Kirsten Avlund

OBJECTIVES: To examine whether tooth loss at age 70 is associated with fatigue in a nondisabled community‐dwelling population cross‐sectionally at age 70 and with onset of fatigue longitudinally at 5‐, 10‐, and 15‐year follow‐ups. SETTING: Community‐based population in Copenhagen. PARTICIPANTS: Five hundred seventy‐three nondisabled 70‐year‐old individuals in 1984. MEASUREMENTS: Data from interviews and a medical and oral examination. Oral health was measured according to number of teeth (0, 1–9, 10–19, ≥20). Fatigue was measured using the Avlund Mobility‐Tiredness Scale on six mobility activities. Covariates, all measured at baseline, were sex, education, income, comorbidity, and smoking. RESULTS: Bivariate logistic regression analyses showed significant cross‐sectional and longitudinal associations between number of teeth at age 70 and onset of fatigue at 5‐ and 10‐ but not 15‐year follow‐up. The associations between having no teeth and fatigue were attenuated when adjusted for socioeconomic position and smoking. CONCLUSION: Tooth loss is associated with onset of fatigue in old age, but the estimates are attenuated when adjusting for socioeconomic position and smoking. Tooth loss may be an early indicator of frailty.

The first professorship in gerontology at the University of Copenhagen has recently been established at the Department of Social Medicine, Institute of Public Health. The research in relation to this professorship will focus on studies of early signs of ageing, on the way different biological, social, mental and health factors in childhood, adolescence and early adulthood influence early signs of ageing in midlife, and on rehabilitation and prevention of disability in late life.

OBJECTIVES: To analyze whether inflammatory processes in the periodontium in early old age are related to subsequent mortality during 21 years of follow‐up in a nondisabled 70‐year‐old population. SETTING: Community‐based population in Copenhagen. DESIGN: The study was based on the Glostrup Aging Study of the 1914 population, with baseline in 1984 when the participants were 70 years old and follow‐up 21 years later. PARTICIPANTS: Three hundred thirty‐five dentate men and women participated in the clinical oral health examination. MEASUREMENTS: Severe periodontal inflammation was measured for all teeth present as the number of teeth with inflammation and periodontal pockets 6 mm deep or more. Mortality data were obtained from the Danish Death Register at 21‐year follow‐up. The Cox proportional hazards regression model was used. Covariates were measured at baseline and included number of teeth, caries, sex, education, income, hypertension, diabetes mellitus, osteoarthritis, arteriostenosis, myocardial infarction, comorbidity, fatigue, and ability to brush teeth. RESULTS: The analyses showed that severe periodontal inflammation in at least three teeth at age 70 was marginally related to mortality during 21‐year follow‐up (crude hazard ratio (HR)=1.17, 95% confidence interval (CI)=0.91–1.78). The estimate increased slightly when adjusted for sex, income, fatigue, and smoking (adjusted HR=1.37, 95% CI=0.97–1.92). The estimates were attenuated when adjusted for the specific diseases, especially arteriostenosis and osteoarthritis. CONCLUSION: Inflammation in the periodontium in early old age tends to be associated with mortality in older age.

The purpose was to analyze whether psychological characteristics and social relations in older men and women were related to accepting and receiving preventive home visits during 3 years, when offered as part of a national scheme. The study was based on secondary data from the Danish Intervention Study on Preventive Home Visits in 34 municipalities. The study population included 3,377 men and women who answered questions about psychological characteristics and social relations at baseline, survived and took part in the three year follow-up study. Number of preventive home visits was registered during 3 years in a specially designed software installed in the municipalities. Psychological characteristics were measured by questions on sadness, aggressiveness, life satisfaction, mood, loneliness and sense of coherence. Social relations were measured by questions on cohabitation status, diversity in social relations and social participation. Covariates included age and disability. Older men with poor psychological rating on most of the variables had larger odds ratios of accepting and receiving preventive home visits compared to older men with higher ratings. Older women with poor rating on the psychological characteristics and high social participation had larger odds of accepting and receiving preventive home visits, and women with a strong sense of coherence had larger odds of receiving many visits. It is concluded that psychological characteristics and social relations in older persons seem to influence whether they accept and receive preventive home visits, but patterns of associations are complex and vary for men and women.

