Health status in the oldest old. Age and sex differences in the Umeå 85+ Study

116 Aging Clin Exp Res, Vol. 18, No. 2

Key words: Epidemiologic studies, geriatrics, health status, population characteristics.Correspondence: P. von Heideken Wågert, RPT, MSc, Geriatric Medicine, Umeå University, SE-901 87 Umeå, Sweden.E-mail: [email protected] November 22, 2004; accepted in revised form June 23, 2005.

ABSTRACT. Background and aims: With an in-creasing population aged 85 years and over, the aim ofthis study was to describe health status and livingconditions in the oldest old and to estimate age andsex differences in a Northern European population.Methods: A population-based cross-sectional study,The Umeå 85+ Study, was carried out in the munici-pality of Umeå in northern Sweden. Out of 319 eligi-ble participants aged 85, 90 and 95 years and over,253 participated. Structured interviews and assess-ments were conducted with the participants in theirhomes, and data were also collected from relatives,caregivers and medical charts. Cognition was screenedwith the Mini-Mental State Examination (MMSE), de-pressive symptoms with the Geriatric Depression Scale-15 (GDS-15) and nutritional status with the Mini Nu-tritional Assessment (MNA). Activities of daily living(ADL) were assessed applying the Staircase of ADL (in-cluding Katz’ Index of ADL) and morale with thePhiladelphia Geriatric Center Morale Scale (PGCMS).Participants also rated their own health. Results:Over half of the participants had hypertension, one outof four was depressed, and the same proportion hadhad a hip fracture; the mean number of drugs takenwas 6.4±4.0. Younger participants had lower rates ofdiagnoses and prescribed drugs, and were less depen-dent in ADL and other functional variables; men hadlower rates of diagnoses and reported symptoms. Themajority of participants rated their general health andmorale as good. Conclusions: There were large vari-ations in social, medical and functional variables with-in and between age and sex groups. This northernpopulation of the oldest old seems to have a veryhigh prevalence of hypertension, depression, hip frac-tures, and many prescribed drugs.(Aging Clin Exp Res 2006; 18: 116-126)©2006, Editrice Kurtis

Health status in the oldest old. Age and sexdifferences in the Umeå 85+ StudyPetra von Heideken Wågert1, Janna MC Gustavsson1, Lillemor Lundin-Olsson1, Kristina Kallin1,Björn Nygren2, Berit Lundman2, Astrid Norberg2, and Yngve Gustafson1

1Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy,2Department of Nursing, Umeå University, Umeå, Sweden

INTRODUCTIONThe world’s population aged 60 years or older com-

prises 10%, and this proportion will double within the next50 years. The oldest old, aged at least 80 years andover, is the fastest growing age group of older people to-day (1). In Sweden, they already account for 22% ofthe total population 60 years or older and, of these,10% are 85 years or older (2). The prevalence of diseasesand impairment increases with advanced age, and con-sequently the demands for healthcare and services amongolder people will be higher in the future. It is therefore ofgreat importance to increase our knowledge about thehealth status and special needs of the oldest old.

Previous population-based studies with separate anal-yses for the oldest old in Sweden (3-8), other countries ofScandinavia (9-14), in the rest of Europe (15-23), in theUS (24-27) and in Canada (28) show that older peoplemore often have reduced ability to manage the activitiesof daily living (ADL) (8, 9, 15, 19) than younger oldpeople. Older people also more often have poorer hear-ing (9, 15, 29) and vision (9, 30), impaired cognition (3,5, 9, 19, 24, 29, 31) and higher rates of dementia (17,22, 26, 29, 32) and depression (15, 19, 24). Studies al-so show that women are more often widowed and livealone, whereas men are more often married (10, 12, 18,30). Women also have poorer ADL ability (4, 8, 9, 19,30, 33), physical capacity (4, 8, 9, 33) and cognition (8,10, 19, 24, 28, 30) and a higher prevalence of demen-tia (6, 10, 17, 22, 24, 28, 32) but a lower prevalence ofmalignancies (4, 30) than men. Despite more diseases anda decline in functions, older people often state that theirhealth is as good as that of younger old people (15, 33,34), and women rate theirs as good as men’s (33).

