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  • 1.
    Bannon, Brittany L.
    et al.
    Univ Utah, Salt Lake City, USA.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Pedersen, Nancy L.
    Karolinska Inst, Stockholm, Sweden.
    Reynolds, Chandra A.
    Univ Calif Riverside, USA.
    Illness behaviors mediate the link between social support and functional decline in the Swedish Adoption Twin Study of Aging2018In: Annals of Behavioral Medicine, ISSN 0883-6612, E-ISSN 1532-4796, Vol. 52, no Suppl. 1, p. S314-S314Article in journal (Refereed)
  • 2.
    Berg, Stig
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Dahl, Anna
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Nilsson, Sven
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Cognitive decline and dementia2007In: Geropsychology: European perspectives for an aging world, Cambridge, Mass.: Hogrefe & Huber , 2007, p. 165-182Chapter in book (Other (popular science, discussion, etc.))
  • 3.
    Berg, Stig
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Dahl, Anna
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Nilsson, Sven
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Declive cognitivo y demencia2009In: PsicoGerontología: Perspectivas Europeas para un mundo que envejece / [ed] Rocio Fernández-Ballesteros, Madrid: Pirámide , 2009, p. 223-243Chapter in book (Other academic)
  • 4.
    Bogl, Leonie H.
    et al.
    Institute for Molecular Medicine FIMM, Finland and University of Helsinki, Finland.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karolinska Institutet, Sweden.
    Kaprio, Jaakko
    Institute for Molecular Medicine FIMM, Finland and University of Helsinki, Finland.
    Does the sex of one’s co-twin affect height and BMI in adulthood?: A study of dizygotic adult twins from 31 cohorts2017In: Biology of Sex Differences, ISSN 2042-6410, Vol. 8, no 1, article id 14Article in journal (Refereed)
    Abstract [en]

    Background: The comparison of traits in twins from opposite-sex (OS) and same-sex (SS) dizygotic twin pairs is considered a proxy measure of prenatal hormone exposure. To examine possible prenatal hormonal influences on anthropometric traits, we compared mean height, body mass index (BMI) and the prevalence of being overweight or obese between men and women from OS and SS dizygotic twin pairs.

    Methods: The data were derived from COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) database, and included 68,494 SS and 53,808 OS dizygotic twin individuals above the age of 20 years from 31 twin cohorts representing 19 countries. Zygosity was determined by questionnaires or DNA genotyping depending on the study. Multiple regression and logistic regression models adjusted for cohort, age and birth year with the twin type as a predictor were carried out to compare height and BMI in twins from OS pairs with those from SS pairs and to calculate the adjusted odds ratios and 95% confidence intervals for being overweight or obese.

    Results: OS females were, on average, 0.31 cm (95% confidence interval (CI): 0.20, 0.41) taller than SS females. OS males were also, on average, taller than SS males, but this difference was only 0.14 cm (95% CI: 0.02, 0.27). Mean BMI and the prevalence of overweight or obesity did not differ between males and females from SS and OS twin pairs. The statistically significant differences between OS and SS twins for height were small and appeared to reflect our large sample size rather than meaningful differences of public health relevance.

    Conclusions: We found no evidence to support the hypothesis that prenatal hormonal exposure or postnatal socialization (i.e., having grown up with a twin of the opposite sex) has a major impact on height and BMI in adulthood.

  • 5.
    Bokenberger, K.
    et al.
    Karolinska Institutet, Department of Medical Epidemiology & Biostatistics, Stockholm, Sweden.
    Sjölander, A.
    Karolinska Institutet, Department of Medical Epidemiology & Biostatistics, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karolinska Institutet, Department of Medical Epidemiology & Biostatistics, Stockholm, Sweden.
    Karlsson, Ida K.
    Karolinska Institutet, Department of Medical Epidemiology & Biostatistics, Stockholm, Sweden.
    Akerstedt, T.
    Stockholm University, Stress Research Institute, Stockholm, Sweden.
    Pedersen, N. L.
    Karolinska Institutet, Department of Medical Epidemiology & Biostatistics, Stockholm, Sweden.
    Midlife shift work and risk of incident dementia2017In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 40, p. A425-A425Article in journal (Refereed)
  • 6.
    Bokenberger, Kathleen
    et al.
    Karolinska Institutet.
    Pedersen, Nancy
    Karolinska Institutet.
    Gatz, Margaret
    University of Southern California.
    Dahl, Anna
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    The Type A behavior pattern and cardiovascular disease as predictors of dementia2014In: Health Psychology, ISSN 0278-6133, E-ISSN 1930-7810, Vol. 33, no 12, p. 1593-1601Article in journal (Refereed)
    Abstract [en]

    Objective: Research has suggested that greater psychophysiological reactivity to stress increases risk of dementia and that those with the Type A behavior pattern (TABP) are predisposed to elevated stress reactivity and cardiovascular disease (CVD), but no study has evaluated the associations among TABP, CVD, and dementia, prospectively. Hence, the present study aimed to investigate dementia risk in relation to TABP and CVD.

    Methods: A population-based cohort of 1,069 persons with a baseline mean age of 64.81 years from the Swedish Twin Registry was followed consecutively for up to 23 years. Based on self-reported items, TABP was measured using 6 scales: Ambition, Stress, Hard-driving, Neuroticism, Cynicism, and Paranoia. CVD was self-reported and dementia was diagnosed adhering to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) or Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria.

    Results: TABP was generally not associated with dementia risk. However, significant interaction effects of stress, paranoia, and cynicism with CVD on dementia risk were observed. That is, for those with CVD, high scores on stress, paranoia, and cynicism were associated with increased risk of dementia (hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 0.95-2.15; HR = 1.39, 95% CI = 0.83-2.33; HR = 1.25, 95% CI = 0.76-2.06, respectively), whereas for those who did not have CVD, high scores on these measures appeared to be protective (HR = 0.76, 95% CI = 0.50-1.14; HR = 0.55, 95% CI = 0.34-0.89; HR = 0.50, 95% CI = 0.29-0.84, respectively).

    Conclusion: Some features of TABP confer an increased risk for dementia in those with CVD, whereas those without CVD are protected. When evaluating the risk of dementia, CVD and personality traits should be taken into consideration.

