Determinants of a sense of insecurity among home-dwelling older people

Aims: A sense of insecurity may have an impact on older people's well-being and their courage to engage actively in meaningful activities. Studies on a sense of insecurity among older people are scarce. The aim of this study was to determine the extent to which home-dwelling older adults perceive their life as being insecure and how a sense of insecurity is associated with their health, functional status, active social engagement, well-being and perceptions of the societal treatment of older people. Methods: This study is part of the Helsinki Aging Study, a cohort study ongoing since 1989. Data were collected using a postal questionnaire that was mailed in 2019 to a random sample of home-dwelling older people ⩾75 years of age living in Helsinki (N=2917; response rate 74%). The questionnaire inquired about the respondents' sense of security/insecurity, and they were subcategorised into those feeling secure and those feeling insecure based on their answers. Results: Seven per cent of respondents felt insecure in their lives. In a stepwise logistic regression analysis, loneliness, living alone and perceived poor societal treatment of older people were associated with a sense of insecurity, while having good self-rated health, having children and meeting friends at least weekly were associated with lower odds of insecurity. Conclusions: Our findings highlight the importance of recognising and combating loneliness, social isolation and societal ageism in order to reduce insecurity among older people and to support their active engagement in life.

Early clinical exposure in undergraduate medical education: A questionnaire survey of 30 European countries

PURPOSE

Fifteen years ago, a European survey demonstrated widespread adoption of early clinical exposure (ECE) programmes but little emphasis in the curricula of medical schools. We now repeat the survey in light of the ample emerging data suggesting multiple positive outcomes of ECE.

METHODS

Online cross-sectional survey in European medical schools conducted by the EURACT Basic Medical Education Committee in 2021. Descriptive quantitative analyses and a thematic analysis approach were used.

RESULTS

Eighy-nine (48%) medical schools in 30 European countries responded. ECE was used in 65 (73%) of the medical schools, and 88% of ECE programmes took place in primary care. The median total time spent on the ECE programme was 5 days. Teaching methods covered unstructured learning opportunities such as observation or shadowing doctors, as well as work-based learning whilst seeing real patients or reflecting on own encounters. Learning goals included knowledge, skills, and attitudes. More than half of the respondents expressed barriers to implementing or expanding ECE.

CONCLUSIONS

Compared to the previous survey, there was no significant change in the adoption or curricular emphasis of ECE programmes. Institutional attitudes towards certain disciplines and a lack of willingness to experiment with new teaching methods may be partially responsible.

Changes in symptom burden from 2019 to 2021 amongst community-dwelling older adults in Finland

BACKGROUND

Symptom burden causes suffering amongst older adults and is associated with healthcare visits and prognosis.

AIMS

We evaluated the prevalence of 10 symptoms and changes in symptom burden amongst home-dwelling older adults in 2019 and 2021 using Finnish cohort data. We analysed factors associated with symptom burden increase during follow-up.

METHODS

Altogether 1,637 people aged 75+ participated in the Helsinki Ageing Study postal survey in 2019, where they reported the presence of 10 common symptoms over the past 2 weeks. Of them, 785 participated in a follow-up in 2021, where the same symptoms were queried. We compared the prevalence of various symptoms and symptom burden scores in the 2-year interval and evaluated factors associated with increased symptom burden during this time.

RESULTS

Of participants, 33% reported at least one daily symptom in 2019 versus 44% in 2021. Symptom burden increased by a mean ratio of 1.29 between 2019 and 2021. The most common symptoms were joint pain, back pain, urinary incontinence and fatigue. The prevalence of four symptoms increased between 2019 and 2021: joint pain, urinary incontinence, dizziness and shortness of breath. Higher age, reduced functional capacity and comorbidities were associated with higher odds of symptom burden increase during follow-up. Psychological well-being (PWB) was strongly associated with lower odds of symptom burden increase in the logistic regression model.

CONCLUSIONS

Symptom burden increased in our cohort aged 75+ between 2019 and 2021 before and during the COVID-19 pandemic. PWB was associated with lower odds of acquiring additional symptoms over time.

Impact of the COVID-19 Pandemic on Older People's Loneliness: Findings from a Longitudinal Study between 2019 and 2021 among Older Home-Dwellers in Finland

OBJECTIVES

To investigate the change in feelings of loneliness among Finnish community-dwelling older people from before the COVID-19 pandemic in 2019 to during the pandemic in 2021. Moreover, we explore the changes in other dimensions of psychological well-being (PWB) during the study period.

