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Background: Few have investigated long-term effect of treatment of posttraumatic olfactory dysfunction (OD). Aims/objectives: To explore if sequential treatment with corticosteroids and olfactory training (OT) improved smell in patients with OD after moderate and severe traumatic brain injury (TBI). Material and methods: Twenty-two patients with persistent OD, mean 62 months after trauma, completed an open uncontrolled intervention study of treatment for 10 d with oral corticosteroids and thereafter for 3 months with OT twice daily. Olfaction was assessed by Sniffin’ Sticks. They were tested at four-time points, with the last assessment 12 months after baseline measurements. Results: Mean age at trauma was 45 (SD 14) years. Mean threshold, discrimination and identification (TDI) score at baseline was 14.4 (SD 7.3) and increased to mean 20.8 (SD 7.4) after 1 year (minimum −3.0; maximum 19.5, p value

Background Insertion of ventilation tubes (VTs) in the tympanic membrane is one of the most common ambulatory surgeries performed on children. Postoperative care may continue for two or more years and is today mostly done by otolaryngologists. Controls by general practitioners (GPs) may represent a sufficient level of health care regarding clinical outcome, but there exist no evidence-based guidelines concerning the level of expertise for this task. Aim To evaluate whether postoperative care after surgery with VTs performed by GPs represent a sufficient alternative to otolaryngologists. Methods/design Randomized controlled trial including patients from seven hospitals in all four Regional Health Authorities in Norway. A total of 400 children aged 3-10 years will be randomized to postoperative care by either otolaryngologist or their regular GP after surgery with VTs in the tympanic membrane. Two years after surgery we will compare hearing thresholds, middle ear function, complication rate, health related quality of life as well as the guardians’ evaluations of the postoperative care. Discussion Results from the ConVenTu study are expected to contribute with knowledge necessary to develop evidence-based guidelines regarding the level of expertise for safe postoperative care for children after surgery with VTs.

Background : Depression is common among residents in long term-care facilities. Therefore, access to a valid and reliable measure of depressive symptoms among nursing home (NH) residents is highly warranted. Aim : The aim of this study was to test the psychometrical properties of the Norwegian version of the Cornell Scale for Depression in Dementia (CSDD). Methods : A sample of 309 NH residents were assessed for depressive symptoms using the CSDD in 2015-2016. Data on CSDD were missing for 64 residents, giving an effective sample of 245 (79.3%). Principal component and confirmatory factor analysis were used. Results : A five-dimensional solution yielded the best fit with the data (χ2=174.927, df=94, χ2/df=1.86, p=0.0001, RMSEA=0.058, p-value for test of close fit=0.152, CFI=0.94, TLI=0.92 and SRMR=0.056). As expected, higher depressive symptoms correlated positively with higher scores on the Minimum Data Set Depression Rating Scale (MDSDRS) and correlated negatively with Quality of life assessed with the Quality of Life in Late Stage-Dementia Scale. Limitations : The excluded residents (n=64, 20.7%) had lower cognitive function, which may limit the generalizability of the study results. Conclusion : This study suggests a five-dimensional solution of the CSDD scale. Sixteen of the 19 original items showed highly significant loadings, explaining a notable amount of the variation in the CSDD-construct. Further development and testing of a well-adapted scale assessing depression in the nursing home population with and without dementia is required.

Objectives: Treatment of depression (in late life) is good. The short-term, but not long-term prognosis after treatment of depression in late life is good. To identify modifiable factors, we wanted to examine whether coping in terms of locus of control and coping strategies in depressed patients were associated with the prognosis of depression at follow-up, adjusted for sociodemographic information and health variables. Method: In total, 122 patients (mean age 75.4 years; SD = 6.6) were followed up (median 13.7 months, Q1-Q3 386-441) with a diagnostic evaluation(ICD-10) for depression and assessment of depressive symptoms (MADRS). Coping was assessed using Locus of Control of behavior (LoC-scale) and Ways of Coping questionnaire (WoC-scale). Results: At follow-up, 37.7% were diagnosed with a depressive episode. A stronger external LoC and lower MMSE-NR score at baseline were in adjusted linear regression analysis significantly more associated to higher depressive symptom scores (MADRS). More use of problem-focused coping, a lower I-ADL functioning, but not emotion-focused coping at baseline were significantly associated with being depressed (ICD-10), at follow-up in adjusted logistic regression analysis. Conclusion: LoC and coping strategies at baseline were associated with the prognosis of depression at follow-up, and may further be studied as indicators for choice of baseline intervention strategies.

Background:Nursing home (NH) residents are in most cases in older ages and use prescriptiondrugs. As alcohol interacts with many commonly prescribed drugs, NH residents may be morevulnerable to the effects of alcohol.Aim:To investigate the experiences of health professionals inNorwegian NHs when it comes to residents’ alcohol consumption and use of psychotropic drugs,and the facilitation of such use in the NH.Method:Focus-groups and individual interviews withNH health professionals were performed in 2017 and 2018. The data were analysed using contentanalysis.Findings:Two main themes emerged: (1) the balancing of alcohol consumption, and (2)the use of psychotropic drugs. Each of these themes involved reasoning, which revealed that theinformants in general had little attention regarding alcohol consumption among residents, and fewinstitutions had policies regarding serving and consumption of alcohol. The informants reported anincreased attention regarding use of psychotropic drugs and a tendency towards less use ofpsychotropic drugs among the residents than before, but few informants reported use of stan-dardised observations tools of symptoms related to prescribing and discontinuation of drugs.Conclusion:Alcohol policies or procedures related to alcohol consumption were uncommon atthe NH that the interviewees of this study represented, and the professionals regarded infrequentserving and consumption of alcohol among the residents as a part of everyday life. In cases whenresidents frequently consumed alcohol, the professionals used dialogue to underpin the adherentrisks and they also tried to control the consumption of the resident in different ways. Theinterviewees were aware of various side-effects of psychotropic drugs; they were also aware oftheir effects in combination with alcohol. https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

BACKGROUND: Little is known about factors associated with alcohol consumption and use of drugs with addiction potential in older adults. The aim of this study was to explore the association between socio-demographic variables, physical and mental health and the later (11 years) use of frequent drinking, prescribed drugs with addiction potential and the possible combination of frequent drinking and being prescribed drugs with addiction potential in older adults (≥ 65 years). METHODS: In this longitudinal study, we used data from two surveys of the Nord-Trøndelag Health Study (HUNT2 1995-1997 and HUNT3 2006-2008), a population based study in Norway. We totally included 10,656 individuals (5683 women) aged 54 years and older when they participated in HUNT2. Frequent drinking was defined as drinking alcohol 4 days or more per week. Data on prescribed drugs with addiction potential were drawn from the Norwegian Prescription Database. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. RESULTS: The typical frequent drinker in HUNT3 was younger, more educated, lived in urban areas, and reported smoking and drinking frequently in HUNT2 compared to the non-frequent drinker in HUNT3. The typical user of prescribed drugs with addiction potential in HUNT3 was an older woman who smoked and was in poor health, suffered from anxiety, had been hospitalized in the last 5 years and used anxiety or sleep medication every week or more often in HUNT2. The typical individual in HUNT3 with the possible combination of frequent drinking and being prescribed drugs with addiction potential had more education, smoked, drank frequently and used anxiety or sleep medication in HUNT2. CONCLUSION: Individuals who were identified as frequent drinkers in HUNT2 were more likely to be frequent drinkers in HUNT3, and to have the possible combination of frequent drinking and being prescribed drugs with addiction potential in HUNT3. Health care professionals need to be aware of use of alcohol among older adults using drugs with addiction potential. This project has been made possible by the Norwegian Extra Foundation for Health and Rehabilitation (https://www.extrastiftelsen.no/) through the Norwegian Council for Mental Health (http://www.psykiskhelse.no/) (2015/ FO5044). In addition, the project has been funded partly by the Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust (http:// www.aldringoghelse.no/). KT is a PhD fellow in this project and she received the funding. The funders had no role in the study design, data collection and analyses, decision to publish, or preparation of the manuscript