  • 7.
    Bokenberger, Kathleen
    et al.
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Sjölander, Arvid
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Karlsson, Ida K.
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Åkerstedt, Torbjörn
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy Lee
    Department of Psychology, University of Southern California, Los Angeles, United States.
    Shift work and risk of incident dementia: a study of two population-based cohorts2018In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 10, p. 977-987Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the association between shift work and incident dementia in two population-based cohorts from the Swedish Twin Registry (STR). The STR-1973 sample included 13,283 participants born 1926–1943 who received a mailed questionnaire in 1973 that asked about status (ever/never) and duration (years) of shift work employment. The Screening Across the Lifespan Twin (SALT) sample included 41,199 participants born 1900–1958 who participated in a telephone interview in 1998–2002 that asked about night work status and duration. Dementia diagnoses came from Swedish patient registers. Cox proportional-hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Potential confounders such as age, sex, education, diabetes, cardiovascular disease and stroke were included in adjusted models. In genotyped subsamples (n = 2977 in STR-1973; n = 10,366 in SALT), APOE ε4 status was considered in models. A total of 983 (7.4%) and 1979 (4.8%) dementia cases were identified after a median of 41.2 and 14.1 years follow-up in the STR-1973 and SALT sample, respectively. Ever shift work (HR 1.36, 95% CI 1.15–1.60) and night work (HR 1.12, 95% CI 1.01–1.23) were associated with higher dementia incidence. Modest dose-response associations were observed, where longer duration shift work and night work predicted increased dementia risk. Among APOE ε4 carriers, individuals exposed to ≥ 20 years of shift work and night work had increased dementia risk compared to day workers. Findings indicate that shift work, including night shift work, compared to non-shift jobs is associated with increased dementia incidence. Confirmation of findings is needed. 

  • 8.
    Bokenberger, Kathleen
    et al.
    Karolinska Institutet.
    Ström, Peter
    Karolinska Institutet.
    Aslan, Anna K. Dahl
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Karolinska Institutet.
    Johansson, Anna
    Karolinska Institutet.
    Åkerstedt, Torbjörn
    Stockholms universitet.
    Pedersen, Nancy L.
    Karolinska Institutet.
    The effect of shift work on cognitive aging across the late adult life course2015In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, article id 360Article in journal (Other academic)
  • 9.
    Bokenberger, Kathleen
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ström, Peter
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Anna L. V.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Åkerstedt, Torbjörn
    Stress Research Institute, Stockholm University, Sweden.
    Association between sleep characteristics and incident dementia accounting for baseline cognitive status: A prospective population-based study2017In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 72, no 1, p. 134-139Article in journal (Refereed)
    Abstract [en]

    Background: While research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

    Methods: Screening Across the Lifespan Twin Study (SALT) participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios (HR) for dementia.

    Results: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤ 6 hours) and extended (> 9 hours) time-in-bed (TIB) compared to the middle reference group (HR=1.40, 95% CI=1.06-1.85, HR=1.11, 95% CI=1.00-1.24, respectively) and rising at 8:00AM or later compared to earlier rising (HR=1.12, 95% CI=1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

    Conclusions: Short and extended TIB as well as delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

  • 10.
    Bokenberger, Kathleen
    et al.
    Karolinska Institutet, Sweden.
    Ström, Peter
    Karolinska Institutet, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karolinska Institutet, Sweden.
    Åkerstedt, Torbjörn
    Karolinska Institutet, Sweden and Stockholm University, Sweden.
    Pedersen, Nancy L.
    Karolinska Institutet, Sweden and University of Southern California, USA.
    Shift work and cognitive aging: A longitudinal study2017In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 43, no 5, p. 485-493Article in journal (Refereed)
    Abstract [en]

    Objectives The few studies of shift work and late life cognitive functioning have yielded mixed findings. The aim of the present study is to estimate the association between shift-work experience and change in cognitive performance before and after retirement age among older adults who were gainfully employed.

    Methods Five hundred and ninety five participants with no dementia were followed up for a mean of 17.6 standard deviation (SD) 8.8 years from a Swedish population-based sample. Participants had self-reported information on any type of shift-work experience (ever/never) in 1984 and measures of cognitive performance (verbal, spatial, memory, processing speed, and general cognitive ability) from up to 9 waves of cognitive assessments during 1986–2012. Night work history (ever/never) from 1998–2002 was available from a subsample (N=320). Early adult cognitive test scores were available for 77 men.

    Results In latent growth curve modeling, there were no main effects of "any-type" or night shift work on the mean scores or rate of change in any of the cognitive domains. An interaction effect between any-type shift work and education on cognitive performance at retirement was noted. Lower-educated shift workers performed better on cognitive tests than lower-educated day workers at retirement. Sensitivity analyses, however, indicated that the interactions appeared to be driven by selection effects. Lower-educated day workers demonstrated poorer cognitive ability in early adulthood than lower-educated shift workers, who may have selected jobs entailing higher cognitive demand.

    Conclusion There was no difference in late-life cognitive aging between individuals with a history of working shifts compared to those who had typical day work schedules during midlife.

  • 11.
    Dahl, Anna
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Body mass index, cognitive ability, and dementia: prospective associations and methodological issues in late life2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of the present study were to investigate the association between overweight and cognitive ability and dementia, and to evaluate the usefulness of self-reported body mass index (BMI) in late life and various data sources commonly used in epidemiological studies to identify persons with dementia. Data were drawn from three population-based studies: the Swedish Adoption/Twin Study of Aging (SATSA), Aging in Women and Men: A Longitudinal Study of Gender Differences in Health Behaviour and Health among Elderly (the Gender Study), and the Finnish Lieto Study. In Study I, the agreement between self-reported and measured BMI over time was evaluated among 774 men and women, ages 40 to 88 years at baseline (mean age 63.9) participating in both the questionnaire phase and in-person testing of SATSA. Latent growth curve (LGC) modeling showed a small but significant increase between self-reported and measured BMI (0.02 kg/m2/y) over time, which would probably not affect the results if self-reported BMI were used as a continuous variable in longitudinal research. In Study II, the agreement between dementia diagnoses from various sources and dementia diagnoses set at a consensus conference was evaluated. Among the 498 elderly people ages 70 to 81 at baseline (mean age 74.5) enrolled in the Gender Study, 87 were diagnosed with dementia during an eight-year period. Review of medical records and nurse evaluations yielded the highest sensitivity (0.83 and 0.80, respectively) and a high specificity (0.98 and 0.96), indicating that these sources might be good proxies of dementia, while data extraction from the Swedish Inpatient Discharge Registry underestimated the prevalence of dementia (sensitivity 0.26). In Study III, the association between being overweight in midlife and cognitive ability in late life was examined in SATSA. The 781 participants ages 25 to 63 at baseline (mean age 41.6) in 1963 or 1973 self-reported their height and weight. From 1986 until 2002, they were assessed five times using a cognitive test battery. LGC models showed that people with higher midlife BMI scores had significantly lower cognitive ability and a significantly steeper decline than their thinner counterparts, an association that persisted when those who developed dementia during the study period were excluded from the analysis. This finding indicates that being overweight might affect cognitive ability independently of dementia. In Study IV, the association between BMI and dementia risk in older persons was described among 605 persons without dementia and ages 65 to 92 at baseline (mean age 70.8) in the Lieto Study. Among these, 86 persons were diagnosed with dementia during eight years of follow-up. Cox regression analyses indicated that for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio = 0.92, 95% confidence interval = 0.87–0.97) and the association remained significant when individuals who developed dementia during the first four years of follow-up were excluded from the analyses. This result suggests that low BMI scores are present almost a decade before clinical dementia onset.