Sweden is a country 1574 km long, and reaches fromlatitudes 55º N to 69º N. Earlier research on younger oldpeople has shown differences between northern andsouthern Sweden, with higher rates, for example, of di-

Aging Clinical and Experimental Research

abetes and cardiovascular diseases in the north. Some sug-gested explanatory factors are dietary habits and sea-sonal variations (35). As the oldest old in northern Swe-den have not been studied, it is not known whetherthere are also any health differences in these age groups.To our knowledge, no population-based studies on theoldest old have been performed as far north as the latitudeof Umeå (64º N). The aim of this study was to describehealth status and living conditions among the oldest old innorthern Sweden and to estimate age and sex differ-ences.

METHODSParticipantsA random sample, comprising half the population

born in 1915 (85-year-olds) and the total populationborn in 1910 (90-year-olds), 1905 and earlier (≥95-year-olds, range 95-103), living in the municipality of Umeå,Sweden on January 1, 2000, were selected for partic-ipation (n=348). Umeå is a university city in northernSweden with approximately 105,000 inhabitants. Ofthese, 12% were at that time 65 years and older and, ofthese, 11% were 85 years and older. These proportionswere lower than in Sweden as a whole (17% and 13%respectively) (2). The names, addresses and civil regis-tration numbers of participants were collected fromthe National Tax Board. The randomization of 85-year-olds was conducted by selecting every second per-son from the lists received from the National Tax Board,on which individuals are listed according to date ofbirth. The random sample had the same sex distributionas the total 1915 population in Umeå. Twenty-nine outof 348 (8.3%) died before they were asked to partici-pate. The deceased did not differ as regards sex orage from the remaining 319. Sixty-six people out of 319(20.7%) declined home visits personally or by theirnext-of-kin. These 66 were more likely to be younger(p=0.008), married (p<0.001) and living in ordinaryhousing (p<0.001). There were no sex differences com-pared with the study sample, either in total or in thethree age groups. The final study sample consisted of253 participants, 79.3% of the 319 who were asked toparticipate (Fig. 1).

In the first step, participants received a letter with in-formation on the study and, about two weeks later, theywere informed about the home visit procedure through atelephone call and gave their informed consent. Theoldest participants were asked first and the total datacollection was performed over a period of 18 months. As-sessments were performed during two to three homevisits by one of four different investigators (two medical stu-dents, one nurse, one physiotherapist). All assessments,questions and scales were interviewer-administered andconducted in the same order for all visits. Data were alsocollected from relatives, caregivers and medical charts.

Each home visit took about two hours, with intervals ofone to two weeks between visits.

Sociodemographic dataStructured interviews concerning participants’ actu-

al living conditions, education and previous occupationwere conducted. Housing was classified as ordinary, ifsubjects lived in a house or apartment, with or withouthelp from homecare services. Residential care coveredprivate apartments with 24-hour access to staff in thesame building. In skilled nursing homes, there wererooms for up to four people, with shared dining and liv-ing rooms. In group dwellings for people with de-mentia, each resident had a single room, with shareddining and living rooms. Education was classified as fol-lows; 0-5 years included incomplete elementary school-ing, 6-7 years included elementary schooling, 8-9 yearsincluded high school and some shorter education afterelementary school. The group ≥10 years had attendedsenior high school, vocational education programs,and university. Occupation was classified in accor-dance with the Swedish Standard Classification of Oc-cupations (AMSYK) (Swedish National Labour Market

Health in the oldest old: the Umeå 85+ Study

Aging Clin Exp Res, Vol. 18, No. 2 117

Aging Clin Exp Res 18: 116-126, 2006©2006, Editrice Kurtis

Died beforerequest, n=298.3% of 348

85: n=130, 91% of 14390: n=106, 91% of 117≥95: n=83, 94% of 88

25% men, 75% women

85: n=95, 73% of 13090: n=86, 81% of 106≥95: n=72, 87% of 83

25% men, 75% women

Studysample, n=25379.3% of 319

Asked toparticipate, n=319

Declined homevisits, n=66

20.7% of 319

85-year-olds: n=14390-year-olds: n=117≥95-year-olds: n=88

26% men, 74% women

Selectedparticipants, n=348

Fig. 1 - Flow chart of study sample.

Board, 1997), based on the International StandardClassification of Occupations, ISCO-88 (ILO, Genève1988), comprising eleven groups.