Background: Depressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time. Methods: In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study with three assessments over 36 months. Depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Clinical Dementia Rating Scale, diagnosis of dementia and mild cognitive impairment, general medical health, personal and instrumental activities of daily living, neuropsychiatric symptoms and the use of psychotropic medication were evaluated during the three assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. Results: The baseline prevalence and cumulative incidence of single depressive symptoms were higher in those with dementia at baseline than in those without dementia. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive impairment and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. Furthermore, being younger, female, in very poor physical health, with neuropsychiatric symptoms and not becoming a nursing home resident were associated with more depressive symptoms when assessed simultaneously. Conclusion: The baseline prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, as well as the relationship we found between the degree of cognitive decline and depressive symptoms over time show that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older adults receiving in-home care. Keywords: Cognitive decline, CSDD, Depressive symptoms, Depression, Domiciliary care, Elderly, Home care, Neuropsychiatric inventory, Symptom load, Physical disease Data collection was financed by the Norwegian Directorate of Health and Innlandet Hospital trust. The funders did not take part in the design of the study; collection, analysis, interpretation of data, or in writing the manuscript.

Study protocol. (PDF 61 kb)

Background Little is known about the validity of the Norwegian versions of the Geriatric Depression Scale-5 (GDS-5) and the Hospital Anxiety and Depression Scale-D (HADS-D). The aim of this study was therefor to validate the two assessment tools in a population of home-dwelling persons of 60 years of age and above. Methods A sample of 194 home-dwelling old adults with and without depressive symptoms were recruited. The participants were examined for depressive symptoms (GDS-5, HADS-D) and cognitive impairment. Sociodemographic information was collected. The participants underwent a blinded diagnostic evaluation for a depressive episode according to the diagnostic criteria of ICD-10. Results In all, 56 (28.9%) participants fulfilled criteria for a depressive episode according to ICD-10. The Receiver Operating Characteristics analyses of HAD-D and GDS-5 using the diagnostic criteria of ICD-10 for depression as gold standard was performed. For GDS-5 the Areal under the Curve was 0.81 and for HAD-D 0.75. The cut-off points of the measures that produced the highest accuracies were ≥2 for GDS-5 with a sensitivity of 73.2% and a specificity of 73.2% and ≥4 for HADS-D with a sensitivity of 70.3% and a specificity of 69.6%. Limitations A larger sample would have given the opportunity for analyzing home dwelling old adults with and without home health care separately. The participants were talked through the self-filling questionnaires. The procedure could have influenced the participants’ answers. Conclusion GDS-5 and HADS-D are useful screening tools for old adults, but only fairly good to identify depression according to criteria of ICD-10.

Background People with dementia describe experiences of loss that threaten their autonomy and ability to contribute to society. They often have difficulties with orientation, loss of roll function, and fear about the future, and need help from others. An increasing body of literature also focuses on how people with dementia search for meaning and maintaining of quality to life, and how they find strategies to live with dementia. A review of the scientific literature on coping and dementia is warranted and can help to advice and inform healthcare personnel and decision makers on how they can support and plan for appropriate healthcare services for people with dementia. The aim of this systematic meta-synthesis was therefore to interpret and synthesize knowledge regarding people with dementia’s experience of coping. Methods We conducted a systematic, computerised search of Medline, Embase, Cinahl Complete, PsycINFO and Age Line combining MeSH terms and text words for different types of dementia with different descriptions of experience. Studies comprised 1) a sample of people with dementia, 2) a qualitative interview as a research method and 3) a description of experiences of coping were included. The search resulted in 7129 articles, of which 163 were read in full text, 80 were excluded due to the exclusion criteria or low quality according. The analysis was conducted in line with qualitative content analyses. Results This interpretative qualitative meta-synthesis included 74 articles of good quality encompassing interviews with 955 persons with dementia. The material revealed two main resources of coping: (1) Humour and (2) Practical and emotional support, and four overall strategies in which people with dementia cope with the challenges they experience: (1) Keep going and holding on to life as usual; (2) Adapting and adjusting to the demands from the situation; (3) Accepting the situation; and (4) Avoiding the situation A comprehensive understanding of the categories led to the latent theme: Balancing the struggle of living with dementia. Conclusion This meta-synthesis indicates that people with dementia cope in different ways and using several parallel strategies. This insight is essential in dementia care to facilitate a supportive environment.

ObjectivesThe primary objective was to investigate the prevalence and factors associated with elevated alcohol consumption among older adults 65 years and above in China and Norway. The secondary objective was to compare the prevalence and factors in the two countries.DesignA secondary data analysis was conducted using two large cross-sectional studies (Chinese Longitudinal Healthy Longevity Survey data in 2008–2009 and Nord-Trøndelag Health Study data in 2006–2008).ParticipantsA total of 3223 (weighted) Chinese older adults and 6210 Norwegian older adults who responded drinking alcohol were included in the analysis.Outcome measuresThe dependent variable was elevated alcohol consumption, which was calculated as a ratio of those with elevated drinking among current drinkers. Multivariable logistic regression was used to test the dependent variable.ResultsThe prevalence of elevated alcohol consumption among current drinkers for the Chinese and Norwegian samples were 78.3% (weighted) and 5.1%, respectively. Being male was related to a higher likelihood of elevated alcohol consumption in both Chinese and Norwegian samples (OR=2.729, 95% CI 2.124 to 3.506, OR=2.638, 95% CI 1.942 to 3.585). Being older, with higher levels of education and a living spouse or partner were less likely to have elevated drinking in the Chinese sample (OR=0.497, 95% CI 0.312 to 0.794, OR=0.411, 95% CI 0.260 to 0.649, OR=0.533, 95% CI 0.417 to 0.682, respectively). Among Norwegian older adults, a higher level of education was related to higher likelihood of elevated drinking (OR=1.503, 95% CI 1.092 to 2.069, OR=3.020, 95% CI 2.185 to 4.175). Living in rural areas and higher life satisfaction were related to lower likelihood of elevated drinking in the Norwegian sample (OR=0.739, 95% CI 0.554 to 0.984, OR=0.844, 95% CI 0.729 to 0.977, respectively).ConclusionsThe elevated alcohol consumption patterns were strikingly different between China and Norway in regards to prevalence and socioeconomic distribution. To develop and implement culturally appropriate public health policies regarding alcohol in the future, public health policy makers and professionals need to be aware of the cultural differences and consider the demographic, social and economic characteristics of their intended population.