  • 12.
    Dahl, Anna
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Kan man undvika demens genom en sund och aktiv livsstil?2008In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 3, p. 22-26Article in journal (Other academic)
    Abstract [sv]

    En vanlig föreställning om åldrandet är att de flesta äldre för eller senare blir glömska. Även om hög ålder är en av de största riskfaktorerna för sämre minnesfunktioner, så har merparten av den åldrande befolkningen väl fungerande minne och andra intellektuella funktioner. Faktum kvarstår dock att det finns stora individuella skillnader, en del äldre har mycket gott minne, medan andra inte minns namnen på sina barn eller ens att de har barn. Hur kommer det sig? Beror det på gener, livsstil, eller är det slumpen som avgör vem som drabbas av glömska på ålderns höst?

  • 13.
    Dahl, Anna
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Psykologiskt åldrande.2011In: Äldre och åldrande.: Grundbok i gerontologi. / [ed] Marie Ernsth Bravell, Stockholm: Gothia Förlag AB , 2011, p. 168-189Chapter in book (Other (popular science, discussion, etc.))
  • 14.
    Dahl, Anna
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Response letter to Dr. Hazzard2009In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 57, no 7, p. 1316-1317Article in journal (Other (popular science, discussion, etc.))
  • 15.
    Dahl, Anna
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Does Swedish health care recognize and clinically evaluate cognitive impairments?2007In: Advances in health care science research, Stockholm, 7-8 nov, 2007Conference paper (Refereed)
  • 16.
    Dahl, Anna
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Nilsson, Sven
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Health factors and cognitive functioning in old age2006In: 18. Nordiska Kongressen i Gerontologi, Jyväskylä, 2006Conference paper (Refereed)
  • 17.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Berg, Stig
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Nilsson, Sven
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Identification of dementia in epidemiological research: A study on the usefulness of various data sources2007In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 19, no 5, p. 381-389Article in journal (Refereed)
    Abstract [en]

    Background and aims: Prevalence and incidence ratios of dementia in epidemiological studies vary according to the data source used. Medical records, cognitive tests, and registry information are sources frequently used to differentiate dementia from normal aging. The aim of the present study was to compare the identification of dementia from these different sources with that from consensus diagnosis. 

    Methods: 498 elderly people (age range 70–81 at baseline) enrolled in a Swedish population-based longitudinal twin study (Gender) were evaluated on physical and mental health and interviewed for their socio-demographic background three times during an eight-year period. Reviews of medical records and the Swedish Discharge Registry (DR) were conducted. The 10th percentile was used to differentiate between dementia and non-dementia in all cognitive tests. Scores of 24 or below on the Mini-Mental State Examination (MMSE) (range 1–30) indicated dementia. A consensus conference diagnosed dementia on the basis of total information. The consensus diagnosis was used as the gold standard. 

    Results: MMSE scores (sensitivity 64%, specificity 96%, kappa 0.65) and the review of medical records (sensitivity 57%, specificity 99%, kappa 0.65) were good sources for dementia identification. The precision of medical records increased when recordings of cognitive impairment were included (sensitivity 83%, specificity 98%, kappa 0.84). The discharge registry had low sensitivity (26%) and kappa coefficient (0.31). 

    Conclusions: The present study shows that both review of medical records and MMSE scores are good although not perfect identifiers of dementia. The discharge registry is an uncertain source of dementia identification.

  • 18.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Fauth, Elizabeth
    Department of Family, Consumer, and Human Development, Utah State University, Logan, Utah.
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Hassing, Linda
    University of Gothenburg.
    Ram, Nilam
    Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennysylvania.
    Gerstorf, Denis
    Department of Psychology, Humboldt University, Berlin, Germany.
    Body Mass Index, Change in Body Mass Index, and Survival in Old and Very Old Persons2013In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 61, no 4, p. 512-518Article in journal (Refereed)
    Abstract [en]

    Background: Current recommendations from the World Health Organization (WHO) are that individuals should seek to maintain a body mass index (BMI) between 18.5-25 kg/m2, independent of age. However, there is an ongoing discussion whether the WHO recommendations apply to old (70 ≥ 80 years) and very old persons (80+ years). In the present study we examine how BMI status and change in BMI are associated with mortality among old and very old individuals.

    Design: Pooled data from three multidisciplinary prospective population-based studies OCTO-twin, GENDER, and NONA.

    Setting: Sweden.

    Participants: 882 individuals aged 70 to 95 years.

    Measurements: Body Mass Index was calculated from measured height and weight as kg/m2. Information about survival status and time of death was obtained from Swedish Civil Registration System

    Results: Mortality hazard was 20% lower for the overweight group relative to the normal/underweight group (RR = 0.80, p < .05), and the mortality hazard for the obese group did not differ significantly from the normal/underweight group (RR = 0.93, > .10), independent of age, education, and multimorbidity. Furthermore, mortality hazard was 141% higher for the BMI loss group relative to the BMI stable group (RR = 1.65, p < .05); and 178% higher for the BMI gain group relative to BMI stable group (RR = 1.53, p < .05).  However, the BMI change differences were moderated by age, i.e. the higher mortality risks associated with both loss in BMI and BMI gain were less severe in very old age.

    Conclusion: Old persons who were overweight had a decreased mortality risk compared to old persons having a BMI below 25, even after controlling for weight change and multimorbidity. Compared to persons who had a stable BMI those who increased or decreased in BMI had a higher mortality risk, particularly among people aged 70 to 80. This study lends further support for the opinion that the WHO guidelines are overly restrictive in old age.