Symptoms, self-rated health and sociabilityFor information about symptoms experienced during

the past three months, participants answered the symp-tom questionnaire from the Gothenburg Quality of Life In-strument (GQL-instrument) (36). They were asked aboutthe most common symptoms by means of this instrument,as given in a Swedish report (37) from the Lund 80+study (5). They answered yes or no if they had experi-enced any of the symptoms (general fatigue, eye prob-lems, impaired hearing, pain in the legs, backache, jointproblems, difficulties in walking, chilliness, sleep distur-bances, depressed mood, breathlessness, difficulty in re-laxing, coughing, nervousness, impaired concentration,headache, bouts of crying, irritability, overweight) duringthe past three months. Health in comparison with that ofage peers was rated using the self-rated health questionfrom the Mini Nutritional Assessment (MNA) (38). Par-ticipants also rated their health in general by answering thefirst question from the 36-item Short Form (SF-36) (39).We developed our own questions with yes or no an-swers concerning feeling safe at home, receiving thehelp one needs, feeling lonely, and having a good friendor family to talk to.

Physical and psychological assessmentsReading vision was rated as unimpaired if the partici-

pant, with or without glasses, could read a word printedin 3-mm capital letters at reading distance. Hearing wasrated as unimpaired if the participant, with or without ahearing aid, could hear a normal speaking voice from adistance of one meter.

Height and weight were assessed with a folding rulerand a digital bathroom scale. Body Mass Index (BMI) wascalculated (kg/m2) from these figures. Nutrition wasassessed using the Mini Nutritional Assessment (MNA)(38), a screening instrument for nutritional status whichis valid for use in the oldest old or residents in institu-tional care (38, 40). The MNA has a maximum score of30, which indicates very good nutritional status. Scoresbetween 23.5 and 17 indicate risk of malnutrition, andscores below 17 malnutrition (40).

Cognition was screened with the Mini-Mental StateExamination (MMSE) (41), with a maximum score of 30.A score of 23 or lower indicates impaired cognition (42).Depressive symptoms were screened with the GeriatricDepression Scale-15 (GDS-15) (43), in which scores be-tween 5 and 9 indicate mild depression, and a score of10 or more indicates moderate to severe depression.Morale was assessed with the Philadelphia GeriatricCenter Morale Scale (PGCMS) (44), in which morale isdefined as a basic sense of satisfaction with oneself, a

feeling that there is a place in the environment foroneself, and a certain acceptance of what cannot bechanged (45). The scale consists of 17 yes/no questionsand, according to the design of the scale, scores between17 and 13 indicate high morale, 12 to 10 middlerange, and 9 to 0 low morale.

Participants answered one question about the fre-quency of walking outdoors independently of others (46)and whether they had been outdoors during the pastweek. Independence in ADL was assessed with the Stair-case of ADL (47) which includes both instrumental (I-) andpersonal (P-) ADL. This is a further development of theKatz’ Index of ADL (48).

Diagnoses and prescribed drugsDiagnoses were collected from participants, rela-

tives and caregivers, and from medical charts at the hos-pital, general practitioners and/or the institutional carefacility. Prescribed drugs were recorded. Participants withassessments indicating undiagnosed conditions wereeither further assessed by specialists in geriatric medicineor were referred for further assessments. Lastly, a spe-cialist in geriatric medicine (YG) evaluated all diagnosticdocumentation, drug treatments and assessments, forcompletion of final diagnoses according to the same cri-teria for all participants.

Dementia was diagnosed if the patient had had a pre-vious diagnosis of dementia based on a previous assess-ment, and/or if the MMSE assessment and OrganicBrain Syndrome Scale (OBS scale) (49) showed cognitiveimpairment, indicating dementia. When the etiology of thecognitive impairment was uncertain, the participant wasreferred to the department of Geriatric Medicine for acomplete dementia assessment.

Depression was diagnosed after evaluation of earlierdocumented diagnoses in medical charts, current treat-ment with antidepressants, and depression screened withGDS-15 and rated with Montgomery-Åsberg Depres-sion Rating Scale (MADRS) (50). Depressive and otherpsychiatric symptoms were also rated according to theOBS scale. The MADRS was assessed only in thosewho scored 5 or more on the GDS-15 and only by a spe-cialist in geriatric medicine (YG or KK). If the person hadan earlier diagnosis of depression with ongoing treat-ment with antidepressants, despite a GDS-15 score <5,s/he was diagnosed as having depression. Similarly, hy-pertension was diagnosed if the person had a docu-mented diagnosis of hypertension with ongoing treat-ment, or had blood pressure of ≥160/95 without ongo-ing treatment for hypertension. Blood pressure was tak-en after five minutes of bed rest.

