the number and age-adjusted incidence of these fatal falls. Welcome observations were that men's age-adjusted incidence of fall-induced deaths started to stabilize during the new millennium and that in women this incidence continuously declined between 1971 and 2009.

“If I drink it anyway, then I rather take the light one”. Appropriation of foods and drinks designed for weight management among middle-aged and elderly Finns

This article examines everyday ideals of eating for weight management as described by middle-aged and elderly Finns with varying experiences of managing their weight. The paper draws on the theoretical approach of appropriation and looks at the meanings, understandings and use of foods for weight management in the context of the practices of eating. The article is based on an analysis of eight focus group discussions with 68 people (47 women, 21 men, aged between 38 and 77) conducted in Helsinki in autumn 2009. The findings of the study suggest that lay understandings of foods suitable for weight management rest not only on simple measures such as energy, fat and sugar, but also on a complex set of generalised food ideals. These include a conflict between foods described as natural against artificial, moral judgements of the necessity of foods designed for weight management, and the overall emphasis on moderation as a basic ideal. The results indicate that people employ two perspectives in assessing foods suitable for weight management: in the context of the whole of diet the products are dismissed as unnecessary, but in specific situations they can replace ‘normal’ products if the latter are deemed more harmful.

Fear in Border Narratives: Perspectives of the Finnish-Russian Border

This study discusses the socially and culturally constructed Finnish- Russian border which has been developed as a lifelong process, in the context of modern elderly Finns. It focuses on the emotions of fear represented in life and historically contextualised narratives discussing the post-war period in eastern borderlands. The included texts concentrate on border issues and are mainly based on the writer's personal experiences. The analysis is based on oral history methodology and highlights mainly the represented personal interpretations of the past, rather than actual historical events. The concept of fear is used as a theoretical tool to interpret the expressions of emotions in narrated memories. The study seeks to illustrate the causes of fear on the Finnish-Russian border in peacetime contemporary Finland.

Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010

We determined the current trend in the number and incidence of hip fracture among persons 50 years of age or older in Finland between 1970 and 2010. After a clear rise until the late 1990s, the incidence of hip fracture has continuously declined. Hip fractures are a major public health issue associated with excess morbidity and mortality. We determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined Caucasian population of 5.4 million people. We took into account all persons 50 years of age or older who were admitted to hospitals for primary treatment of hip fracture between 1970 and 2010. The number of hip fractures rose sharply till the end of 1990s (from 1,857 in 1970 to 7,122 in 1997), but since then, the rise has leveled off (7,594 fractures in 2010). Similarly, the age-adjusted incidence of hip fracture increased until 1997 but declined thereafter. The decline was especially clear in women whose age-adjusted incidence was 515.7 (per 100,000 persons) in 1997 but only 382.6 in 2010. In men, the corresponding incidence was 245.3 in 1997 and 210.7 in 2010. The number of hip fractures will increase 1.8-fold by 2030 even with the current 2010 incidence rates because the size of the 50-year-old or older population is likely to increase sharply in the near future. The declining trend in the incidence of hip fracture in Finland has continued through the entire first decade of the new millennium. Reasons for this development are uncertain, but possible explanations include increased average body weight, improved functional ability among elderly Finns, and specific measures to prevent bone loss and reduce the risk of falling.

Radiological signs indicating infection of dental origin in elderly Finns

Objective. The aim was to assess the prevalence and background factors of signs of infection of dental origin in elderly Finns. Materials and methods. Every third birth cohort between 60–78 years of age (n = 1733) in a southern and a northern region in Finland were invited. Altogether, 1069 subjects attended radiographic examination. Of those, 660 were dentate and formed the study sample. In the analysis an index as a sum of points (scale per lesion 0–3, range 0–420) indicating the severity of infection from periapical lesions, furcal lesions, vertical bone pockets, horizontal bone loss and severe dental caries was used. Results. The index ranged individually from 0–91. Horizontal bone loss was found in 94%, vertical bone loss in 19%, periapical lesions in 46%, furcal lesions in 19% and carious lesions in 39% of the subjects. Only 3% of the subjects were free of dental infections, while 2% had mild, 17% moderate and 78% severe risk of dentogenic infection. Statistically significant background factors were region, level of education, number of regular drugs in use, drugs reducing salivation, alcohol consumption, cardiovascular disease, asthma and rheumatoid arthritis. Conclusions. Elderly Finns have high a prevalence of signs of infections of dental origin, which is associated with several socio-demographic and health-related factors.

Health information literacy in everyday life: A study of Finns aged 65–79 years

This article examines the health information literacy of elderly Finns. The results are based on a survey conducted in January 2011. The questionnaire was distributed to 1000 persons that were randomly drawn from the Finnish Population Register. The respondents were aged 65-79 years (mean age 70 years) and lived in the Turku region in Finland. A total of 281 questionnaires (28%) were returned. χ(2) analyses were used to find possible relationships between demographic factors, as well as interest, seeking activity, current self-rated health and different dimensions of health information literacy, including needs, seeking and use of health-related information. Significant relationships were found between education level, interest in health information, seeking activity, self-rated current health and dimensions of health information literacy. Some categories of elderly people are more vulnerable regarding obtaining and use of health information: those with lower levels of education, those with poor health, and those who are not interested in and active at seeking information. For people who are found in any of these categories, it is important that available health-related information is understandable and can be accessed without too much effort-something that information providers should take into account.