  • 19.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Hassing, Linda
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Obesity and cognitive aging2013In: Epidemiologic reviews, ISSN 0193-936X, E-ISSN 1478-6729, Vol. 35, no 1, p. 22-32Article in journal (Refereed)
    Abstract [en]

    Obesity is a health problem that has reached epidemic proportions. Given the high prevalence of obesity, even a small adverse impact of obesity on cognitive aging might have a serious effect on public health. The purpose of this systematic review was to examine the relation between obesity and cognitive function in late life among persons not diagnosed with dementia and to evaluate the evidence for a causal association. Medline was used to search for the following terms: obesity, overweight, cognition, cognitive, age, and aged. To be included, studies must have had a population-based, dementia-free sample and a 5-year minimum interval between measurement of the predictor and the outcome. Only 11 studies met the criteria. Of these, 7 studies assessed obesity in midlife and cognitive function in later life, and 4 studies assessed obesity and cognitive function in late life. The reviewed studies showed clear evidence that midlife obesity was associated with cognitive aging, whereas this association was weaker in late life; thus, no firm conclusions could be drawn. The findings of this review suggest that, although there is evidence for an association between midlife obesity and low cognitive abilities in late life, the direction of the association and the causality remain to be clarified.

  • 20.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Hassing, Linda B.
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Berg, Stig
    Reynolds, Chandra A.
    Gatz, Margrete
    Pedersen, Nancy L.
    Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life2010In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 65A, no 1, p. 57-62Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time. METHODS: Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25-63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion. RESULTS: Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis. CONCLUSIONS: Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia

  • 21.
    Dahl, Anna
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Hassing, Linda
    Göteborgs Universitet, Psykologiska institutionen.
    Fransson, Eleonor
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Gatz, Margaret
    University of Southern California.
    Reynolds, Chandra
    University of California Riverside.
    Pedersen, Nancy
    Karolinska Institutet.
    Midlife body mass index and late life cognitive functioning: findings from the Swedish Adoption/Twin Study of Aging2008In: Conference of Life History Research Society, 2008Conference paper (Refereed)
  • 22.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Hassing, Linda
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Margaret, Gatz
    Reynolds, Chandra
    Pedersen, Nancy
    Body mass index across midlife and cognitive change in late life2013In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 37, no 2, p. 296-302Article in journal (Refereed)
    Abstract [en]

    Background: High midlife body mass index (BMI) has been linked to a greater risk of dementia in late life, but few have studied the effect of BMI across midlife on cognitive abilities and cognitive change in a dementia-free sample.

    Methods: We investigated the association between BMI, measured twice across midlife (mean age 40 and 61 years, respectively), and cognitive change in four domains across two decades in the Swedish Adoption/Twin Study of Aging.

    Results: Latent growth curve models fitted to data from 657 non-demented participants showed that persons who were overweight/obese in early midlife had significantly lower cognitive performance across domains in late life and significantly steeper decline in perceptual speed, adjusting for cardio-metabolic factors. Both underweight and overweight/obesity in late midlife were associated with lower cognitive abilities in late life. However, the association between underweight and low cognitive abilities did not remain significant when weight decline between early and late midlife was controlled for.

    Conclusion: There is a negative effect on cognitive abilities later in life related to being overweight/obese across midlife. Moreover, weight decline across midlife rather than low weight in late midlife per se was associated with low cognitive abilities. Weight patterns across midlife may be prodromal markers of late life cognitive health.

  • 23.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Hassing, Linda
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Pedersen, Nancy
    Agreement between self-reported and measured height, weight and body mass index in old age: a longitudinal study with 20 years of follow-up2010In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 39, no 4, p. 445-451Article in journal (Refereed)
    Abstract [en]

    Background: self-reported body mass index (BMI) based on self-reported height and weight is a widely used measure of adiposity in epidemiological research. Knowledge about the accuracy of these measures in late life is scarce.

    Objective: the study aimed to evaluate the accuracy and changes in accuracy of self-reported height, weight and BMI calculated from self-reported height and weight in late life.

    Design: a longitudinal population-based study with five times of follow-up was conducted.

    Participants: seven hundred seventy-four community-living men and women, aged 40–88 at baseline (mean age 63.9), included in The Swedish Adoption/Twin Study of Aging.

    Methods: participants self-reported their height and weight in a questionnaire, and height and weight were measured by experienced research nurses at an in-person testing five times during a 20-year period. BMI was calculated as weight (kilogramme)/height (metre)2.

    Results: latent growth curve modelling showed an increase in the mean difference between self-reported and measured values over time for height (0.038 cm/year) and BMI (0.016 kg/m2/year), but not for weight.

    Conclusions: there is a very small increase in the mean difference between self-reported and measured BMI with ageing, which probably would not affect the results when self-reported BMI is used as a continuous variable in longitudinal studies.

  • 24.
    Dahl, Anna
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Hassing, Linda
    Fransson, Eleonor
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Pedersen, Nancy
    Is self-reported Body Mass Index a valid and reliable measure in old age?: Findings from the Longitudinal Swedish Adoption/Twin Study of Aging2009In: 62nd Annual Scientific Meeting of Gerontological Society of America, 2009Conference paper (Refereed)
  • 25.
    Dahl, Anna
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Hassing, Linda
    Fransson, Eleonor
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Reynolds, Chandra
    Gatz, Margaret
    Pedersen, Nancy
    Body Mass Index across midlife and cognitive change in late life: delayed and cumulative effects2011In: 64th Annual Scientific Meeting of Gerontological Society of America, 2011Conference paper (Refereed)
  • 26.
    Dahl, Anna
    et al.
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Hassing, Linda
    Fransson, Eleonor
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Reynolds, Chandra
    Gatz, Margaret
    Pedersen, Nancy
    Midlife Body Mass Index and Longitudinal Trajectories of Cognitive Change in Late Life: findings from the Swedish Adoption/Twin Study of Aging2009In: 62nd Annual Scientific Meeting of Gerontological Society of America, 2009Conference paper (Refereed)
  • 27.
    Dahl, Anna K
    et al.
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Hassing, Linda B
    Fransson, Eleonor I
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Pedersen, Nancy L
    Is Self-reported Body Mass Index Less Reliable in Late Life?  2010Conference paper (Refereed)
    Abstract [en]

    Objectives: Self-reported Body Mass Index (BMI) based on self-reported height and weight is a widely used measure of adiposity in epidemiological research. Knowledge about the accuracy of these measures in late life is scarce, and especially if there is intra-individual changes over time.

    Methods: Seven hundred seventy-four men and women, aged 40 to 88 at baseline (mean age 63.9), in The Swedish Adoption/Twin Study of Aging self-reported and had their height and weight measured by experienced research nurses five times during a twenty year period. BMI was calculated as weight (kilos)/height (meter)2.

    Results: There was significant correlation between self-reported and measured height (0.97-0.98), weight (0.97-0.98), and BMI (0.93-0.95) at each measurement occasion, and substantial agreement for BMI as a categorical variable (Kappa coefficient 0.72-0.81). Latent growth curve modeling showed an increase in the mean difference between self-reported and measured values over time for height (0.04 cm/year) and BMI (0.02 kg/m2/year), but not for weight.