EthicsThe Ethics Committee of the Medical Faculty of Umeå

University approved the study (Dnr 99-326).

P. von Heideken Wågert, J.M.C. Gustavsson, L. Lundin-Olsson, et al.



Data analysisSPSS package 11.5 was used for calculations. Per-

centages with 95% confidence interval (CI) of proportionsand means with standard deviation (SD) and 95% CIwere used to describe the sample and to estimate differ-ences between age groups and sexes. When the 95% CIdid not overlap, the differences were regarded as statis-tically significant. When presenting data for all women, allmen, and for the total sample, respectively, data wereweighted by counting every 85-year-old twice. This wasdone due to the sampling procedure, in which half the 85-year-old population was included in the study in con-trast to the total population aged 90 and ≥95 years.Student’s t-test was used to analyse differences in PGCMSscores between depressed and non-depressed groups.

RESULTSSociodemographic dataSociodemographic data are listed in Table 1, which

shows that most 85-year-olds but few of the ≥95-year-oldslived in ordinary housing, and a larger proportion of theyounger age groups lived with someone. Men more oftenlived with someone, were married, and less often widowedthan women. No men lived in group dwellings for peoplewith dementia. Of the participants who lived in ordinaryhousing, the younger age groups were more likely to beindependent of help from others (data not shown). No ma-jor differences were seen between the age groups re-garding education and occupation. More women thanmen had worked in service and care, or had been house-wives, and more men had been carpenters or industrialworkers (Table 1).

Twenty-four per cent of subjects had been smokers,4% were still smokers, and 21% drank alcohol at leastonce a month. The oldest age group drank alcoholmore seldom than the younger age groups, and twice asmany men (34%) as women (17%) drank alcohol.

Symptoms, self-rated health and sociabilityThe number and type of reported symptoms did not dif-

fer significantly between age groups (Table 2). Only 4%,significantly more men than women, reported none of thesymptoms asked. About half reported general fatigue(55%), eye problems (52%), impaired hearing (50%) andpain in their legs (50%). Fewer men than women report-ed backache (28% vs 54%), eye and joint problems (33%vs 60% and 21% vs 54%, respectively) and also fewersymptoms in general. Health was rated as both better thanthat of their age peers and generally as excellent to goodby half the responding participants (Table 2). Participantswho rated their health as excellent to good had fewer butstill several diagnoses, drugs, symptoms, and a high ADLdependency, compared with those who rated their healthas fair to poor (data not shown). The great majority (95%)felt safe at home, the same proportion received help

needed (93%) and half of the sample (50%) never or sel-dom felt lonely. Seventy-seven per cent had a good friendto talk to, and 89% had family to talk to. Neither health ingeneral, nor feelings of safety or loneliness differed sig-nificantly between age groups or sexes (data not shown).

Physical and psychological assessmentsFour out of five subjects could hear a normal speaking

voice from a distance of one meter, with or withoutaids, and a similar proportion had unimpaired visionwhen reading, with or without aids. Reading vision andhearing were better in the younger age groups, and menhad better reading vision than women (Table 2). Almost50% had MNA scores indicating either risk of or actualmalnutrition, and the same proportion had MMSE scoresindicating cognitive impairment. MNA, MMSE scoresand BMI were significantly higher in the younger agegroups than in the oldest, and men had significantlyhigher MNA scores than women (Table 2).

Neither GDS nor PGCMS mean scores differed be-tween age groups or sexes (Table 2). Twenty-seven percent of the sample had GDS-15 scores of ≥5, and asimilar proportion had diagnosed depression. Partici-pants with diagnosed depression had significantly lowerPGCMS scores (mean±SD 9.6±3.1 vs 12.2±2.9,p<0.001). Participants who rated their morale as high hadfewer but still several diagnoses, drugs, symptoms and ahigh ADL dependency, compared with those who ratedtheir morale as low (data not shown). The prevalence ofwalking outdoors independently and having been outdoorsin the past week was higher in the younger age groups.In the youngest age group, three out of four subjectswalked outdoors independently compared with one out offour in the oldest age group (Table 2).