Prevalence and severity of cerebral amyloid angiopathy: a population‐based study on very elderly Finns (Vantaa 85+)

Cerebral amyloid angiopathy (CAA) is frequent in patients with Alzheimer's disease while its prevalence in different populations is variable. We investigated the prevalence and severity of CAA in a very elderly Finnish population. Neuropathological investigation was performed on 306 subjects from the population-based Vantaa 85+ Study (253 women, 53 men, mean age at death 92.3 years). The presence of CAA was analysed in six brain regions by using Congo red and immunohistochemistry with an antibody against amyloid beta peptide. The severity of CAA was assessed by counting the percentage of the CAA-positive blood vessels. In total, 69.6% of the participants (170 women, 43 men) had CAA, with median severity of 1.0%, inter-quartile range (IQR) 0-5.4% and range 0-72.7%. CAA was more prevalent (81.1% vs. 67.2%; P = 0.046) and severe (median 2.7%, IQR 0.4-7.5%, range 0-72.7%) in the men than in the women (median 1.0%, IQR 0-4.6%, range 0-52.8%; P = 0.004). Parietal lobe showed the highest prevalence (57.8%) whereas the severity was highest (median 1.0%, IQR 0-6.0%, range 0-77%) in the frontal lobe. Prevalence of CAA in the six regions was variable, but the severity indices between those regions correlated highly (P < 0.001 for all regions). Meningeal CAA was more prevalent (69.5%) than cortical (59.3%; P < 0.001). CAA was highly prevalent, albeit mild, in the very old. The prevalence and severity of CAA were found to be highest in the frontal and parietal lobes respectively - independent of the staining method used (Congo red or amyloid beta peptide).

Declining age-adjusted incidence of fall-induced injuries among elderly Finns

Elderly people's fall-induced injuries are a major public health challenge. We determined the current trends in the number and age-adjusted incidence (per 100,000 persons) of fall-induced injuries among older adults in Finland by taking into account all persons 80 years of age or older who were admitted to Finnish hospitals for primary treatment of a first fall injury over the period 1970-2009. The number of fall-induced injuries in elderly Finns increased considerably during the study period: for women and men separately, these numbers were from 927 to 10,333 (an 11-fold rise), and from 212 to 3,258 (a 15-fold rise), respectively. In both genders, the age-adjusted incidence (per 100,000 persons) of fall-induced injuries increased till the late 1990s but decreased thereafter, the incidence being 2,729 (women) and 1,455 (men) in 1970, and 5,930 (women) and 4,240 (men) in 2009. Even with the current injury incidence the number of these injuries is expected to more than double by the year 2030. The rise in the age-adjusted incidence of hospital-treated fall injuries of 80 year old and older Finns from the 1970s to the late 1990s has been followed by declining injury rates. Despite this we have to effectively continue implementation of fall prevention actions.

Cerebral amyloid angiopathy, neurodegeneration, and dementia in a population-based study on the very elderly Finns (Vantaa 85+)

Cerebral amyloid angiopathy, neurodegeneration, and dementia in a population-based study on the very elderly Finns (Vantaa 85+)

Validity of the Finnish Prescription Register for Measuring Psychotropic Drug Exposures among Elderly Finns

Pharmacoepidemiological studies assessing the associations between psychotropic drug use and adverse events in the elderly frequently employ automated pharmacy databases as the source of exposure data. However, information on the validity of these databases for estimating psychotropic drug exposures in elderly people is scarce. This study evaluated the validity of the Finnish Prescription Register for estimating current exposures to psychotropic drugs in elderly people. Furthermore, the potential change in the validity over time was determined. This was a population-based intervention study (GeMS; Geriatric Multidisciplinary Strategy for the Good Care of the Elderly) conducted between 2004 and 2007. Initially, 1000 randomly selected persons aged >or=75 years living in the City of Kuopio, Finland, in November 2003 were invited to participate in the study. Of these, 716 agreed to participate at baseline (2004) and 570 were still available for 3-year follow-up (2007). The validity of the Prescription Register was assessed by comparing it with the self-reported information collected by interviews in 2004 and in 2007 in the GeMS study. Using the self-reported data as a reference standard, sensitivity, specificity and Cohen's kappa statistic (measure of inter-rater agreement for qualitative [categorical] items) with 95% confidence intervals were computed for different categories and subcategories of psychotropic drugs, applying fixed-time windows of 4, 6 and 12 months. In 2007, the sensitivity varied between psychotropic categories and subcategories, being generally highest with the 12-month time window (0.57-0.96). The specificity was highest with the 4-month time window (0.94-0.99), showing a slight tendency to decrease with an extended time window. The sensitivity and specificity were highest for antidepressants and antipsychotics, followed by benzodiazepines. The agreement was almost perfect (kappa = 0.81-1.00) or substantial (kappa = 0.61-0.80) for all categories and subcategories of psychotropic drugs. Few differences in validity were observed between the two years. Using self-reported data as a reference standard, the Prescription Register provides valid information on current exposures to antidepressants and antipsychotics in elderly people if the time window is selected with adequate consideration. However, the validity is lower for benzodiazepines, suggesting that other sources of information should be considered when performing pharmacoepidemiological studies.