    Conclusions: There is a very small significant increase in the mean difference between self-reported and measured BMI with aging, mainly due to unawareness of changes in height, which probably would not affect the results when self-reported BMI is used as a continuous variable in longitudinal studies.

  • 28.
    Dahl, Anna K.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Karolinska Institutet.
    Starr, J. M.
    University of Edinburgh, Scotland.
    Allerhand, M.
    University of Edinburgh, Scotland.
    Deary, I. J.
    University of Edinburgh, Scotland.
    Acceptance of bodily appearance in young-old and old age - Prevalence and predictors2015In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, p. 355-355Article in journal (Other academic)
  • 29.
    Dahl, Anna
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Löppönen, Minna
    Isoaho, Raimo
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Kivelä, Sirkka-Liisa
    Overweight and obesity in old age is not associated with increased risk of dementia2008Conference paper (Refereed)
  • 30.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Löppönen, Minna
    Åbo University.
    Isoaho, Raimo
    Åbo University.
    Berg, Stig
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Kivelä, Sirkka-Lisa
    Åbo University.
    Overweight and obesity in old age are not associated with greater dementia risk2008In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 56, no 12, p. 2261-2266Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons.

    DESIGN: Prospective population‐based study, with 8 years of follow‐up.

    SETTING: The municipality of Lieto, Finland, 1990/91 and 1998/99.

    PARTICIPANTS: Six hundred five men and women without dementia aged 65 to 92 at baseline (mean age 70.8).

    MEASUREMENTS: Weight and height were measured at baseline and at the 8‐year follow‐up. Dementia was clinically assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.

    RESULTS: Eighty‐six persons were diagnosed with dementia. Cox regression analyses, adjusted for age, sex, education, cardiovascular diseases, smoking, and alcohol use, indicated that, for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio (HR)=0.92, 95% confidence interval (CI)=0.87–0.97). This association remained significant when individuals who developed dementia early during the first 4 years of follow‐up were excluded from the analyses (HR=0.93, 95% CI=0.86–0.99). Women with high BMI scores had a lower dementia risk (HR=0.90, 95% CI=0.84–0.96). Men with high BMI scores also tended to have a lower dementia risk, although the association did not reach significance (HR=0.95, 95% CI=0.84–1.07).

    CONCLUSION: Older persons with higher BMI scores have less dementia risk than their counterparts with lower BMI scores. High BMI scores in late life should not necessarily be considered to be a risk factor for dementia.

  • 31.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Reynolds, Chandra A.
    Deparment of Psychology, University of California – Riverside, Riverside, United States of America.
    Accuracy of Recalled Body Weight-A Study with 20-years of Follow-Up2013In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 21, no 6, p. 1293-1298Article in journal (Refereed)
    Abstract [en]

    Objective:

    Weight changes may bean important indicator of an ongoing pathological process.Retrospective self-report might be the only possibility to capture prior weight. The objective of the study was to evaluate the accuracy of retrospective recallof body weight in old age and factors that might predict accuracy.

    Design and Methods:

    In 2007, 646 participants (mean age, 71.6 years) of the Swedish Adoption/Twin Study of Aging (SATSA)answered questions about their present weight and how much they weighed 20-years ago. Of these, 436 had self-reported their weighttwenty years earlier and among these 134 had also had their weight assessed at this time point.

    Results:

    Twenty yearretrospectively recalled weight underestimated the prior assessed weight by -1.89 ± 5.9 kg and underestimatedprior self-reported weight by -0.55 ±5.2 kg.Moreover, 82.4% of the sample were accurate within 10%, and 45.8% were accurate within 5% of their prior assessed weights;similarly, 84.2% and 58.0 %were accurate within 10% and 5% respectively, forprior self-reported weight. Current higher body mass index and preferences of reporting weights ending with zero or five was associated with an underestimation of prior weight, while greater weight change over 20 year, and low Mini-Mental State Scores (MMSE) (<25) led to an overestimation of prior weight.

    Conclusions:

    Recalled weight comes close to the assessed population mean, but at the individual level there is a large variation. The accuracy is affected by current BMI, changes in weight, end-digit preferences, and current cognitive ability. Recalled weight should be used with caution.

  • 32.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Reynolds, Chandra
    Department of Psychology, University of California Riverside, Riverside, CA 92521, USA.
    Fall, Tove
    Uppsala University.
    Magnusson, Patrik
    Karolinska Institutet.
    Pedersen, Nancy
    Karolinska Institutet.
    Multifactorial analysis of changes in body mass index across the adult life course: a study with 65 years of follow-up2014In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 38, no 8, p. 1133-1141Article in journal (Refereed)
    Abstract [en]

    Background: Although the negative consequences on health of being obese are well known, most adults gain weight across the lifespan. The general increase in body mass index (BMI) is mainly considered to originate from behavioral and environmental changes; however, few studies have evaluated the influence of these factors on change in BMI in the presence of genetic risk. We aimed to study the influence of multifactorial causes of change in BMI, over 65 years.

    Methods and Findings: Totally, 6130 participants from TwinGene, who had up to five assessments, and 536 from the Swedish Adoption/Twin Study of Aging, who had up to 12 assessments, ranging over 65 years were included. The influence of lifestyle factors, birth cohort, cardiometabolic diseases and an individual obesity genetic risk score (OGRS) based on 32 single nucleotide polymorphisms on change in BMI was evaluated with a growth model. For both sexes, BMI increased from early adulthood to age of 65 years, after which the increase leveled off; BMI declined after age of 80 years. A higher OGRS, birth after 1925 and cardiometabolic diseases were associated with higher average BMI and a steeper increase in BMI prior to 65 years of age. Among men, few factors were identified that influence BMI trajectories in late life, whereas for women type 2 diabetes mellitus and dementia were associated with a steeper decrease in BMI after the age of 65 years.

    Conclusions: There are two turning points in BMI in late adulthood, one at the age of 65 years and one at the age 80 years. Factors associated with an increase in BMI in midlife were not associated with an increase in BMI after the age of 65 years. These findings indicate that the causes and consequences of change in BMI differ across the lifespan. Current health recommendations need to be adjusted accordingly.

  • 33.
    Dahl Aslan, Anna K.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Starr, John M.
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh.
    Pattie, Alison
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh.
    Deary, Ian
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh.
    Cognitive consequences of overweight and obesity in the ninth decade of life?2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 1, p. 59-65Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: the association between late-life obesity and late-life cognitive abilities is poorly understood. We studied the association between body mass index (BMI) and cognitive change in longitudinal population-based study spanning over the ninth decade of life.