DESIGN

Questionnaires were mailed in the 2019 Helsinki Aging Study, a repeated cohort study. A follow-up interview was carried on over the telephone during the year 2021.

SETTING AND PARTICIPANTS

A random sample of 2,917 home-dwelling older people aged 75-104 years residing in Helsinki, Finland were mailed the questionnaire. Altogether 898 participated in the follow-up.

MEASUREMENTS

Loneliness was measured using a single item question "Do you suffer from loneliness?". Other items of psychological well-being were measured: "Are you satisfied with your life?" (yes/no), "Do you feel useful?" (yes/no), "Do you have a zest for life?" (yes/no),"Do you have plans for the future?" (yes/no), and "Do you feel depressed?"("rarely or never"/ "sometimes"/ "often or always").

RESULTS

Altogether 898 people participated both in 2019 and 2021. The subjects' mean age was 83 years and 66% were women. Between 2019 and 2021, the prevalence of experienced loneliness increased among older home-dwellers from 26% to 30%. During two years of the pandemic feelings of loneliness (RR 1.79, 95% CI: 1.30 to 2.46) and depression (RR 1.37, 95% CI: 1.12 to 1.67) increased even adjusted with various confounders.

CONCLUSION

Considering the impact loneliness has on health and well-being, the finding of increased feelings of loneliness among older people is alarming. Actions to combat loneliness need to be taken.

European standards for undergraduate medical education in general practice; a blueprint - for action

There is compelling evidence that general practice (GP) is the most effective form of healthcare. However, healthcare policy appears independent of evidence and GP is woefully under-resourced in all countries, and this affects recruitment. Recruitment to GP is proportional to the quantity and quality of undergraduate experience and national and transnational guidelines can improve undergraduate experiences by defining both the desired quantity and quality. There is good evidence that these professionally developed guidelines can be effective in changing Government policy if they are used as a touchstone to collaborate with policymakers.EURACT (European Academy of Teachers in General Practice / Family Medicine) have therefore developed transnational guidelines covering the European region. The guidelines cover the desired quantity, quality and support for undergraduate experience. Three main design principles have been used. Firstly, it is democratic. Secondly it is evidence-based, using extensive literature searching, situational analysis and surveys. Finally, it adopts a 'principles-based approach'. Generalist medicine is articulated as a series of interconnected principles that integrate and then re-focus specialist medicine to achieve the enhanced patient-orientated outcomes of primary-care. This way of articulating generalist practice delivers general principles, which can be used as learning outcomes, that are adaptable to a wide range of learning environments. Most clinical learning documents are irrelevant and are destined for dusty drawers or forgotten digital files. We therefore encourage primary care educators to use these guidelines to work with policy-makers at all levels to advocate for change, strengthening primary care education at local, national and international levels.

Symptom burden in community-dwelling older people: temporal trends in the Helsinki Aging Study

Background

Changes in older people’s symptoms across recent decades have not been investigated.

Aims

We analyzed temporal trends in symptom burden by comparing data from independent, cross-sectional cohorts retrieved in 1989, 1999, 2009, and 2019. Furthermore, we compared the association between symptom burden and psychological wellbeing (PWB) in older men and women.

Methods

The Helsinki Aging Study recruited a random sample of people aged 75, 80, and 85 in 1989, and random samples aged 75, 80, 85, 90, and 95 in 1999, 2009, and 2019 (four study waves). Altogether, 6263 community-dwelling people answered the questions concerning symptoms in the questionnaire surveys. The symptoms inquired in all study waves were dizziness, back pain, joint pain, chest pain, shortness of breath, and loss of appetite. Symptom burden was calculated according to the number of symptoms and their frequency (score range: 0–6). PWB and the Charlson comorbidity index were calculated.

Results

Symptom burden decreased in both men and women aged 75 and 80 from 1989 to 2019. Changes in cohorts aged 85 + were nonsignificant. There was a significant difference in symptom burden between men and women in all ages with men having fewer symptoms. PWB decreased with increasing symptom burden. Men had greater PWB than women up to severe levels of symptom burden.

Conclusions

Symptom burden decreased from 1989 to 2019 in cohorts aged 75–80, whereas changes remained nonsignificant in cohorts aged 85 +. To our knowledge, this is the first study to examine temporal trends in symptom burden.

