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Complex health problems in the oldest old in Sweden 1992–2002

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Abstract

Most studies on health trends in the elderly population focus on specific conditions, studied one at a time. However, health problems are often interrelated and exist simultaneously in late life. Individuals with health problems in several domains present special challenges to care services. To estimate future needs for care it may be relevant to study trends of complex health problems as well as single health items. This study identified serious problems in three domains (diseases/symptoms, mobility, cognition/communication) in two representative samples of the Swedish population aged 77 and older (1992: n=537; 2002: n=561). People with serious problems in two or three domains were considered to have complex health problems. Changes between 1992 and 2002 in the prevalence of persons having serious problems in no, one and two/three domains were analyzed with logistic regressions. When examining each domain separately all three showed a significant increase of serious problems. For diseases/symptoms the increase remained significant after controlling for different age and gender distributions in the two surveys. Results showed a significant increase in the prevalence of having problems in one domain, as well as having problems in two or three domains (complex problems). Results persisted when adjusting for different distributions in age, gender and education between 1992 and 2002. Results suggest a worsening of health during the 10-year period and an increase of complex problems. This emphasizes the necessity of cooperation and collaboration between different kinds of medical and social services for elderly people.

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References

  • Ahacic K, Parker MG, Thorslund M (2000) Mobility limitations in the Swedish population from 1968 to 1992: age, gender and social class differences. Aging (Milano) 12(3):190–198

    Google Scholar 

  • Ahacic K, Parker MG, Thorslund M (2003) Mobility limitations 1974–1991: period changes explaining improvement in the population. Soc Sci Med 57(12):2411–2422

    Article  Google Scholar 

  • Akner G (2004) Geriatric medicine in Sweden: a study of the organisation, staffing and care production in 2000–2001. Age Ageing 33(4):338–341

    Article  Google Scholar 

  • Andersen M (ed) (2003) Mat och näring för sjuka inom vård och omsorg [Diet and nutrition for persons receiving social services or medical care]. Uppsala: Livsmedelsversket

  • Bortz WM 2nd (2002) A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci 57(5):M283–M288

    Google Scholar 

  • Brayne C, Matthews FE, McGee MA, Jagger C (2001) Health and ill-health in the older population in England and Wales. The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS). Age Ageing 30(1):53–62

    Article  Google Scholar 

  • Crimmins EM (2004) Trends in the health of the elderly. Ann Rev Public Health 25:79–98

    Article  Google Scholar 

  • Crimmins EM, Saito Y (2001) Trends in healthy life expectancy in the United States, 1970–1990: gender, racial, and educational differences. Soc Sci Med 2(11):1629–1641

    Article  Google Scholar 

  • Deeg DJH (2004) Robine and Michel’s “Looking forward to a general theory on population aging”: population aging: the benefit of global versus local theory. J Gerontol A Biol Sci Med Sci 9(6):M600; author reply M616–620

  • Doblhammer G, Kytir J (2001) Compression or expansion of morbidity? Trends in healthy-life expectancy in the elderly Austrian population between 1978 and 1998. Soc Sci Med 2(3):385–391

    Article  Google Scholar 

  • Fillenbaum GG, Pieper CF, Cohen HJ, Cornoni-Huntley JC, Guralnik JM (2000) Comorbidity of five chronic health conditions in elderly community residents: determinants and impact on mortality. J Gerontol A Biol Sci Med Sci 55(2):M84–M89

    Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  Google Scholar 

  • Freedman VA, Martin LG, Schoeni RF (2002) Recent trends in disability and functioning among older adults in the United States: a systematic review. JAMA 288(24):3137–3146

    Article  Google Scholar 

  • Freedman VA, Crimmins E, Schoeni RF, Spillman BC, Aykan H, Kramarow E, Land K, Lubitz J, Manton K, Martin LG, Shinberg D, Waidmann T (2004) Resolving inconsistencies in trends in old-age disability: report from a technical working group. Demography 41(3):417–441

    Article  Google Scholar 

  • Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–156

    Google Scholar 

  • Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 59(3):255–263

    Google Scholar 

  • Gatz M, Fratiglioni L, Johansson B, Berg S, Mortimer JA, Reynolds CA, Fiske A, Pedersen NL (2005) Complete ascertainment of dementia in the Swedish Twin Registry: the HARMONY study. Neurobiol Aging 26(4):439–447