Half the participants were independent in P-ADL,and one out of five, more younger participants, were to-tally independent in both P- and I-ADL (Fig. 2). The dif-ferences in ADL were significant for most items in all threeage groups. In general, men tended to be more inde-pendent than women (Fig. 3).

Diagnoses and prescribed drugsOne out of four subjects had depression, and the

same proportion had dementia and/or had had a hipfracture (Table 3). Over half had hypertension, andthe same proportion had some kind of eye disease. On-ly 4% were not prescribed any drugs, and over halfwere prescribed analgesics and/or diuretics. In theyoungest age group, constipation, dementia, heart fail-ure, atrial fibrillation and glaucoma were less commonthan in the oldest, whereas hypertension was less com-mon in the oldest age groups. Sixty per cent had den-tures, without age or sex differences (data not shown).Fewer men than women had suffered hip and/or wristfractures or had had urinary tract infections in the




previous year, and fewer women had had malignanciesin the past five years. Fewer drugs were prescribed in

the youngest age group than in the oldest. Fewer lax-atives were prescribed in the youngest age groups,




Table 1 - Sociodemographic data. Prevalence in % or means±SD with 95% confidence interval. Figures for men and women are weighted.

85-year-olds 90-year-olds ≥95-year-olds Men Womenn=95 n=86 n=72 n=62 n=191

Female 73 73 8264-82 64-82 73-91

HousingOrdinarya 85 52 21 72 61

78-92 41-63 12-30 61-83 54-68Residential carea 11 30 42 20 22

5-17 20-40 31-53 10-30 16-28Skilled nursing homesa 3 10 22 8 9

0-6 4-16 12-32 1-15 5-13Group dwellings 1 7 15 0 7for people with dementiaa 0-3 2-12 7-23 3-11

Living circumstancesTogether with someonea 21 8 6 33 8

13-29 2-14 0-11 21-45 4-12

Marital statusMarrieda 18 7 8 40 3

10-26 2-12 2-14 28-52 1-5Never married 6 9 7 7 7

1-11 3-15 1-13 1-13 3-11Divorced 0 3 6 1 2

0-7 1-11 0-3 0-3Widoweda 76 80 79 51 87

67-85 72-88 70-88 39-63 82-92

Number of children born 2.3±1.7 2.3±1.8 2.0±1.8 2.2±1.4 2.2±1.81.9-2.6 1.9-2.7 1.6-2.4 1.9-2.5 2.0-2.4

Number of children in 6.2±3.7 6.0±3.1 6.9±3.0 6.4±3.2 6.2±3.5childhood family 5.4-6.9 5.3-6.6 6.2-7.6 5.7-7.1 5.8-6.7

Education0-5 years 7 8 13 3 11

2-12 2-14 5-21 0-7 7-156-7 yearsa 57 64 65 76 55

47-67 51-77 54-76 65-87 48-628-9 yearsa 28 21 10 15 25

19-37 12-30 3-17 6-24 19-31≥10 years 7 7 12 6 9

2-12 2-12 4-20 0-12 5-13

Occupationb

Theoretical specialist 5 8 17 5 101-9 2-14 8-26 0-10 6-14

Service and carea 16 15 11 5 189-23 7-23 4-18 0-10 13-23

Farming and forestry 16 17 11 24 127-23 9-25 4-18 13-35 7-17

Carpentrya 11 12 13 28 55-17 5-19 5-21 17-39 2-8

Industrial occupationa 11 7 4 23 35-17 2-12 0-9 13-33 1-5

Household occupationa 24 26 31 0 3515-33 17-35 20-42 28-42

aVariables with non-overlapping confidence intervals between at least two age groups or between sexes. bOccupation classification included 11 categories; here,the six most common occupations are presented.




Table 2 - Symptoms, self-rated health, physical and psychological assessments. Prevalence in % or means±SD with 95% confidence in-terval. Figures for men and women are weighted.