Tables S1, S2_1, S2_2, S2_3 and S2_4. Table S1 shows effect on location on use of psychotropic drugs with covariates measured at baseline or at the same time-point. Table S2_1, S2_2, S2_3 and S2_4 shows interpretation of the interaction term in the model for use of Antipsychotics, Antidepressants, Anxiolytics and Sedatives, respectively. (DOCX 47 kb)

Aim To estimate the prevalence of toileting difficulties over time among older people (≥70 years) with and without dementia receiving formal in‐home care at baseline and to explore whether dementia at baseline was associated with toileting difficulties at the last assessment when adjusting for relevant covariates. We hypothesize that those with dementia have a higher prevalence and that baseline dementia is associated with toileting difficulties at last follow‐up. Design A longitudinal observational study with three assessments over 36 months. Older people (≥70 years) from 19 Norwegian municipalities with in‐home care needs were included. The participants and their next of kin were interviewed. Method In total, 1,001 (68% women) persons with a mean (SD) age 83.4 (5.7) years participated at baseline. Toileting difficulties were assessed using Lawton and Brody's Physical Self‐Maintenance Scale and Individual Nursing and Care Statistics. Information on physical comorbidity, number of prescribed drugs, cognitive function and formal care given was included. Dementia was diagnosed based on all information gathered. Results At all time points, toileting difficulties were more prevalent in people with than without dementia. In adjusted analyses, dementia at baseline was associated with toileting difficulties at the last assessment. Nursing home admission was associated with increased odds for toileting difficulties. © 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Objective Extensive research has documented the negative nutritional impact of head neck cancer (HNC) treatment, but few studies have addressed the patients' experiences. The purpose of this study was to describe how patients with HNC experience the nutritional situation and perceive nutritional support from diagnosis to the post‐treatment phase. Methods Patients with HNC were recruited from a randomised pilot study. Individual interviews were conducted after radiotherapy with 10 participants aged 49 – 70 years and analysed by qualitative content analysis. Results Undergoing surgery was experienced as a poor nutritional starting point for the upcoming radiotherapy. During radiotherapy, increasing side effects made the participants customise their meals to improve food intake. About halfway through radiotherapy, virtually no food intake was experienced and hospital admissions and initiations of tube‐feeding occurred in this period. Oral nutritional supplements were recommended for all, but eventually became unbearable to ingest. When radiotherapy was finally completed, the participants felt discouraged about the persistent side effects preventing them from resume eating. The participants missed tailored information about development of side effects and involvement of a dietitian when reflecting on the treatment‐period. Conclusion The comprehensive nutritional problems experienced by patients with HNC require early nutritional assessments and improved individually tailored nutritional support. © 2019 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

The reference range, limit of detection and total analytical coefficient of variation (CV) of biochemical methods used. (PDF 61 kb)

ObjectivesWomen with high body mass index (BMI) have increased risk for symptoms of anxiety and depression during pregnancy and postpartum. In this prespecified secondary analysis from the exercise training in pregnancy trial, our aim was to examine effects of supervised exercise during pregnancy on psychological well-being in late pregnancy and postpartum among women with a prepregnancy BMI ≥28 kg/m2.DesignSingle-centre, parallel group, randomised controlled trial.SettingUniversity Hospital, Norway.ParticipantsNinety-one women (age 31.2±4.1 years, BMI 34.5±4.2 kg/m2), 46 in the exercise group, 45 in the control group, were included in the trial.InterventionThe exercise group was offered 3 weekly supervised exercise sessions (35 min of moderate intensity walking/running and 25 min of resistance training), until delivery.Primary and secondary outcomes measuresPrimary analyses were based on intention to treat, with secondary perprotocol analyses. To assess psychological well-being, we used the ‘Psychological General Well-Being Index’ (PGWBI) at inclusion (gestational week 12–18), late pregnancy (gestational week 34–37) and 3 months postpartum. We assessed postpartum depression using the ‘Edinburgh Postnatal Depression Scale’ (EPDS).ResultsNumbers completed data collection: late pregnancy 72 (exercise 38, control 36), postpartum 70 (exercise 36, control 34). In the exercise group, 50% adhered to the exercise protocol. Baseline PGWBI for all women was 76.4±12.6. Late pregnancy PGWBI; exercise 76.6 (95% CI 72.2 to 81.0), control 74.0 (95% CI 69.4 to 78.5) (p=0.42). Postpartum PGWBI; exercise 85.4 (95% CI 81.9 to 88.8), control 84.6 (95% CI 80.8 to 88.4) (with no between-group difference, p=0.77). There was no between-group difference in EPDS; exercise 2.96 (95% CI 1.7 to 4.2), control 3.48 (95% CI 2.3 to 4.7) (p=0.55).ConclusionsWe found no effect of supervised exercise during pregnancy on psychological well-being among women with high BMI. Our findings may be hampered by low adherence to the exercise protocol.Trial registration numberNCT01243554

BACKGROUND: The aim of this study was to investigate whether frequent drinking, use of drugs with addiction potential and the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older adults. METHODS: We used data from the Nord-Trøndelag Health Study (HUNT3 2006-08), a population-based study in Norway. A total of 11,545 (6,084 women) individuals 65 years and older at baseline participated. We assessed frequent drinking (≥ 4 days a week), occasional drinking (i.e. a few times a year), never drinking and non-drinking in the last year. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. This information was drawn from the Norwegian Prescription Database. The main outcome was all-cause mortality with information drawn from the Norwegian Cause of Death Registry. Follow-up continued until death or latest at 31 December 2013. Logistic regression analyses were used to investigate all-cause mortality since date of study entry and exact age at time of death was unknown. RESULTS: The adjusted logistic regression analyses showed that frequent drinking was not associated with all-cause mortality compared to occasional drinking. Men who reported to be never drinkers and non-drinkers in the last year had higher odds of mortality compared to those who drank occasionally. Use of prescribed drugs with addiction potential was associated with increased mortality in men, but not in women. No association was found between the possible combination of frequent drinking and use of prescribed drugs with addiction potential and mortality. CONCLUSION: Neither frequent drinking nor the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older women and men. Use of prescribed drugs with addiction potential was associated with higher odds of mortality in men. This finding should lead to more caution in prescribing drugs with addiction potential to this group. This project has been made possible by the Norwegian Extra Foundation for Health and Rehabilitation (https://www.extrastiftelsen.no/) through The Norwegian Council for Mental Health (http://www.psykiskhelse.no/) (2015/FO5044 to KT). In addition, the project has been funded partly by the Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust (http://www. aldringoghelse.no/) (185106 to KT). The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript.