Prevalence of Musculoskeletal Pain and Analgesic Treatment Among Community-Dwelling Older Adults: Changes from 1999 to 2019

Background

Pain is undertreated in older populations. At the same time, increased use of opioids is of concern in the Western world.

Aims

We sought to analyze temporal trends in musculoskeletal pain and prescribed analgesic treatment among community-dwelling people aged 75–95 years using cross-sectional cohort data spanning 20 years.

Methods

The Helsinki Aging Study recruited random samples of people aged 75, 80, 85, 90, and 95 years in 1999, 2009, and 2019. In total, 5707 community-dwelling persons participated in the study. The participants reported their medical diagnoses, regular prescription medications, and the presence of back pain or joint pain within the last 2 weeks (never, sometimes, or daily). We compared analgesic use among participants reporting and not reporting musculoskeletal pain in 1999, 2009, and 2019.

Results

Of the participants, 57–61% reported intermittent or daily musculoskeletal pain. The percentage receiving a prescribed daily analgesic increased from 9% in 1999 to 16% in 2019. The use of non-steroidal anti-inflammatory drugs (NSAIDs) decreased from 1999 to 2019, while the use of paracetamol increased from 2 to 11%. Opioids were taken by 2% in 1999 and 3% in 2019. Of those reporting daily musculoskeletal pain, 20%, 35%, and 32% received regular pain medication in 1999, 2009, and 2019, respectively.

Conclusions

Pain remains undertreated in the community-dwelling older population, although the use of regular prescribed analgesics increased between 1999 and 2019. The use of NSAIDs has decreased, while the use of paracetamol has increased. Daily opioid use has remained modest.

Secular trends in functional abilities, health and psychological well-being among community-dwelling 75- to 95-year-old cohorts over three decades in Helsinki, Finland

Background: Life expectancy has increased markedly in the past decades. Thus, it is of great importance to understand how people are ageing and if the trajectories of health and disability are changing over time. This study aimed to examine trends in functional abilities and health in independent cohorts of people aged 75–95 over three decades. Methods: This Helsinki Ageing Study consists of repeated cross-sectional postal surveys examining independent cohorts of old people (75, 80, 85 and 90+ years old). This study combined data from four waves (1989, 1999, 2009 and 2019). Results: In the most recent wave, there was an increase in the portion of participants who were able to walk outdoors easily (75-year-olds p=0.03, 80-year-olds p=0.002, 85-year-olds p<0.001; p for linearity for the study year effect, all adjusted for sex). Fewer people in the youngest age group (75-year-olds) needed daily help from another person in 2019 compared to the earlier waves (p=0.02 for linearity for the study year). Over the past three decades, the proportions of self-reported good mobility have risen 8.7% (95% confidence interval (CI) 2.3–15.1) in 75-year-olds, 11.7% (95% CI 3.9–19.6) in 80-year-olds and 20.1% (95% CI 10.7–29.4) in 85-year-olds, after adjusting for sex. Furthermore, in 2019, more people rated their health as good and scored better in psychological well-being than in the previous waves among 75-, 80- and 85-year-olds. However, no improvements were found among 90+-year-olds in any of these variables. Conclusions: People between 75 and 85 years old are presently feeling and functioning better than their predecessors. This may be an important objective for both economics and health policy.

Symptom Burden Is Associated with Psychological Wellbeing and Mortality in Older Adults

IMPORTANCE

Over half of outpatient visits are due to physical symptoms; yet, the significance of symptoms in relation to older people's wellbeing and prognosis has gained very little research attention.

OBJECTIVES

This study aims to analyze the prognostic value of symptom burden, derived from symptom count and frequency, in an older cohort aged 75 to 95. We also explore the association between symptom burden and psychological wellbeing.

DESIGN

Randomly assigned cohorts of community-dwelling people aged 75-95 filled in the postal questionnaire of the Helsinki Aging Study in 2009.

SETTING

Community-based, postal questionnaires (survey response rate 74%).

PARTICIPANTS

1583 community-dwelling people aged 75-95 in the urban Helsinki area. Main outcomes and measures: The inquired symptoms were dizziness, back pain, joint pain, chest pain or discomfort, shortness of breath, leg pain when walking, loss of appetite, and urinary incontinence. Symptom burden was calculated according to the number of symptoms and their frequency (score range: 0-8). The participants were subdivided into four groups according to their symptom burden. Mortality data was extracted from the Finnish Population Register in 2014. Psychological wellbeing (PWB) was measured using the validated PWB score.