    Article  Google Scholar 

  • Guralnik JM (1996) Assessing the impact of comorbidity in the older population. Ann Epidemiol 6(5):376–380

    Article  Google Scholar 

  • Gurner U, Thorslund M (2001) Helhetssyn behövs i vården av multisviktande äldre. Förslag till förändring av vård- och omsorgsstrukturen i Stockholms län. [Holistic perspective is needed in care of multiimpaired elderly. A proposal for structural change of the organization of care in the county of Stockholm]. Läkartidningen 98(21):2596–2602

    Google Scholar 

  • Gurner U, Thorslund M (2003). Dirigent saknas i vård och omsorg för äldre [The lack of coordination in care and services for older people]. Stockholm: Natur och Kultur

  • Hogan DB, MacKnight C, Bergman H (2003) Models, definitions, and criteria of frailty. Aging Clin Exp Res 15(3 Suppl):1–29

    Google Scholar 

  • Lagergren M (2004) Utvecklingen av de äldres hälsa och levnadslängd. Stockholm: Stiftelsen Stockholms läns Äldrecentrum 2004:9

    Google Scholar 

  • Lagergren M, Batljan I (2000) Will there be a helping hand? Macroeconomic scenarios of future needs and costs of health and social care for the elderly in Sweden, 2000– 30. Ministry of Health and Social Affairs Stockholm

    Google Scholar 

  • Larsson K, Thorslund M (2005) Äldres hälsa [The health of elderly people]. In: Persson G (ed) Folkhälsorapport 2005 [The National Public Health Report 2005]. National Board of Health and Welfare, Stockholm, pp 272–290

    Google Scholar 

  • Larsson K, Silverstein M, Thorslund M (2005) Delivering care to older people at home. In: Johnson M (ed) The Cambridge handbook of age and ageing. Cambridge University Press, Cambridge, pp 630–637

    Google Scholar 

  • Leveille SG, Resnick HE, Balfour J (2000) Gender differences in disability: evidence and underlying reasons. Aging (Milano) 12(2):106–112

    Google Scholar 

  • Lipsitz LA (2002) Dynamics of stability: the physiologic basis of functional health and frailty. J Gerontol A Biol Sci Med Sci 57(3):B115–125

    Google Scholar 

  • Longino CF, Murphy JW (1995). The old age challenge to the biomedical model, paradigm strain and health policy. Baywood Publishing, New York

    Google Scholar 

  • Lundberg O, Thorslund M (1996) Fieldwork and measurement considerations in surveys of the oldest old. Soc Indic Res 37(2):165–187

    Article  Google Scholar 

  • Lunney JR, Lynn J, Hogan C (2002) Profiles of older medicare decedents. J Am Geriatr Soc 50(6):1108–1112

    Article  Google Scholar 

  • Malmberg JJ, Miilunpalo SI, Vuori IM, Pasanen ME, Oja P, Haapanen-Niemi NA (2002) Improved functional status in 16 years of follow up of middle aged and elderly men and women in north eastern Finland. J Epidemiol Community Health 56(12):905–912

    Article  Google Scholar 

  • Manton KG (1982) Changing concepts of morbidity and mortality in the elderly population. Milbank Mem Fund Q Health Soc 60(2):183–244

    Article  Google Scholar 

  • Markle-Reid M, Browne G (2003) Conceptualizations of frailty in relation to older adults. J Adv Nurs 44(1):58–68

    Article  Google Scholar 

  • Melzer D, McWilliams B, Brayne C, Johnson T, Bond J (2000) Socioeconomic status and the expectation of disability in old age: estimates for England. J Epidemiol Community Health 54(4):286–292

    Article  Google Scholar 

  • Myers GC, Lamb VL, Agree EM (2003) Patterns of disability change associated with the epidemiologic transition. In: Robine JM, Jagger CD, Mathers CD, Crimmins EM, Suzman RM (eds) Determining health expectancies. Wiley, Chichsterpp 59–74

    Google Scholar 

  • Palmer K, Wang HX, Backman L, Winblad B, Fratiglioni L (2002) Differential evolution of cognitive impairment in nondemented older persons: results from the Kungsholmen Project. Am J Psychiatry 159(3):436–442