Number of n=92 n=74 n=43 n=59 n=150symptomsa 6.3±3.4 6.6±3.6 6.1±4.2 5.4±3.4 6.7±3.6

5.6-7.0 5.8-7.4 4.8-7.4 4.7-6.2 6.2-7.2

Health status in comparison n=91 n=77 n=45 n=59 n=154with age peers

Better 52 40 51 59 4542-62 29-51 36-66 46-72 37-53

As gooda 34 19 11 25 2824-44 9-28 2-20 14-36 21-35

Does not knowa 12 36 36 14 255-19 25-47 22-50 5-23 18-32

Not as good 2 4 2 2 30-5 0-8 0-6 0-6 0-6

Health in general n=84 n=64 n=30 n=51 n=127Excellent 4 3 13 4 5

0-8 0-7 1-25 0-9 1-9Very good 6 3 7 9 4

1-11 0-7 0-16 1-17 1-7Good 44 33 33 46 38

33-55 21-45 16-50 32-60 30-46Fair 37 55 47 36 45

27-47 43-67 29-65 23-49 36-54Poor 10 6 0 4 9

4-16 0-12 0-9 4-14

Reading visiona n=94 n=83 n=69 n=61 n=185Unimpaired 89 73 49 89 74

83-95 63-83 37-61 81-97 68-80

Hearinga n=95 n=85 n=72 n=61 n=191Unimpaired 89 78 53 78 79

83-95 69-87 41-64 68-88 73-85

BMI, kg/m2a n=91 n=84 n=64 n=58 n=18125.4±4.1 24.2±4.9 22.7±4.5 25.2±4.0 24.4±4.624.5-26.2 23.1-25.3 21.6-23.8 24.3-26.1 23.8-24.9

MNA scorea n=91 n=84 n=67 n=58 n=18424.6±3.4 22.0±5.1 19.6±5.8 24.8±3.6 22.3±5.023.9-25.3 20.9-23.1 18.2-21.0 24.0-25.6 21.7-22.9

MMSE scorea n=93 n=81 n=60 n=59 n=17524.3±5.4 21.2±8.3 15.9±10.6 23.5±5.6 21.4±8.623.2-25.4 19.3-23.0 13.1-18.6 22.3-24.8 20.3-22.5

GDS-15 score n=91 n=72 n=42 n=57 n=1483.5±2.3 4.1±2.6 4.5±3.0 3.4±2.2 4.0±2.63.0-4.0 3.5-4.7 3.5-5.4 2.9-3.9 3.6-4.3

PGCMS score n=86 n=73 n=40 n=55 n=14412.1±3.0 10.8±3.1 11.0±3.2 11.9±3.2 11.5±3.111.5-12.8 10.1-11.6 10.0-12.1 11.2-12.7 11.1-12.0

Walking outdoors n=95 n=86 n=72 n=62 n=191independently 75 49 24 69 54(≥once/month)a 66-84 38-60 14-34 57-81 47-61

Been outdoors in 81 63 33 73 65past weeka 73-89 53-73 22-44 62-84 58-72aVariables with non-overlapping confidence intervals between at least two age groups or between sexes. BMI=Body Mass Index; MNA=Mini-Nutritional As-sessment; MMSE=Mini-Mental State Examination; GDS-15=Geriatric Depression Scale, with 15 questions; PGCMS=Philadelphia Geriatric Center Morale Scale.

and men were prescribed fewer analgesics and laxativesthan women.

DISCUSSIONThis study indicates that the oldest old in this norther-

ly-living population have more depression, hypertension

and hip fractures, as well as a higher consumption ofdrugs than comparable, more southerly-living popula-tions. These results support previous studies demon-strating great variations in health and living conditionsamong the oldest old. However, there were no age or sexdifferences in self-rated health or morale.




Eating**

Continence**

Transfer**

Toileting**

Dressing**

Bathing**

Cooking**

Transport**

Grocery shopping**

Cleaning**

0 20 40 60 80 100%

Activities performed independently

85-year-olds, n=94*90-year-olds, n=86>95-year-olds, n=72

Fig. 2 - Activities performed independently according to ADL Staircase, as % of participants in age groups. *One case missing. **Vari-ables with non-overlapping confidence intervals between at least two age groups.

Eating

Continence

Transfer

Toileting

Dressing

Bathing

Cooking

Transport

Grocery shopping

Cleaning

0 20 40 60 80 100%

Activities performed independently

Men, n=62Women, n=190*

Fig. 3 - Activities performed independently according to ADL Staircase, as % of men and women. *One case missing.




Table 3 - Diagnoses and prescribed drugs, in descending order according to weighted prevalence of total study sample (n=253). Preva-lence in % or means±SD with 95% confidence interval. Figures for men and women are weighted.