    SUBJECTS/METHODS: in total, 475 participants free of dementia at baseline from the Lothian Birth Cohort 1921 (mean age: 79.1 years, SD: 0.6) were included. Height and weight were assessed at baseline. BMI was calculated as kg/m(2). Cognitive abilities were assessed at age ∼11 years and at age ∼79, ∼83, ∼87 and ∼90 years.

    RESULTS: latent growth models showed that men being overweight and obese had a 0.65 (SD: 0.3) and 1.10 (SD: 0.5) points less steep decline in general cognitive ability (as measured by the Moray House Test) for each year than people of normal weight. These associations were to some extent confounded by childhood intelligence. No other association between BMI and cognition was significant, either for men or women. People who were obese in old age had significantly lower childhood intelligence (m = 43.6, SD: 1.3) than people who were normal in weight (m = 47.0, SD: 0.8) and persons being overweight (m = 47.5, SD: 0.8), F (472, 3) = 3.2, P = 0.043.

    CONCLUSIONS: the current study shows weak or no evidence for an association between BMI in old age and cognitive function, especially not when childhood intelligence is controlled for. Lower intelligence at the age of 11 years predicted obesity at the age of 79 years.

  • 34. Dybjer, E.
    et al.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Nilsson, P.
    Hassing, L.
    Trajectories of survival in men with type 1 diabetesfFollowed for 56 years after conscript testing at 18 years of age2019Conference paper (Refereed)
  • 35.
    Emery, Charles F.
    et al.
    Ohio State University, USA.
    Finkel, Deborah
    Indiana University, USA.
    Dahl Aslan, Anna
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Gatz, Margaret
    University of South California, USA.
    Pedersen, Nancy L.
    Karolinska Institutet.
    Greater depressive symptoms lead to increased body fat in older adults2015In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, article id 323Article in journal (Other academic)
  • 36.
    Emery, Charles F.
    et al.
    Department of Psychology, Ohio State University, Columbus, USA.
    Finkel, Deborah
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Psychology, Indiana University Southeast, New Albany, USA.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles, USA.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Evidence of bi-directional associations between depressive symptoms and body mass among older adults2019In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Body fat, measured with body mass index (BMI), and obesity are associated with depressive symptoms. Among younger adults there is stronger evidence of obesity leading to depressive symptoms than of depressive symptoms leading to obesity, but the temporal relationship is unknown among older adults. This study utilized dual-change-score models (DCSMs) to determine the directional relationship between body mass and depressive symptoms among older adults.

    METHOD: Participants (n=1743) from the Swedish Twin Registry (baseline age range 50-96 years) completed at least one assessment of BMI (nurse measurement of height and weight) and the Center for Epidemiologic Studies-Depression scale (CESD). More than half the sample completed three or more assessments, scheduled at intervals of 2-4 years. DCSMs modeled the relationship of BMI and CESD across age, both independently and as part of bivariate relationships.

    RESULTS: Depressive symptoms contributed to subsequent changes in BMI after age 70, while BMI contributed to subsequent changes in depressive symptoms after age 82. Thus, there is a reciprocal relationship that may change with age. The effect was more pronounced for women.

    DISCUSSION: The association of BMI and depressive symptoms is bi-directional among older adults, and it appears to be affected by both age and sex.

  • 37. Ericsson, M.
    et al.
    Pedersen, Nancy L.
    Fors, S.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Frailty and mortality: Investigating sex differences and socioeconomic influences using Swedish twins2019Conference paper (Refereed)
  • 38.
    Ericsson, Malin
    et al.
    Karolinska Institutet.
    Lundholm, Cecilia
    Karolinska Institutet.
    Fors, Stefan
    Karolinska Institutet.
    Dahl, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Karolinska Institutet.
    Reynolds, Chandra A.
    University of California, USA.
    Zavala, Catalina
    Karolinska Institutet.
    Pedersen, Nancy L.
    Karolinska Institutet.
    Childhood socioeconomic status as a predictor of old age cognitive performance2015In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, article id 362Article in journal (Other academic)
  • 39.
    Ericsson, Malin
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundholm, Cecilia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fors, Stefan
    Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Zavala, Catalina
    Department of Psychology, University of Southern California, Los Angeles, United States.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Pedersen, Nancy L.
    Department of Psychology, University of Southern California, Los Angeles, United States.
    Childhood social class and cognitive aging in the Swedish Adoption/Twin Study of Aging2017In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 114, no 27, p. 7001-7006Article in journal (Refereed)
    Abstract [en]

    In this report we analyzed genetically informative data to investigate within-person change and between-person differences in late-life cognitive abilities as a function of childhood social class. We used data from nine testing occasions spanning 28 y in the Swedish Adoption/Twin Study of Aging and parental social class based on the Swedish socioeconomic index. Cognitive ability included a general factor and the four domains of verbal, fluid, memory, and perceptual speed. Latent growth curve models of the longitudinal data tested whether level and change in cognitive performance differed as a function of childhood social class. Between-within twin-pair analyses were performed on twins reared apart to assess familial confounding. Childhood social class was significantly associated with mean-level cognitive performance at age 65 y, but not with rate of cognitive change. The association decreased in magnitude but remained significant after adjustments for level of education and the degree to which the rearing family was supportive toward education. A between-pair effect of childhood social class was significant in all cognitive domains, whereas within-pair estimates were attenuated, indicating genetic confounding. Thus, childhood social class is important for cognitive performance in adulthood on a population level, but the association is largely attributable to genetic influences.

  • 40.
    Ericsson, Malin
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Anna L. V.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fors, Stefan
    Aging Research Center, Karolinska Institutet.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Life-course socioeconomic differences and social mobility in preventable and non-preventable mortality: a study of Swedish twins2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite advances in life expectancy, low socioeconomic status is associated with a shorter lifespan. This study was conducted to investigate socioeconomic differences in mortality by comparing preventable with non-preventable causes of death in 39 506 participants from the Swedish Twin Registry born before 1935.

    METHODS: Childhood social class, own education, own social class and social mobility were used as separate indicators of socioeconomic status. These data were linked to the Swedish Cause of Death Register. Cause of death was categorized as preventable or non-preventable mortality according to indicators presented in the Avoidable Mortality in the European Union (AMIEHS) atlas. Using Cox proportional hazard models, we tested the association between the socioeconomic measures and all-cause mortality, preventable mortality and non-preventable mortality. Additional co-twin control analyses indicated whether the associations reflected genetic confounding.