    Article  Google Scholar 

  • Parker MG, Thorslund M, Lundberg O (1994) Physical function and social class among Swedish oldest old. J Gerontol 49(4):S196–201

    Google Scholar 

  • Parker MG, Ahacic K, Thorslund M (2005) Health changes among Swedish oldest old: prevalence rates from 1992 and 2002 show increasing health problems. J Gerontol A Biol Sci Med Sci 60(10):1351–1355

    Google Scholar 

  • Puts MTE, Lips P, Deeg DJH (2005a) Sex differences in the risk of frailty for mortality independent of disability and chronic diseases. J Am Geriatr Soc 53(1):40–47

    Article  Google Scholar 

  • Puts MTE, Lips P, Deeg DJH (2005b) Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. J Clin Epidemiol 58(11):1188–1198

    Article  Google Scholar 

  • Puts MTE, Lips P, Ribbe MW, Deeg DJH (2005c) The effect of frailty on residential/nursing home admission in the Netherlands independent of chronic diseases and functional limitations. Eur J Ageing 2(4):264–274

    Article  Google Scholar 

  • Robine JM, Michel JP (2004) Looking forward to a general theory on population aging. J Gerontol A Biol Sci Med Sci 59(6):M590–597

    Google Scholar 

  • Rockwood K, Hogan DB, MacKnight C (2000) Conceptualisation and measurement of frailty in elderly people. Drugs Aging 17(4):295–302

    Article  Google Scholar 

  • Romoren TI, Blekeseaune M (2003) Trajectories of disability among the oldest old. J Aging Health 15(3):548–566

    Article  Google Scholar 

  • Rosen M, Haglund B (2001) Chapter 10. The importance of health and medical care for public health. Health in Sweden: The National Public Health Report 2001. Scand J Public Health 58(Suppl):219–230

    Google Scholar 

  • Rosen M, Haglund B (2005) From healthy survivors to sick survivors–implications for the twenty-first century. Scand J Public Health 33(2):151–155

    Article  Google Scholar 

  • Spillman BC (2004) Changes in elderly disability rates and the implications for health care utilization and cost. Milbank Q 82(1):157–194

    Article  Google Scholar 

  • Steen B (2002) The elderly yesterday, today and tomorrow: aspects on cohort differences from the gerontological and geriatric population studies in Goteborg, Sweden (H70). Arch Gerontol Geriatr 35(Suppl):359–370

    Article  Google Scholar 

  • The Canadian Study of Health, Aging Working Group (2001) Disability and frailty among elderly Canadians: a comparison of six surveys. Int Psychogeriatr 13(Supp 1):159–167

    Google Scholar 

  • Thorslund M, Lundberg O (1994) Health and inequalities among the oldest old. J Aging Health 6(1):51–69

    Article  Google Scholar 

  • Wilhelmson K, Allebeck P, Steen B (2002) Improved health among 70-year olds: comparison of health indicators in three different birth cohorts. Aging Clin Exp Res 14(5):361–370

    Google Scholar 

Download references

Acknowledgments

We are grateful for financial support from the Swedish Council for Working Life and Social Research, grants 2003–0539 and 2002–0919, and from the Swedish Research Council, grant 2000–0893/28. The Karolinska Institute Ethics Committee approved the project.

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Authors and Affiliations

  1. Aging Research Center, Karolinska Institute & Stockholm University, GÄVLEGATAN 16, 113 30, Stockholm, Sweden

    Bettina Meinow, Marti G. Parker, Ingemar Kåreholt & Mats Thorslund

  2. Department of Social Work, Stockholm University, 106 91, Stockholm, Sweden

    Bettina Meinow, Ingemar Kåreholt & Mats Thorslund

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  1. Bettina Meinow
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  2. Marti G. Parker
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  3. Ingemar Kåreholt
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  4. Mats Thorslund
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Correspondence to Bettina Meinow.

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Meinow, B., Parker, M.G., Kåreholt, I. et al. Complex health problems in the oldest old in Sweden 1992–2002. Eur J Ageing 3, 98–106 (2006). https://doi.org/10.1007/s10433-006-0027-z

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