Calculation of free and bioavailable 25(OH)D. (PDF 469 kb)

Background The purpose was to study hearing aid (HA) use in persons 65 years and older, and to investigate how socioeconomic and hearing related factors were associated to use of HA. Method This study included 11,602 persons (65 years and above) from the second Nord-Trøndelag Health Study (HUNT2) and the integrated North-Trøndelag hearing loss study (NTHLS) in 1995–1997. Audiometry was taken of all participants. Missing information about use of HA in possible users of HA existed in data from 1103 (9.5 %) of the participants. Effects of sociodemographic variables, low, medium and high frequency hearing thresholds and being bothered by their hearing were explored in men and women, adjusting the effects for each other. Cross tabulations and logistic regression analyses were used. Results In all, 14 % (1472 of 10,499) were users of HA, but 62 % had a mean hearing impairment (HI) based on 0.5, 1, 2, 4 kHz over both ears >25 dB. Use of HA was associated with higher education. Adjusting for all covariates and hearing variables, each 10 dB medium frequency threshold shift increased the chance of HA-use by a factor of two-three in both men and women. Having reported being bothered by hearing loss additionally increased the chance around sevenfold. Low frequency hearing thresholds were not associated with HA-use in women. In men, low frequency hearing thresholds up to 50 dB increased odds for use of HA, but low frequency hearing thresholds ≥ 70 dB decreased odds for use of HA. Men living with a spouse had higher odds for using HA compared to men without a spouse. For women there is no difference between those with and without spouse in use of HA. Men and women without spouse did not differ in their use of HA. Conclusions About two third of 65 years and older participants had a HI higher than 25 dB, but only one seventh used HA. Use of HA was associated with higher than basic education. Men without a spouse were less likely to use HA compared to men with a spouse.

We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS) in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163) and 2010/2011 (n = 1,858). Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR) sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia. © 2016 The Author(s) Published by S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).

To assess the frequency and factors associated with posttraumatic olfactory dysfunction, including anosmia, in a follow-up of patients with moderate and severe traumatic brain injury (TBI).The setting was a cross-sectional study of patients that were consecutively included in the Trondheim TBI database, comprising injury-related variables. Eligible participants 18-65 years were contacted 9-104 months post trauma and asked olfactory-related questions. Those reporting possible posttraumatic change of olfaction were invited to further examination using the Sniffin' Sticks panel.Of 211 eligible participants, 182 (86.3%) took part in telephone interviews and 25(13.7%) were diagnosed with olfactory dysfunction. 60% of these, or 8.2% of all participants, had anosmia. In age-adjusted logistic regression analyses, fall (OR 2.5, 95% CI 1.0-6.2), skull base fracture (OR 2.9, 95% CI 1.2-7.1) and cortical contusion(s) (OR 6.0, 95% CI 2.1-17.3) were associated with olfactory dysfunction. In an analysis of anosmia, fall (OR 3.4, 95% CI 1.1-10.6) and cortical contusion(s) (OR 19.7, 95% CI 2.5-156.0) were associated with the outcome.Of the study participants 13.7% had olfactory dysfunction and 8.2% had anosmia. Higher age, trauma caused by fall and CT displaying skull base fracture and cortical contusion(s) were related to olfactory dysfunction.

Background:We aimed to assess whether there were any changes in the use of psychotropic drugs in Norwegian nursing homes between 2004 and 2011. Also, we investigated whether the predictors of use of specific psychotropic drug groups have changed.Methods:We conducted a secondary analysis of two cohort studies of two Norwegian nursing home samples (2004/05 and 2010/11). Multivariate models were applied.Results:We found a significant decrease in the prescription of antipsychotic drugs between 2004 and 2011 (0.63 OR, 95%CI = 0.49–0.82, p < 0.001) even after adjusting for relevant demographic and clinical variables. There are only minor changes for the other psychotropic drugs. We found that (1) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with more affective symptoms and (2) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with lower scores on the Physical Self-Maintenance scale.Conclusion:This is the first study to show a robust decrease in antipsychotic drug use in nursing home patients with dementia unrelated to possible changes in case mix. The change might be explained by treatment recommendations against its use except in the most severe conditions of aggression or psychosis. Our findings indicate that it takes several years to implement scientific knowledge in clinical practice in nursing homes.

Objectives: We described the duration from symptom debut to assessment at specialist healthcare outpatient clinics for dementia in Norway and explored whether educational level was associated with time from symptom debut to dementia assessment. Methods: The study comprised 835 persons from a register for individuals with cognitive symptoms (NorCog). The outcome variable was time in months from symptom debut to assessment. The main independent variable was the number of years of education. Also age, gender, marital status, cognitive function, neuropsychiatric symptoms, assistance and location were assessed. Results: In an adjusted linear mixed model, a higher educational level was associated with a longer duration from symptom debut to assessment, where 5 additional years of education increased the time from symptom debut to consultation by 10%. Conclusion: The findings may perhaps be explained by the hypothesis that highly educated people may be able to compensate better for cognitive impairment, which is in line with a hypothesis of cognitive reserve. © 2018 The Author(s) Published by S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense).

Background The primary goal of this study is to compare pre- and postoperative symptoms and health related quality of life (HQOL) in 57 patients who underwent septoplasty (group-1), 56 patients who underwent septoplasty combined with radiofrequency therapy of inferior turbinates (RFIT) (group-2) and 58 patients who underwent RFIT alone (group-3). The secondary goal is to investigate if the change in symptoms and HQOL differed between these three patient groups after surgery. Methods All patients reported symptoms on a visual analogue scale (VAS) and HQOL on Sino-Nasal-Outcome-Test-20 (SNOT-20) and Short-Form-Health-Survey-36 (SF-36) before and 6 months after surgery. The pre- and postoperative scores and improvement were compared within and between the three patient groups. Results Preoperatively the three patient groups had a fairly similar symptom burden and HQOL, except for group-1 which reported more symptoms of oral breathing than group-3 (p

Response letter. (DOCX 18 kb)

BACKGROUND: Dementia and physical morbidity are primary reasons for nursing home admission globally. However, data on physical morbidity in nursing home residents with and without dementia are scarce. The first aim of the present study was to explore whether presence and severity of dementia were related to the number of physical diagnoses in nursing home residents. The second aim was to explore if the severity of dementia was associated with having registered the most frequent complexes of physical diagnoses when controlling for physical health and demographic factors. METHODS: A total of 2983 Norwegian nursing home residents from two cross-sectional samples from 2004/2005 and 2010/2011 were included in the analysis. By the use of assessment scales, the severity of dementia (Clinical Dementia Rating), physical health (General Medical Health Rating), activities of daily living (Physical Self-Maintenance Scale) and neuropsychiatric symptoms (Neuropsychiatric Inventory Nursing Home) were determined. Physical diagnoses and medications were assembled from the medical records. The physical diagnoses were categorized into complexes, using the ICD-10 chapters. Linear mixed models and generalized linear mixed models were estimated. RESULTS: Residents with dementia were registered with fewer physical diagnoses than residents without dementia. The frequency of physical diagnoses decreased with increasing severity of dementia. Cardiovascular, musculoskeletal and endocrine, nutritional and metabolic diagnoses were the most common complexes of physical diagnoses in individuals with and without dementia. The odds of having cardiovascular and musculoskeletal diagnoses increased for males and decreased for females with increasing severity of dementia, in contrast to endocrine diagnoses where the odds increased for both genders. CONCLUSION: Increasing severity of dementia in nursing home residents may complicate the diagnostics of physical disease. This might reflect a need for more attention to the registration of physical diagnoses in nursing home residents with dementia. Unrestricted grants from the Eastern Norway Regional Health authorities and Innlandet Hospital trust funded the data collection. The funding did not influence the collection, analysis or interpretation of any data. In the present study of previously collected data, the analysis and preparation of the manuscript were done without any funding.