RESULTS

Of 1583 participants, 18% reported no symptoms over the past 2 weeks (Group 0), 31% scored 0.5-1 in the symptom burden score (Group 1), 23% scored 1.5-2 (Group 2), and 28% scored 2.5-8 (Group 3). There was a linear relationship between symptom burden and comorbidities, functional status, falls, and PWB. The groups showed a significant difference in 5-year mortality, even adjusted for age, sex, and comorbidities: Group 1 1.18, 95% CI 0.84-1.66; Group 2 1.63, 95% CI 1.15-2.31, and Group 3 2.08, 95% CI 1.49-2.91 compared to Group 0 (p for linearity <0.001). Conclusion and relevance: Symptom burden is associated with higher mortality and lower PWB independent of comorbidities in community-dwelling people aged 75-95. We conclude that somatic symptoms need to be assessed when examining the general health status of an aging patient. Self-reported symptoms seem to convey information about health that cannot be derived from medical diagnoses only.

Associations of perceived poor societal treatment among the oldest-old

BACKGROUND

Previous studies of perceived ageism among older people have focused on younger age groups with the respondents' mean age far below 80.

OBJECTIVE

To explore the perceptions of poor societal treatment of older people among home-dwelling people aged 75-100+ and how their perceptions are associated with demographic characteristics, health, functioning, and wellbeing.

METHODS

In the Helsinki Aging Study, a random sample of 2,917 home-dwelling people aged 75-104 received a postal questionnaire inquiring about their health, wellbeing and experiences. The response rate was 74%. We asked: 'How in your opinion are older people treated in Finland?' (well/moderately/poorly) and categorized the respondents according to their responses. A multivariable forward stepwise ordered logistic regression model was used to determine the independent associations of the variables on the ordinal level of perceptions of treatment.

RESULTS

Of the participants, 1,653 responded to the index item. Of these, only 13% thought that older people are treated well in society, and 66% and 21% were of the opinion that older people are treated moderately or poorly in society, respectively. Perceived poor societal treatment was more common among women, the younger respondents, and those with lower incomes, as well as family caregivers and those with lower self-rated health and lower psychological wellbeing. Those who were able to walk outside unassisted and those with a regular hobby perceived poor societal treatment more often.

CONCLUSIONS

Several demographic factors, self-rated health, psychological wellbeing and better functioning were associated with perceptions of poor treatment among the oldest-old.

Changes in disability, self-rated health, comorbidities and psychological wellbeing in community-dwelling 75-95-year-old cohorts over two decades in Helsinki

OBJECTIVE

To explore changes in self-reported disabilities, health, comorbidities and psychological wellbeing (PWB) in aged cohorts over two decades.

DESIGN, SETTING AND SUBJECTS

Cross-sectional cohort studies with postal surveys were conducted among community-dwelling people aged 75, 80, 85, 90 and 95 years in 1989 (n = 660), 1999 (n = 2598) and 2009 (n = 1637) in Helsinki, Finland.

MAIN OUTCOME MEASURES

Self-reported items on disability, self-rated health (SRH), diagnoses and PWB were compared between cohorts of the same age. Standardized mortality ratios (SMRs) were calculated for each study year to explore the representativeness of the samples compared to general population of same age.

RESULTS

A significantly lower proportion of the 75-85-year-olds of the later study years reported going outdoors daily, although this group had improvements in both SRH and PWB scores. The number of comorbidities increased over time among 75-85-year-olds. The only significant change that could be verified among 90- and 95-year-olds between 1999 and 2009, was the lower proportion of participants going outdoors daily. The trend of leveling-off in disabilities was not explained by the SMRs (0.90, 0.71 and 0.60 for 1989, 1999 and 2009).

CONCLUSIONS

The latest older people's cohorts showed an end to previously reported improvements in disabilities, despite having favorable trends in SRH and PWB. Primary care may be faced with increasing need of appropriate services for their senior members.

Do you want to live to be 100? Answers from older people

BACKGROUND

little is known about the oldest-olds' views on ageing.

OBJECTIVE

to investigate older people's desire and the reasons they give for wanting to live to 100.