    RESULTS: The social gradient for mortality was most prominent for the adult socioeconomic measures. There was a social gradient in both preventable mortality and non-preventable mortality, but with an indication of a moderately stronger effect in preventable causes of death. In analyses of social mobility, those who experienced life-time low socioeconomic status (SES) or downward social mobility had an increased mortality risk compared with those with life-time high SES and upward social mobility. Adjustments for genetic confounding did not change the observed associations for education, social class or social mobility and mortality. In the co-twin control analyses of reared-apart twins, the association between childhood social class and mortality weakened, indicating possible genetic influences on this association.

    CONCLUSIONS: Our results indicate that there is an association between low adult socioeconomic status and increased mortality independent of genetic endowment. Thus, we do not find support for indirect social selection as the basis for mortality inequalities in Sweden.

  • 41.
    Ernsth Bravell, Marie
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Finkel, Deborah
    Indiana University Southeast, USA.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karolinska Institutet, Sweden.
    Reynolds, Chandra A.
    University of California, USA.
    Hallgren, Jenny
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Pedersen, Nancy L.
    Karolinska Institutet, Sweden and University of Southern California, USA.
    Motor functioning differentially predicts mortality in men and women2017In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 72, p. 6-11Article in journal (Refereed)
    Abstract [en]

    Introduction

    Research indicates gender differences in functional performance at advanced ages, but little is known about their impact on longevity for men and women.

    Objective

    To derive a set of motor function factors from a battery of functional performance measures and examine their associations with mortality, incorporating possible gender interactions.

    Method

    Analyses were performed on the longitudinal Swedish Adoption/Twin Study of Aging (SATSA) including twenty-four assessments of motor function up to six times over a 19-year period. Three motor factors were derived from several factor analyses; fine motor, balance/upper strength, and flexibility. A latent growth curve model was used to capture longitudinal age changes in the motor factors and generated estimates of intercept at age 70 (I), rates of change before (S1) and after age 70 (S2) for each factor. Cox regression models were used to determine how gender in interaction with the motor factors was related to mortality.

    Results

    Females demonstrated lower functional performance in all motor functions relative to men. Cox regression survival analyses demonstrated that both balance/upper strength, and fine motor function were significantly related to mortality. Gender specific analyses revealed that this was true for women only. For men, none of the motor factors were related to mortality.

    Conclusion

    Women demonstrated more difficulties in all functioning facets, and only among women were motor functioning (balance/upper strength and fine motor function) associated with mortality. These results provide evidence for the importance of considering motor functioning, and foremost observed gender differences when planning for individualized treatment and rehabilitation.

  • 42.
    Finkel, Deborah
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Emery, Charles F.
    Department of Psychology, Ohio State University, Columbus, USA.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles, USA.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Evidence of bi-directional associations between depressive symptoms and body mass among older adults2019Conference paper (Other academic)
  • 43.
    Finkel, Deborah
    et al.
    Department of Psychology, Indiana University Southeast, New Albany.
    Gerritsen, Lotte
    Karolinska Institutet.
    Dahl, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Pedersen, Nancy L.
    Karolinska Institutet.
    Etiology of individual differences in human health and longevity2014In: Annual Review of Gerontology and Geriatrics, ISSN 0198-8794, Vol. 34, no 1, p. 189-227Article in journal (Refereed)
    Abstract [en]

    In this chapter, we review of the field of gerontological genetics with respect to subjective and objective health, the role of stress on health, and finally frailty and longevity. For most indices of subjective and objective health, frailty, and longevity, genetic influences contribute only modestly to individual differences, wherein heritabilities are typically on the order of 35%–40%. Notable exceptions are the moderate to strong heritabilities for lipid measures and brain structure and function, with a remarkably increasing role of genetic influences for longevity with advancing age. Although candidate gene and genome-wide association studies (GWAS) studies have identified gene variants associated with many subjective and objective health traits, their effect sizes are typically relatively small, as expected for complex traits. There is some evidence for gene–environment interactions, and stress may be an important moderator of genetic variance for health. For example, carrying a risk genotype for cardiovascular disease (CVD) in the angiotensin converting enzyme gene (ACE) may predict stress responsivity and risk of cardiovascular-related diagnoses. Moreover, the gene coding for apolipoprotein E (APOE) may moderate responsiveness to stress evoking experiences, impact of physical exercise, and associate with sleep characteristics in those who develop cognitive impairments. For metabolic syndrome (MetS), encompassing the co-occurrence of obesity, hypertension, hypertriglyceridemia, and hyperinsulinemia, promising associations exist although no single genotype or any gene clusters have been consistently associated with MetS across populations, suggesting that complex gene–environment interactions must be understood before the use of genetic markers can be realized in clinical practice. Future investigations of subjective and objective health, frailty, and longevity are needed to further identify sources of genetic and environmental contributions—and their dynamics across adulthood—to advance understanding of aging processes, prevention, and intervention avenues, and ultimately successful aging.

  • 44. Gold, Carol
    et al.
    Malmberg, Bo
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    McClearn, Gerald
    Pedersen, Nancy
    Dahl, Anna
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Nilsson, Sven
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Rovine, Michael
    The Gender Study: A Longitudinal Study of Health and Behavior of Older Unlike-Sex Twins in Sweden2009In: 62nd Annual Scientific Meeting of Gerontological Society of America, 2009Conference paper (Refereed)
  • 45.
    Granic, Antoneta
    et al.
    School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA .
    Andel, Ross
    School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA .
    Dahl, Anna
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Pedersen, Nancy
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Midlife dietary patterns and mortality in the population-based study of Swedish twins2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 7, p. 578-586Article in journal (Refereed)
    Abstract [en]

    Background We examined midlife dietary patterns in relation to (1) sociodemographic and health-related characteristics and (2) survival.

    Methods A two-step cluster analysis of a 12-item food questionnaire was used to derive dietary patterns in a cohort of 16 649 members of the Swedish Twin Registry, a prospective, population-based study of twins. The average age at baseline (1967) was 55.5 years; the follow-up for all-cause mortality extended until 2011 (26.8±12.35 years or 345 127 person-years) via death records.

    Results Four dietary patterns (classes) distinguishable by demographic and health characteristics emerged: Moderate Intake and Starch Diet (Class 1), Moderate Intake Diet with Low Flour-Based Foods (Class 2), Meat and Starch Diet (Class 3) and Low Meat Intake Diet (Class 4). Membership in Class 3 was associated with 7% increased risk of mortality compared with Class 2 independent of baseline age, cohort, sex and body mass index. These results were mostly explained by sociodemographic and lifestyle factors. When follow-up was restricted to those in the study for 20+ years, both Classes 1 and 3 conferred increased risk of mortality compared with Class 2, independent of covariates. Analyses conducted within twin pairs revealed similar results.