Background Identifying how persons with dementia experience lived space is important for enabling supportive living environments and creating communities that compensate for the fading capabilities of these persons. Several single studies have explored this topic; however, few studies have attempted to explicitly review and synthesize this research literature. The aim of this systematic meta-synthesis was therefore to interpret and synthesize knowledge regarding persons with dementia’s experience of space. Methods A systematic, computerized search of AgeLine, CINAHL Complete, Embase, Medline and PsycINFO was conducted using a search strategy that combined MeSH terms and text words for different types of dementia with different descriptions of experience. Studies with 1) a sample of persons with dementia, 2) qualitative interviews as a research method and 3) a description of experiences of lived space were included. The search resulted in 1386 articles, of which 136 were identified as eligible and were read and assessed using the CASP criteria. The analysis was inspired by qualitative content analyses. Results This interpretative qualitative meta-synthesis included 45 articles encompassing interviews with 672 persons with dementia. The analysis showed that living in one’s own home and living in long-term care established different settings and posed diverse challenges for the experience of lived space in persons with dementia. The material revealed four main categories that described the experience of lived space: (1) belonging; (2) meaningfulness; (3) safety and security; and (4) autonomy. It showed how persons with dementia experienced a reduction in their lived space due to the progression of dementia. A comprehensive understanding of the categories led to the latent theme: “Living with dementia is like living in a space where the walls keep closing in”. Conclusion This meta-synthesis reveals a process whereby lived space gradually becomes smaller for persons with dementia. This underscores the importance of being aware of the experiences of persons with dementia and the spatial dimensions of their life-world. To sustain person-centred care and support the preservation of continuity and identity, one must acknowledge not only the physical and social environment but also space as an existential experience for persons with dementia. © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

Purpose: Septoplasty and radiofrequency therapy for inferior turbinate hypertrophy (RFIT) are common techniques used to improve nasal patency. Our aim was to compare nasal geometry and function using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) in three patients groups undergoing surgery for nasal obstruction, and to investigate if the improvement in minimal-cross-sectional-area (MCA) and nasal-cavity-volume (NCV) occurred in different nasal cavity areas in the groups. Finally, we evaluated the correlation between the objective measurements and the patients’ assessment of nasal obstruction (SNO). Methods: This prospective, observational study investigated 148 patients pre-operatively and 6 months post-operatively. Fifty patients underwent septoplasty (group 1), 51 underwent septoplasty combined with RFIT (group 2), and 47 underwent RFIT alone (group 3). The minimal-cross-sectional-area (MCA) and nasal-cavity-volume (NCV) were measured at two distances (MCA/NCV0-3.0 and MCA/NCV3-5.2), in addition to measuring PNIF and SNO. Results: Pre-operatively, groups 1 and 2 had narrower MCA0-3.0 on one side than group 3 [0.31± 0.14 and 0.31± 0.14] versus [0.40 ± 0.16] cm2. Post-operatively, total MCA0-3.0 and MCA/NCV3-5.2 increased in group 1. In group 2, MCA/NCV0-3.0 at the narrow side and total MCA/NCV3-5.2 increased, while total MCA/NCV3-5.2 increased in group 3. PNIF improved from 106 ± 49 l/min to 150 ± 57 l/min post-operatively. We found a correlation between increased MCA and NCV and less SNO in the septoplasty group (p

The study builds on the concept of united airways, which describes the link between the upper and lower airways. Explorations of this concept have mainly related to asthma and less to chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate paranasal sinus opacification at magnetic resonance imaging (MRI) in COPD, self-reported asthma and respiratory symptoms. In this cross-sectional study, 880 randomly selected participants in the Nord-Trøndelag health survey (HUNT) (mean age 57.7 years, range 50-66 years, 463 women) were investigated using MRI of the paranasal sinuses. Participants were allocated to four mutually exclusive groups: (1) COPD (n = 20), (2) asthma (n = 89), (3) respiratory symptoms (n = 199), and (4) reference group (n = 572). Paranasal sinus opacifications were categorised as mucosal thickening, polyps and retention cysts, and fluid. In each participant, measurements ≥1 mm from all sinuses were summed to give a total for each category of opacities. The sums for these three categories were further added together, and referred to as the total sum. Using the 75th percentile cut-off values, the likelihood of having paranasal sinus opacifications was more than six times higher in participants with COPD and twice as high in participants with asthma than among the reference group. Respiratory symptoms were only associated with mucosal thickening. The present study shows that paranasal sinus opacification is associated not only with asthma, but also with COPD and respiratory symptoms. This is in accordance with the united airways hypothesis, and should be kept in mind when handling patients with these conditions.

Background Studies revealed that misuse of drugs and alcohol is an increasing phenomenon among older people (aged 65 years and above), and we know that such misuse is a risk factor for mortality and morbidity. Furthermore, we do not know to what extent older people have experiences, understanding and knowledge about the use and misuse of alcohol and psychotropic drugs. Aim To investigate older peoples' experiences with and reflections on the use and misuse of alcohol and psychotropic drugs among older people. Method Qualitative interviews with 16 older people were performed during 2013 and 2014. The sample included informants aged from 65 to 92 years from 11 municipalities. The data were analysed by using the phenomenological hermeneutic method. Findings The first theme that arose from the informants' narratives was to be a part of a culture in change that details the informants' experiences with and reflections on the cultural changes regarding the use and misuse of alcohol and psychotropic drugs. This theme is divided into three subthemes: to use and attitudes toward use, to trivialise use and risks of use, and to disclaim responsibility for use and misuse. The second theme, to explain use and misuse involved reasons for the use and misuse of alcohol and psychotropic drugs. It included the subthemes: to be afraid, to be lonely, and to be informed. Conclusion The study revealed that most informants had experiences with the use of alcohol and psychotropic drugs, but disclaimed any challenges with their use. The use was trivialised and seen as something older people just do. They disclaimed responsibility for their own psychotropic use as their general practitioners were defined as the responsible persons. Moreover, the study showed that the informants had poor knowledge about the risk of use and misuse of alcohol and psychotropic drugs.