DESIGN

a postal questionnaire, analysed both quantitatively and qualitatively.

SETTING

population based in Helsinki, Finland.

SUBJECTS

a random sample (response rate 64%; N = 1,405) of community-dwelling older people (aged 75-96).

METHODS

a structured self-completed questionnaire with an open-ended question on the reasons why/why not participants wished/did not wish to live to 100.

RESULTS

one-third (32.9%) of home-dwelling older people wanted to live to be 100. Those who did were older, more often male and self-rated their health better than those who did not. Often the desire for long life was conditional: 'Yes, if I stay healthy'. Among the reasons is that many were curious to see what would happen. Many stated that they loved life, they had twinkle in their eye or significant life roles. Those who did not want to live extremely long lives gave various rationales: they would become disabled, life would be meaningless, they were reluctant to become a burden to others or they feared loss of autonomy or suffering pain or loneliness. Some people also shared the view that they should not intervene in destiny or they felt that they had accomplished what they wanted in life.

CONCLUSIONS

one-third of the oldest-old participants wanted to live to 100. Identifying what motivated them to desire long life could be a resource in their care plans.

[Procedural skills of students qualifying as a doctor - towards blended learning]

Medical students feel that their ability to carry out procedures is lower than desired. Whereas supervised learning is easily arranged at scheduled appointment clinics, experience in emergency procedures often accumulates only during practical training. A large part of the students had turned to the internet in search for advice or repetition about typical emergency procedures. With the growing yearly intake by the faculties it will be difficult to increase contact teaching at the clinical stage, but it is possible to improve its quality through flipped classroom. Procedural videos found in the internet are well suited for stimuli prior to contact teaching.

Will-to-live and survival in a 10-year follow-up among older people

BACKGROUND

there is little research how older people's will-to-live predicts their survival.

OBJECTIVE

to investigate how many years home-dwelling older people wish to live and how this will-to-live predicts their survival.

METHODS

as a part of the Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study, 400 home-dwelling individuals aged 75-90 were recruited into a cardiovascular prevention trial in Helsinki. In 2000, a questionnaire about the wishes of their remaining life was completed by 283 participants. Participants were inquired how many years they would still wish to live, and divided into three groups according to their response: group 1: wishes to live <5 years, group 2: 5-10 years, group 3: >10 years. Mortality was confirmed from central registers during a 10-year follow-up. The adjusted Cox proportional hazard model was used to determine how will-to-live predicted survival.

RESULTS

in group 1 wishing to live less than 5 years, the mean age and the Charlson comorbidity index were the highest, and subjective health the poorest. There were no differences between the groups in cognitive functioning or feeling depressed. Mortality was the highest (68.0%) among those wishing to live <5 years compared with those wishing to live 5-10 years (45.6%) or over 10 years (33.3%) (P < 0.001). With group 1 as referent (HR: 1.0) in the Cox proportional hazard model adjusting for age, gender, Charlson comorbidity index and depressive feelings, HR for mortality was 0.66 (95% CI: 0.45-0.95) (P = 0.027) and 0.47 (95% CI: 0.26-0.86) (P = 0.011) in groups 2 and 3, respectively.

CONCLUSION

the will-to-live was a strong predictor for survival among older people irrespective of age, gender and comorbidities.

The perceptions of a GP's work among fifth-year medical students in Helsinki, Finland

OBJECTIVE

To explore medical students' potential interest in family medicine in the future and their perceptions of a GP's work.

DESIGN

A cross-sectional survey in 2008-2010.

SETTING AND SUBJECTS

Fifth-year medical students prior to their main course in General Practice at the University of Helsinki.

MAIN OUTCOME MEASURES

The students' opinions regarding the GP's work and their perceptions of the main aims of a GP's work.

RESULTS

309/359 medical students (mean age 25.7 years, 64% females) responded to the survey. Among the students, 76% considered the most attractive feature in the GP's work to be that it is versatile and challenging. The least attractive features included: too hasty, pressing work, too lonely work, and too many non-medical problems. The majority of the students considered the main aim of a GP's work as to identify serious diseases/disorders in order to refer those patients for specialized care (82%). Treatment of chronic diseases is an important responsibility of a GP's work according to 63% of the students. Only 38% considered health promotion to be an important aim.

CONCLUSIONS

Medical students may have perceptions of the GP's work that influence their career choices to specialize in other fields.