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Knuutila MT, Lehti TE, Karppinen H, Kautiainen H, Strandberg TE, Öhman H, Savikko NM, Jansson AH, Pitkälä KH. Determinants of a sense of insecurity among home-dwelling older people. Scand J Public Health 2024; 52:64-70. [PMID: 36271626 PMCID: PMC10845813 DOI: 10.1177/14034948221131419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Mia T. Knuutila
- Social Services and Health Care, City of Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Finland
| | - Tuuli E. Lehti
- Social Services and Health Care, City of Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Finland
| | - Helena Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Timo E. Strandberg
- Clinics of Internal Medicine and Geriatrics, Helsinki University Hospital, Finland
- Department of Internal Medicine and Geriatrics, University of Helsinki, Finland
| | - Hannareeta Öhman
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- Clinics of Internal Medicine and Geriatrics, Helsinki University Hospital, Finland
| | - Niina M. Savikko
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- City of Espoo, Elderly Care, Finland
| | - Anu H. Jansson
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- The Finnish Association for the Welfare of Older People, Finland
| | - Kaisu H. Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Finland
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Lehti TE, Knuutila M, Öhman H, Kautiainen H, Karppinen H, Tilvis R, Strandberg T, Pitkälä KH. Changes in symptom burden from 2019 to 2021 amongst community-dwelling older adults in Finland. Age Ageing 2023; 52:6974847. [PMID: 36626321 PMCID: PMC9831265 DOI: 10.1093/ageing/afac317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/11/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Tuuli E Lehti
- Address correspondence to: Tuuli E. Lehti, Tukholmankatu 8 B, FI-00290 Helsinki, Finland.
| | - Mia Knuutila
- Primary Health Care Unit, Helsinki University Hospital, Helsinki, Finland,Social Services and Health Care, City of Helsinki, Helsinki, Finland,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Hanna Öhman
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Helena Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Reijo Tilvis
- Geriatric Unit, Department of Internal Medicine, University of Helsinki, Helsinki, Finland
| | - Timo Strandberg
- Geriatric Unit, Department of Internal Medicine, University of Helsinki, Helsinki, Finland,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Kaisu H Pitkälä
- Primary Health Care Unit, Helsinki University Hospital, Helsinki, Finland,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Knuutila MT, Rautiainen L, Lehti TE, Karppinen H, Kautiainen H, Strandberg TE, Öhman H, Savikko NM, Jansson AH, Pitkälä KH. 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. J Nutr Health Aging 2023; 27:619-625. [PMID: 37702334 DOI: 10.1007/s12603-023-1949-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/15/2023] [Indexed: 09/14/2023]
Abstract
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.
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Affiliation(s)
- M T Knuutila
- Mia Knuutila, Tammisalontie 20 as 4, 00830 Helsinki, Finland, , ORCID ID: 0000-0001-5220-103X
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Lehti TE, Öhman H, Knuutila M, Kautiainen H, Karppinen H, Tilvis R, Strandberg T, Pitkälä KH. Symptom burden in community-dwelling older people: temporal trends in the Helsinki Aging Study. Aging Clin Exp Res 2021; 33:3065-3071. [PMID: 34216378 PMCID: PMC8595189 DOI: 10.1007/s40520-021-01918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- T E Lehti
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
- Social Services and Health Care, Helsinki, Finland.
- Primary Health Care Unit, Helsinki University Hospital, Helsinki, Finland.
- , Tukholmankatu 8 B, Biomedicum 2 B, 00290, Helsinki, Finland.
| | - H Öhman
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Knuutila
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Social Services and Health Care, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - H Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - R Tilvis
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - T Strandberg
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - K H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Primary Health Care Unit, Helsinki University Hospital, Helsinki, Finland
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Öhman HR, Karppinen H, Lehti TE, Knuutila MT, Tilvis R, Strandberg T, Kautiainen H, Pitkala KH. 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. Scand J Public Health 2021; 50:524-531. [PMID: 33899588 PMCID: PMC9152590 DOI: 10.1177/14034948211007688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Hanna R Öhman
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Finland
| | - Helena Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Tuuli E Lehti
- Department of General Practice and Primary Health Care, University of Helsinki, Finland.,Social Services and Health Care, City of Helsinki, Finland
| | - Mia T Knuutila
- Department of General Practice and Primary Health Care, University of Helsinki, Finland.,Social Services and Health Care, City of Helsinki, Finland
| | - Reijo Tilvis
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Timo Strandberg
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Kaisu H Pitkala
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
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Lehti TE, Öhman H, Knuutila M, Kautiainen H, Karppinen H, Tilvis R, Strandberg TE, Pitkala KH. Symptom Burden Is Associated with Psychological Wellbeing and Mortality in Older Adults. J Nutr Health Aging 2021; 25:330-334. [PMID: 33575724 DOI: 10.1007/s12603-020-1490-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- T E Lehti
- Tuuli Elina Lehti, Ilkantie 10 B 22 00400 Helsinki, Finland,
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Knuutila M, Lehti TE, Karppinen H, Kautiainen H, Strandberg TE, Pitkala KH. Associations of perceived poor societal treatment among the oldest-old. Arch Gerontol Geriatr 2020; 93:104318. [PMID: 33310658 DOI: 10.1016/j.archger.2020.104318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- M Knuutila
- Social Services and Health Care, City of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
| | - T E Lehti
- Social Services and Health Care, City of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - H Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - T E Strandberg
- Clinics of Internal Medicine and Geriatrics, Helsinki University Hospital, Helsinki, Finland; Department of Internal Medicine and Geriatrics, University of Helsinki, Helsinki, Finland
| | - K H Pitkala
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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