Summary Background & aims Malnutrition is an important issue in patient outcome. Screening tools to find risk patients need to be evaluated. This study looks at the validity and reliability of nutritional risk screening (named NRS-2002) in hospitalized patients with chronic heart failure. Methods In this cross-sectional study nutritional screening was performed using NRS-2002 in 131 patients with chronic heart failure. The predictive validity was evaluated in relation to whether NRS-2002 predicted the incidence of complications and length of hospital stay. NRS-2002's ability to locate nutritional risk in patients with edema was evaluated. The inter-rater reliability was measured between three investigators screening 45 patients each. Results The prevalence of nutritional risk was 57%. The incidence of complications and the median length of hospital stay were significantly higher in patients at nutritional risk compared to patients not at nutritional risk. Only the component of severity of disease in NRS-2002 and not the component of the nutritional status was associated with increased length of hospital stay in multivariate analysis. Patients with edema were classified correctly regarding nutritional risk status by NRS-2002 in all but one occasion. The inter-rater reliability was documented, kappa >0.60. Conclusion NRS-2002 was a reliable screening tool in an in-patient sample with chronic heart failure. The validity of NRS-2002 needs further investigation in a larger sample of hospitalized patients with chronic heart failure.

Background/Aims: The aim of this study was to compare the presence and severity of dementia in two large cross-sectional samples of nursing home residents from 2004/2005 and 2010/2011. Methods: Demographic information as well as data on the type of nursing home unit, length of stay before assessment, physical health, regularly used prescribed drugs and Clinical Dementia Rating scale scores were used in the analyses. Logistic and linear regression models for hierarchical data were estimated. Results: The odds of the occurrence and of a greater severity of dementia were higher in 2010/2011 than in 2004/2005. Independent of the time of study, married men had more severe dementia than single men, and single women had more severe dementia than single men. Conclusion: The findings may reflect the increase in the need for more nursing home beds designed for people with dementia between 2004/2005 and 2010/2011.

Background: Use of restraint and finding the balance between security and ethics is a continuous dilemma in clinical psychiatry. In daily clinic and in planning health-care service, knowledge on the characteristics of restraint situations is necessary to optimize its use and avoid abuse. Methods: We describe characteristics in the use of pharmacological and mechanical restraint in psychiatric acute wards in a hospital in Middle Norway over an eight-year period. Data on all cases of mechanical and pharmacological restraint from 2004 to 2011 were retrospectively collected from hand-written protocols. Complementary information on the patients was obtained from the hospital patient administrative system. Results: Restraint in acute wards was used on 13 persons per 100,000 inhabitants annually. The percentage of admitted patients exposed to restraint was 1.7%, with a mean of 4.5 cases per exposed patient. Frequency per 100 admitted patients varied from 3.7 (in 2007) to 10 (in 2009). The majority of restraint cases concerned male patients under 50 years and with substance-abuse, psychotic, or affective disorders. Significantly more coercive means were used during daytime compared to night and morning. There was a significant increase in pharmacological coercion during spring and mechanical coercion during summer. Conclusions: Restraint was used on 1.7% of admitted patients, representing 13 per 100,000 inhabitants per year. Use of restraint was higher during certain periods of the day and was associated with the patient’s diagnosis, age, gender, and legal status of hospitalization. There was a marked variation over the years. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Background Little is known about the consumption habits of older adults in Norway with respect to alcohol and the use of drugs with addiction potential, such as benzodiazepines, z-hypnotics and opioids, among regular drinkers. We studied the prevalence of self-reported consumption of alcohol on a regular basis in community-living older men and women (≥ 65 years). Furthermore, we investigated the prevalence of dispensed prescribed drugs with addiction potential in older men and women who were regular drinkers. Methods We used data from the Nord-Trøndelag Health Study 2006–2008 (HUNT3). Of 12,361 older adults in the HUNT3 study, 11,545 had answered the alcohol consumption item and were included in our study. Regular drinkers were defined as consuming alcohol one or more days a week. Data on dispensed drugs with addiction potential were drawn from the Norwegian Prescription Database. Addiction potential was defined as at least one prescription for benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years. Results In total 28.2% of older Norwegian adults were regular drinkers. Men in the study were more likely to be regular drinkers than women. Drugs with addiction potential were used by 32.4% of participants, and were more commonly used by women. Nearly 12% of participants used benzodiazepines, 19% z-hypnotics and 12.4% opioids. Among regular drinkers, 29% used drugs with addiction potential, which was also more common among women. Adjusted for age, gender and living situation, use of z-hypnotics was associated with regular alcohol intake, while use of opioids was associated with no regular alcohol intake. Conclusion The prevalence of the use of drugs with addiction potential was high in a Norwegian population of older adults who reported regular consumption of alcohol. Strategies should be developed to reduce or prevent alcohol consumption among older adults who use drugs with addiction potential. Use of alcohol and drugs with addiction potential among older women and men in a population-based study. The Nord-Trøndelag Health Study 2006-2008 (HUNT3) This project has been made possible by the Norwegian Extra Foundation for Health and Rehabilitation (https://www.extrastiftelsen.no/) through The Norwegian Council for Mental Health (http://www.psykiskhelse.no/) (2015/FO5044). In addition, the project has been funded partly by the Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust (http://www. aldringoghelse.no/). KT is a phd-fellow in this project and she received the funding. The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript.

Background: Increased awareness among health professionals regarding older people’s alcohol and prescribed psychotropic drug use may be beneficial for reducing their unhealthy consumption among elderly. Aim: This study explores how health professionals experienced their participation in a study in which they collected data on alcohol and psychotropic drug use among patients treated in old-age psychiatry departments and, subsequently, how they experienced their work day after the study ended. Method: Focus-group and individual interviews with 15 professionals in specialist psychiatric hospitals were performed in 2016. The data were analysed using content analysis. Results: Two themes emerged from the data: the informants’ “experiences with participation” and “consequences of participation”. These themes described how the informants had experienced their participation in the study and whether these experiences subsequently affected their work routines. The first theme included two subthemes: “approaching the topic” covered the challenges and “applying assessment scales” described the participants’ opinions about the scales. Two subthemes were included in the second theme: “increasing knowledge”, which covered their reflections on new knowledge; and “influencing work routines”, which described their new approach to the topic. Conclusion: Study participation positively affected the informants’ work routines regarding alcohol and psychotropic drug use. The results of this study may contribute to a better understanding, development, and organization of services for people with increased substance use and thus may more holistically promote the health of older people. (C) The Author(s) 2017. Creative Commons CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Objective Prevention of type 2 diabetes mellitus is possible through lifestyle programs, but the effect depends on the program's content, resources, and setting. Lifestyle programs are often confronted with high rates of non-participation and attrition. This study invited individuals at high risk for type 2 diabetes to a lifestyle program in the Norwegian primary healthcare setting. The aims were to investigate possible differences in characteristics between participants and non-participants and to study the effect of the lifestyle program at 24-month follow-up for participants. Research design and methods Individuals identified at high risk for type 2 diabetes during the third survey of the Nord-Trøndelag Health Study (HUNT3) from two municipalities (n=332) were invited to a lifestyle program (the VEND-RISK Study). A cross-sectional design was used to explore if the participants’ characteristics differed from non-participants. A non-randomized, single-arm, pre–post examination was used to examine the effect of the lifestyle program on participants’ characteristics at 24-month follow-up. Results Of all individuals at high risk for type 2 diabetes invited to the lifestyle program, 86% (287/332) declined to participate. Non-participating women had fewer years of education (p