DiagnosesInsomnia 42 41 49 35 46

32-52 31-51 37-61 23-47 39-53

Constipationa 24 45 64 26 4215-33 34-56 54-74 15-37 35-49

Hypertensiona 73 50 26 47 6164-82 39-61 16-36 35-59 54-68

Cataract 38 37 24 36 3428-48 27-47 14-34 24-48 27-41

Dementiaa 20 27 47 22 2912-28 18-36 41-53 12-32 23-35

Urinary tract infection 22 31 31 13 31in past yeara 14-30 21-41 20-42 5-21 24-38

Depression 17 34 32 19 26(n=242)b 8-27 24-44 21-43 9-29 20-32

Previous hip 20 23 33 8 29fracturea 12-28 14-32 22-44 1-15 23-35

Heart failurea 15 29 35 24 228-22 19-39 24-46 13-35 16-28

Previous wrist 25 20 17 0 30fracturea 16-34 12-28 8-26 24-36

Cerebrovascular 20 29 17 28 19disease 12-28 19-39 8-26 17-39 13-25

Atrial 9 21 28 18 15fibrillationa 3-15 12-30 18-38 8-28 10-20

Glaucomaa 7 19 31 11 162-12 11-27 20-42 3-19 11-21

Diabetes 12 12 14 16 115-19 5-19 6-22 7-25 7-15

Malignancies in 14 12 4 28 5past five yearsa 7-21 5-19 0-9 17-39 2-8

Prescribed drugsAnalgesicsa 47 60 65 36 60

37-57 50-70 54-76 24-48 53-67

Diuretics 44 64 57 51 5234-54 53-75 46-68 39-63 45-59

Benzodiazepines 32 36 40 25 3823-41 26-46 29-51 14-36 31-49

Laxativesa 20 40 64 20 3812-28 30-50 53-75 10-30 31-49

Beta-blockers 28 33 18 30 27incl. eye drops 19-37 23-43 9-27 19-41 21-33

Digitalis 16 24 19 23 179-23 15-33 10-28 13-33 12-22

Antidepressants 13 24 18 13 186-20 15-33 9-27 5-21 13-23

Neuroleptics 13 17 26 17 176-20 9-25 16-36 8-26 12-22

ACE inhibitors 7 16 10 15 82-12 8-24 3-17 6-24 4-12

Number of drugs 5.6±3.6 7.5±4.3 7.4±4.2 5.6±3.9 6.7±4.04.9-6.4 6.6-8.4 6.4-8.4 4.7-6.4 6.3-7.2

aVariables with non-overlapping confidence intervals between at least two age groups or between sexes. b242 valid cases of depression: 85-year-olds, n=95;90-year-olds, n=82; ≥95-year-olds, n=65; men, n=60 and women, n=182. ACE=Angiotensin-converting enzyme

We found a higher prevalence of both diagnosed de-pression and depressive symptoms than reported in oth-er studies (51, 52). Participants with diagnosed de-pression in the present study included both those notpreviously diagnosed or treated, and those undergoingtreatment. About half of those prescribed antidepres-sants in the present sample scored five or more on theGDS-15, which may indicate unsuccessful treatment(53). However, a very recent study evaluated the GDS-15 and found high sensitivity and specificity for diag-nosed depression in a general population of the oldestold (54). A comparison of different diagnoses withthose given in other studies may be misleading, as thediagnoses were applied differently. In this study, the di-agnosis of hypertension was determined after evaluationof current treatment, documented diagnosis, and bloodpressure. Other studies used different combinationsof these methods, or diagnosed hypertension accordingto ICD-9. However, the specific figures for each methodin this study were higher than previously reported (29,30, 55).

Hip fractures seem to be more common in this north-ern older population compared with studies from south-ern Sweden (37, 56), and most probably in other popu-lations as well, because Sweden has one of the highest in-cidence rates of hip fractures in the world (57, 58). Twoexplanations for this are hereditary factors and climate (57,58). Half the participants did walk outdoors indepen-dently but, even with help, only one-third in the oldest agegroup had been outdoors in the previous week. Not go-ing outdoors also leads to vitamin D deficit, which en-hances osteoporosis (57, 58). The long winter may ex-plain some of the low figures of being outdoors and thehigh fracture rate, especially in the oldest age groups. Thecold climate has also been suggested as one explanatoryfactor for the previously shown high prevalence of car-diovascular diseases (35).