    Conclusions Midlife diet over-represented by meat and starch-based foods may increase the risk of mortality, whereas the diet low in starch may be beneficial. These results appear to be independent of factors shared by twins, as well as at least partially a function of social and lifestyle factors, particularly marital status and smoking.

  • 46.
    Hallgren, Jenny
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Risk factors for hospital readmission among Swedish older adults2018In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 9, no 5, p. 603-611Article in journal (Refereed)
    Abstract [en]

    Introduction 

    Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge.

    Methods

    A prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/ Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers. Logistic regression models controlling for age and sex were conducted to analyze risk factors for readmissions.

    Results

    Of the 772 participants, [mean age 69.7 (±11.1), 84 (63%)] were hospitalized and among these 208 (43%) had one or several readmissions within 30 days during the follow-up period. Most of the readmissions (57%) occurred within the frst week; mean days from hospital discharge to readmission was 7.9 (±6.2). The most common causes of admission and readmission were cardiovascular diseases and tumors. Only 8% of the readmissions were regarded as avoidable admissions. In a multivariate logistic regression, falling within the last 12 months (OR 0.57, p=0.039) and being a male (OR 1.84, p=0.006) increased the risk of readmission.

    Conclusions

    Most older persons that are readmitted return to hospital within the frst week after discharge. Experiencing a fall was a particular risk factor of readmission. Preventive actions should preferably take place already at the hospital to reduce the numbers of readmission. Still, it should be remembered that most readmissions were considered to be necessary.

  • 47.
    Hallgren, Jenny
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Dahl, Anna
    Ernsth Bravell, Marie
    Mölstad, Sigvard
    Midlöv, Patrik
    Östgren, Carl Johan
    Malmberg, Bo
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Factors associated with a greater risk of hospitalization among nursing home residents2013Conference paper (Refereed)
    Abstract [en]

    Background: Nursing home residents are at a higher risk of hospital care as they represent the oldest and most frail segment of the population. At the same time, hospitalization is associated with a greater risk of various diseases, such as iatrogenic disorders, physical impairments and other adverse outcomes. Knowledge about factors associated with greater risk of hospitalization among nursing home residents is scarce. The aim of this study was to identify predictors of hospitalization among nursing home residents. Methods: Four hundred twenty-nine Swedish nursing home residents (mean age 84.9 years, ± 7.27, 71% females) were followed during three years in the longitudinal SHADES study. Participants were examined on physical, psychological, and social functioning, and information about hospitalization was recorded across the study period. Results: Of the 429 participants, 196 (45.7%) had at least one hospital admission during the three year follow-up period. The most common cause of admission was cardiovascular diseases (CVD) and complications due to falls.  Cox proportional hazard regression model controlling for dependency within nursing homes and municipalities showed that nursing home residents with previous falls (HR=1.59, p=.000), cognitive impairment (HR=1.28, p=.008) and malnutrition (HR=1.51, p=.018) were at a greater risk of hospitalization. Discussion: The results suggest that nursing home residents are at high risk of hospitalization, especially due to CVD and falls. Several modifiable factors associated with an increased risk of hospitalization were identified, including nutritional status and falls. Hospital admissions for older people could potentially be reduced by preventive measures aiming at fall reduction and malnutrition. 

  • 48.
    Hallgren, Jenny
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Risk of hospitalization and readmission2019Conference paper (Refereed)
  • 49.
    Hallgren, Jenny
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Older persons´ arguments for seeking hospital care while receiving home health care2014Conference paper (Other academic)
    Abstract [en]

    Background: Hospitalization among older persons is not unusual and can lead to serious consequences such as iatrogenic conditions. Although the majority of the hospitalizations are necessary, there are probably a substantial number of hospitalizations that could be avoided. Many of those persons that are hospitalized are living at home, and are entitled for home health care, meaning that they can receive basic as well as advanced medical care in their own home. Little is known about older persons’ perceptions about seeking hospital care despite having home health care.

    Aim: To explore older persons’ reasoning for seeking hospital care.

    Method: Twenty-two older persons (age 66-93, 73 % females) living in southern Sweden, receiving home health care and having experiences of hospitalization, were interviewed about their health care experiences. The data was analyzed using qualitative content analysis.

    Results: Preliminary results indicate that the older persons’ emotions, past experiences and perceptions of health care resources influenced transitions to hospital. The results are illustrated by three categories: Home health care design; Specific medical condition; and Superior care at hospital. Conclusion: Understanding about older persons’ arguments for seeking care at hospital may have implication for how the homecare staff encounters individual’s perceived needs. Further, fulfillment of perceived health needs may reduce avoidable hospitalization and consequently improve quality of life.

  • 50.
    Hallgren, Jenny
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Ernsth Bravell, Marie
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Dahl, Anna
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Östgren, Carl-Johan
    Midlöv, Patrik
    Mölstad, Sigvard
    Elderly living in institutions and their visits to acute care - Patterns; needs och habits?.2012Conference paper (Other academic)
    Abstract [en]

    Background: Every year 1.4 million visits are made to acute care or hospital in Sweden. Elderly makes about one third of these visits and many of them are considered to be unnecessary. Little is known about the patterns of hospitalization and visits to acute care among elderly living in institutions.

    Objective: The aim of this study is to longitudinally describe patterns of hospitalization and visits to the acute care among elderly living in institutions.

    Method: SHADES is a longitudinal study including 423 elderly (mean age of 84.8 years, ± 7.27, 71% females) living in institutions in Sweden. Participants were examined every six months during three years. One-hundred thirty individuals participated in all the six in-person testings.

    Results: At baseline 16 % of the respondents had visited the acute care at least once and around a fourth had been hospitalized the last six months. The most common reasons for visits to acute care were falls and infections. The reasons for hospitalization were mostly complications after falls (n=25) and circulatory diseases (n=24). About one third (n=48) of those who participated at all six IPTs visited the acute care in the hospital at least once during the study and nearly half (n=60) was hospitalized at least once during the study period.

    Discussion and Conclusion: Hospitalization and visits to acute care are common among persons living in institutions. The next step is to analyze the longitudinal trajectories of visits to the acute care and hospitalization in this group of elderly living in institutions. For the presentation analyzes will also be performed with the aim to examine which factors (e.g. diseases, drugs, function in daily life, social network factors) that relate to visits to the acute care and hospitalization. The results will provide important knowledge that can be used to prevent unnecessary hospitalization in order to provide continuity in the institutional care for the elderly and to save costs.

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