Background The prevalence of psychotropic drug (PTD) use in NH residents is high, but few have explored prevalence and persistency in PTD in NH residents and factors associated with persistency. This at the same time as we know that risk of side events may be higher with long- term use in older adults. Thus, the aim of this study was to describe the prevalence and persistence in use of PTD and to explore factors associated with persistence in use of PTD at two consecutive time points in nursing home (NH) residents. Methods We included 1163 NH residents in a 72-month longitudinal study with five assessments. Use of PTD, neuropsychiatric symptoms (NPS), severity of dementia and physical health were assessed each time. Results The prevalence over time and persistent use of antipsychotic drugs, antidepressants, anxiolytics and sedatives at two consecutive time points were high in residents with and without dementia. There was an association between greater NPS at the first time point, and persistent use of these drugs, but changes in NPS between time points, did not explain such use. A longer NH stay increased the odds for persistent use of antipsychotics. Conclusion Psychotropic drugs are frequently used as a long-term treatment among NH residents and are associated with severity of neuropsychiatric symptoms, but not with severity of dementia. Closer attention should be paid to follow-up of psychotropic drug treatment, and especially for long –term use of antipsychotics, since the duration of such treatment should be as short as possible.

Background: Although alcohol and prescribed psychotropic drug use has increased among older people, the usefulness of information provided about these substances in patients’ referrals to departments of old-age psychiatry (OAPsy) is unknown. Aims: To examine whether patients’ self-reported elevated use of alcohol and prescribed psychotropic drugs corresponds with information provided in the referrals to OAPsy departments and to explore the factors associated with elevated self-reported use of these substances. Methods: We recorded the information provided in referrals about the elevated use of alcohol and psychotropic drugs in a sample of 206 patients (69 men) from 12 OAPsy departments. The Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) helped to assess self-reported use. We also collected demographic data, as well as information about cognitive functioning and symptoms of anxiety and depression. Results: Seventy-three patients (35%) scored above the cut-off for alcohol use for women/men (AUDIT ≥ 3/4) or psychotropic drugs (DUDIT ≥ 6/8), if not both. Twenty patients (10%) reported an elevated use of both alcohol and psychotropic drugs, and the referrals for eight (40%) and ten (50%) of them, respectively, included information about this use. There was a significant association between self-reported use of alcohol above the cut-off and information about elevated use in the referrals. However, no such association was found between information in the referrals and self-reported use of prescribed psychotropic drugs. Elevated alcohol use was associated with more years of education, while elevated use of psychotropic drugs was associated with younger age and severe symptoms of anxiety and depression. Conclusion: The information reported in referrals about the elevated use of alcohol and psychotropic drugs demonstrated a trend in associations with self-reported use. However, the risk factors for elevated use of alcohol and psychotropic drugs in the elderly need to be examined further. ©The Author(s) 2017. Creative Commons CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Background There is little knowledge about the consumption of alcohol among Chinese and Norwegian older adults aged 65 years and over. The aim of this study was to investigate the prevalence and factors related to alcohol consumption among older adults in China and Norway. Methods The Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2008–2009 conducted in China and The Nord-Trøndelag Health Study data in 2006–2008 (HUNT3) conducted in Norway were used. Mulitvariable logistic regression was used to test the factors related to alcohol consumption. Results The prevalence of participants who drink alcohol in the Chinese and Norwegian sample were 19.88% and 46.2%, respectively. The weighted prevalence of participants with consumption of alcohol in the Chinese sample of women and men were 7.20% and 34.14%, respectively. In the Norwegian sample, the prevalence of consumption of alcohol were 43.31% and 65.35% for women and men, respectively. Factors such as younger age, higher level of education, living in urban areas, living with spouse or partner, and better health status were related to higher likelihood of alcohol consumption among Norwegian older women and men; while reported better health status and poorer life satisfaction were related to higher likelihood of alcohol consumption among Chinese. In addition, rural males and older females with higher level of education were more likely to consume alcohol. Conclusion The alcohol consumption patterns were quite different between China and Norway. Besides economic development levels and cultures in the two different countries, demographic characteristics, socioeconomic status, overall health status, and life satisfaction were associated with alcohol consumption as well. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Background To investigate health personnel's perceptions and experiences of alcohol and psychotropic drug use among older people (65 years and above) and to what extent this is an issue when services are planned for and implemented. Method Qualitative interviews with 16 health professionals who work with older patients, 13 registered district nurses, two occupational therapists and one physiotherapist, were performed during 2013. The sample included informants aged 34–62 years from 14 municipalities, four were male. Findings Two main categories emerged: state of practice and a desire to improve services. The first category details the informants' perceptions of legitimacy and attention to substance use and misuse among older people in need of healthcare, and their competence and knowledge on the topic. The topic was experienced as demanding to bring up. Health personnel described a lack of attention and competence how to handle use and misuse of alcohol and psychotropic drugs. The category is described in the subcategories legitimacy and attention to substance use and misuse and competence and knowledge in practice. The second category demonstrates the informants' desire to improve services so it better can contribute to detect misuse among older people and contribute to treatment. The variation is contained in the subcategories improving collaboration and changing routines. Conclusion Use and misuse of alcohol and psychoactive drugs among older people had little attention when the community health service is planned for and implemented. The participating health professionals had a desire to improve routines and collaboration in the healthcare services, but were also in need of improved competence about use and misuse of alcohol and psychoactive drugs.

The aim of the study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older people receiving in-home care, and to explore the association between cognitive function and the course of depressive symptoms. In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study over 36 months. Depressive symptoms, cognitive function, general medical health, activities of daily living, neuropsychiatric symptoms and use psychotropic drugs were assessed at three assessments. Dementia and mild cognitive impairment were diagnosed at all assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. We found the prevalence and cumulative incidence of individual depressive symptoms to be higher in those with dementia at baseline than in those without. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive decline and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. In conclusion: The differences in prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, and the association found between degree of cognitive decline and depressive symptoms over time shows that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older people receiving in-home care.

Aim: The purpose was to explore the possible associations between measured hearing thresholds and work related disability pension granted for other medical reasons in a Norwegian population. Method: This study included 25,537 persons from the Nord-Trøndelag Health Study (HUNT) aged 20–54 years at baseline in HUNT1 (1984–1986) who also participated in the follow-up study 11 years later, HUNT2 (1995–1997) that included a hearing examination. Logistic regression analyses of disability pension granted up to 1996 or earlier in life were conducted for men and women separately and in two age strata. Effects of low, middle and high-frequency hearing thresholds were explored, adjusting the effects of each hearing frequency for each other. Further adjustment was made for educational level, category of work (seven categories) and general health in HUNT1. Results: In all, 0.4% (16 of 4306) of the disability pensions granted up to 1996 was due to hearing related diagnoses. The risk of being granted disability pension up to 1996 with registered diagnoses not related to hearing loss increased with degree of loss of low-frequency hearing in young and middle-aged men and middle-aged women (OR 1.72, 95% CI 1.25–2.37; OR 1.16, 95% CI 1.04–1.30; OR 1.11, 95% CI 1.00–1.23). Conclusions: Hearing loss diagnoses are rarely reported as main causes in disability statistics, however, degree of hearing loss increased the risk of being granted with disability pensioning with diagnoses not related to hearing loss.