Fewer participants in the present study had no drugtreatment at all compared with subjects in other studies (4,5, 10, 13). They were also prescribed a larger number ofdifferent drugs (10, 59), particularly analgesics, diureticsand laxatives (13, 15, 59). The high number of pre-scribed drugs may reflect the high prevalence, for exam-ple, of hypertension and treatment of symptoms relatedto depression.

Malnutrition is a serious health problem among old-er persons. Almost half the participants were either atrisk of malnutrition, or were malnourished according tothe cut-off scores of the MNA scale. However, the pro-portion of malnourished subjects was lower than inresidential care patients (60), but higher than in oldpeople living at home (38). This may indicate that oursample had figures similar to those found in other stud-ies, and that malnutrition is a common problem, as inseveral other countries.

Similar figures of self-rated health as younger old peo-ple, despite higher rates of diagnoses and functional dis-abilities, have previously been reported in old age groups(15, 33, 34). It has been suggested that older peopleadapt to a decline in their health and functional perfor-mance with increasing age (34), perhaps for the same rea-sons as morale, which did not differ between age or sexgroups. However, why women rate their health as beingas good as that of men, despite a higher prevalence of dis-ease and symptoms, remains unknown.

The participation rate in this study was similar to thatof several other studies (3, 9, 10, 13, 19, 24, 28),and higher than in some (4, 5, 18). Non-responderswere younger, more often married and living in thecommunity than participants and, therefore, the preva-lence of certain diagnoses may be somewhat overesti-mated for this population: they must be interpretedwith some caution. There were more community-livingpersons among non-responders also in other studies (5,17), but the non-responders were also older (17, 18),and a larger proportion of them were women (11, 33).The present study population had an even higher pro-portion of women (75%) compared with other sam-ples from Europe and the United States (9, 10, 12, 17,20, 21). The response rates in this study differ in ques-tions and scales. A larger proportion of the older agegroups and women were too ill or cognitively impairedto answer certain questions. We did not use certaincut-off scores on the MMSE when deciding what ques-tions, scales and ratings participants would respondto. It has previously been shown that the cognitively im-paired are able to rate both their quality of life andmorale (61, 62).

It is acknowledged that this study has certain limitations.First, three separate age groups selected from the pop-ulation 85 years and older were studied, with different se-lection criteria for each age group. Second, this article in-cludes multiple comparisons, and some significant dif-ferences might have occurred as a result. Also, somesignificant differences may be absent because of small sub-group sizes. Third, data collection was performed over aperiod of 18 months, and some eligible participants diedbefore they could be asked to participate.

The positive aspects of the long data collection periodwere that only six investigators collected all data, and theyfollowed a strict protocol during home visits. Duringhome visits, much effort was made to create an atmo-sphere in which participants felt comfortable and able toexpress their experiences and feelings. Participants withassessments indicating undiagnosed conditions were alsoeither further assessed by specialists in geriatric medicineor referred for further assessment and treatment. Otherstrengths of this study are that eligible participants wereasked to participate regardless of housing, cognitive lev-el, or chronic diagnoses.




CONCLUSIONSThis northern population seems to have very high

rates of hypertension, depression, hip fractures, andmany prescribed drugs compared with subjects in similarstudies from more southerly latitudes. There were largevariations in social, medical and functional variables with-in and between age and sex groups. In general, youngerparticipants had lower rates of diagnoses and prescribeddrugs, were less dependent in ADL and other functionalvariables than older participants, and men had lowerrates of diagnoses and reported symptoms than women.Despite many diagnoses, drugs and symptoms, as well asa high ADL dependency, the majority of the partici-pants rated their general health and morale as good.

ACKNOWLEDGEMENTSThis study was supported by grants from The Vårdal Research

Foundation, King Gustaf V and Queen Viktoria’s Foundation, LionsClubs International Swedish Research Foundation for Aging-related Dis-eases, The Research Foundation of the Faculty of Medicine andOdontology at Umeå University, The Borgerskapet of Umeå Re-search Foundation, the Detlof Research Foundation, the Gun andBertil Stohne Foundation, and Sigurd and Elsa Golje Memorial ResearchFoundation.

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Health status in the oldest old. Age and sex differences in the Umeå 85+ Study