Aim: To examine perceived health of elderly medically hospitalized patients 1 year after hospitalization, and to explore factors associated with the perceived health at follow-up. Methods: A one-year follow-up study included 363 (175 men) elderly previously medical inpatients with age range 65–98 (mean 80.2, SD 7.5) years. Information was collected at baseline and follow-up, where perceived health – the dependent variable – was measured by one self-report item. The independent variables were assessed by the Hospital Anxiety and Depression scale (HAD), the Mini-Mental State Examination (MMSE), Lawton and Brody’s scales for physical self-maintenance and performance of the instrumental activities of daily living (PSMS and I-ADL). Results: The proportion of elderly people assessing their health as good at baseline was 43.3% ( n = 157) and at 12 months 41.3% ( n = 150). Of those with poor health at baseline, 34% ( n = 70) experienced good health at 12 months. In the analysis controlling for physical health, perceived health, physical and instrumental functioning, and depression at baseline, an increase in the level of physical and instrumental functioning and reduced symptom level of depression were independently associated with good perceived health at 12 months. Conclusions: Improvement in performing the activities of daily living and a reduction of depressive symptoms are important factors for the perception of health one year after hospitalization. The rehabilitation of medically ill elderly patients could be the means of achieving this improvement.

Prospective studies of whether sense of coherence (SOC) affects perceived health over time in cognitively intact older adults are rare. In the current study, we aimed to investigate the association between perceived health one year after hospitalization (T2) and SOC at baseline (T1) among persons aged 65 years or more without cognitive impairment. Patients at a public general hospital in Norway were followed up 1 year after inclusion. At T1, SOC, depression and anxiety, physical health and functional status were assessed. Hospitalizations between T1 and T2 were recorded. At T1 and T2 44 (44.0%) and 51 (52.5%), respectively, perceived their health as good. The odds for good perceived health at T2 were reduced in people who had been hospitalized between T1 and T2. Gender and SOC at T1 interacted on perceived health at T2; men with a low SOC and women with a medium high SOC had reduced odds for perceiving their health as good at T2. The SOC had limited importance for perceived health one year after hospitalization in this sample of older people. Thus, the importance of including SOC in rehabilitation programs after hospitalization is questionable.

Background Clinical guidelines for single diseases often pose problems in general practice work with multimorbid patients. However, little research focuses on how general practice is affected by the demand to follow multiple guidelines. This study explored Norwegian general practitioners’ (GPs’) experiences with and reflections upon the consequences for general practice of applying multiple guidelines. Methods Qualitative focus group study carried out in Mid-Norway. The study involved a purposeful sample of 25 Norwegian GPs from four pre-existing groups. Interviews were audio-recorded, transcribed and analyzed using systematic text condensation, i.e. applying a phenomenological approach. Results The GPs’ responses clustered around two major topics: 1) Complications for the GPs of applying multiple guidelines; and, 2) Complications for their patients when GPs apply multiple guidelines. For the GPs, applying multiple guidelines created a highly problematic situation as they felt obliged to implement guidelines that were not suited to their patients: too often, the map and the terrain did not match. They also experienced greater insecurity regarding their own practice which, they admitted, resulted in an increased tendency to practice ‘defensive medicine’. For their patients, the GPs experienced that applying multiple guidelines increased the risk of polypharmacy, excessive non-pharmacological recommendations, a tendency toward medicalization and, for some, a reduction in quality of life. Conclusions The GPs experienced negative consequences when obliged to apply a variety of single disease guidelines to multimorbid patients, including increased risk of polypharmacy and overtreatment. We believe patient-centered care and the GPs’ courage to non-comply when necessary may aid in reducing these risks. Health care authorities and guideline developers need to be aware of the potential negative effects of applying a single disease focus in general practice, where multimorbidity is highly prevalent. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/ The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Background: Knowledge about long-term change in health related quality of life (HQoL) among older adults after hospitalization for treatment of depression has clinical relevance. The aim was firstly to describe the change of HQoL one year after admission for treatment of depression, secondly to explore if improved HQoL was associated with remission of depression at follow-up and lastly to study how HQoL in patients with remission from depression were compared to a reference group of older persons without depression. Method: This study had the one year follow-up information of 108 older patients (≥60 years), all hospitalized for depression at baseline, and a reference sample of 106 community-living older adults (≥60 years) without depression. HQoL was measured using the EuroQol Group's EQ-5D Index and a visual analog scale (EQ-VAS). Depression and remission were diagnosed according to ICD-10. Socio-demographic variables (age, gender, and education), depressive symptom score (Montgomery-Aasberg Depression Rating Scale), cognitive functioning (Mini Mental State Examination scale), instrumental activities of daily living (the Lawton and Brody's Instrumental Activities of Daily Living Scale), and poor general physical health (General Medical Health Rating) were included as covariates. Results: HQoL had improved at follow-up for the total group of depressed patients, as indicated by better scores on the EQ-5D Index and EQ-VAS. In the multivariate linear regression model, improved EQ-5D Index and EQ-VAS was significantly better in those with remission of depression and those with better baseline physical health. In adjusted analyses, the HQoL in patients with remission from depression at follow-up did not differ from the HQoL in a reference group without depression. Conclusion: Older hospital patients with depression who experienced remission one year after admission gained HQoL and their HQoL was comparable with the HQoL in a reference group of older adults without depression when adjusting for differences in socio-demographics and health conditions. The data collection was funded by the participating Old Age Psychiatry Units in Norway. No funding was otherwise given for the present study.

Background The association between headache and paranasal sinus disease is still unclear. Because of symptom overlap, the two conditions are not easily studied on the basis of symptoms alone. The aim of the present study was to investigate whether paranasal sinus opacification on magnetic resonance imaging (MRI) was associated with migraine, tension-type headache (TTH) or unclassified headache. Methods This was a cross-sectional study of 844 randomly selected participants (442 women, age range 50–65 years, mean age 57.7 years). Based on 14 headache questions, participants were allocated to four mutually exclusive groups: migraine, TTH, unclassified headache or headache free. On MRI, opacifications as mucosal thickening, polyps/retention cysts and fluid in the five paired sinuses were measured and recorded if ≥1 mm. For each participant, opacification thickness was summed for each sinus and, in addition, a total sum of all sinuses was calculated. Opacification in each sinus was compared between headache-free participants and the headache groups using non-parametric tests, and the total sum was compared by logistical regression. Results No significant association was found between paranasal sinus opacification and headache in general, nor when headache was differentiated into migraine, TTH and unclassified headache. This was also true in separate analyses of mucosal thickening and fluid and of opacification from each paranasal sinus. Conclusion Migraine, TTH and unclassified headache were found not to be associated with an increased degree of paranasal sinus opacification at MRI.

Background Two of the most common types of young-onset dementia (