The purpose was to analyse 1) whether fatigue is related to physical functioning and utilization of health services at one-year follow-up in a young and old sample and 2) to compare the results of two different measures of fatigue. The study is a longitudinal cohort study based on 182 young (age 20-35) and 199 older (age 70-85) community-dwelling individuals recruited from nine general practitioners in Aarhus, Denmark. Physical functioning was measured by the physical health scale from the SF-12-questionnaire. Data on health care utilization were extracted from the county's central register during one year. Fatigue was measured as Vitality-Tiredness by a question from the SF-12 questionnaire and Mobility-Tiredness by the Avlund Mobility-Tiredness Scale on fatigue in six daily activities. The predictive value of the two measures varied by the age of the participants. The Vitality-Tiredness Scale was related to the outcome measures in both samples, while the Mobility-Tiredness Scale was only predictive in the old population. In the young sample the associations were attenuated by the covariates, while the estimates in the old sample remained strong and significant in the adjusted analyses. Fatigue is related to subsequent physical functioning and use of health services at one year follow-up, both in young and old individuals.

A preventive home visitation scheme has been part of Danish legislation since 1996. The aim of this study was to describe functional trajectories of older home-dwelling people, and to identify whether education of the preventive home visitation staff and individual risk factors were related to specific functional decline patterns. The study is a secondary analysis of a population-based prospective controlled cohort study. Participation totalled 3,129 non-disabled 75- and 80-year-old men and women without mobility disability at baseline living in 34 municipalities. Self-reported functional ability was measured at baseline and after 1½, 3 and 4½ years follow-up. No functional decline was seen in 58% of the participants. A total of 17% developed catastrophic decline, 6% progressive and 7% showed a reversible decline pattern. The remaining 12% showed mixed patterns. Education of the preventive home visitation staff was associated with a reduced risk of progressive decline, RR = 0.66 (CI 95% 0.50–0.86, p = 0.002). Not receiving home visits and living alone were associated with increased risk of catastrophic decline. Younger age (75 at baseline) was less associated with all decline patterns compared with older age (80 at baseline). Men had less risk of developing progressive, reversible and mixed decline patterns than women, but an increased risk of developing catastrophic decline. A feasible educational preventive staff intervention was associated with a reduced risk of progressive functional decline but not with other functional decline patterns. Early signs of functional decline may serve as an important trigger for when to intensify the search for and actively seek to ameliorate preventable conditions.

The objective was to investigate whether a 3-year educational intervention towards primary health care professionals had effect on change in tiredness in daily activities during a 3-year intervention period in non-disabled older adults. The design was a controlled 3-year intervention study in 34 Danish municipalities with randomization and intervention at municipality level. The 17 intervention municipality visitors received regular education and general practitioners were introduced to a short assessment program. The effect was measured among old non-disabled individuals living in the municipalities by a validated scale on tiredness in daily activities at baseline and at the end of the intervention period. In total 2,515, 75- and 80-year-old men and women participated in all parts of the present study. Eighty-year-old non-disabled men and women who lived in the control municipalities had larger odds ratios of sustained tiredness during the 3-year intervention period compared with 80-year-olds living in intervention municipalities where both GPs and home visitors participated in the educational programme (OR = 3.48; 95% CI 1.51–8.00) and in intervention municipalities where only the home visitors (OR = 2.63; 95% CI 0.97–7.12) were educated. The intervention had no effect on stability and change in tiredness among the 75-year-old men and women. A brief, feasible educational intervention for primary care professionals has beneficial effect on changes in feelings of tiredness in non-disabled 80-year-old men and women.

The objectives were to investigate in older adults (1) whether regular preventive home visits are associated with change or stability in physical activity and (2) whether education of home visitors influences stability and change in physical activity. The design was a prospective controlled randomised follow-up study with randomization at municipality level (17 intervention and 17 control municipalities) and outcomes measured at individual level. Visitors in the intervention-municipalities received regular education during 3 years. The effect of the intervention was measured by a questionnaire survey among 1,913 old persons living in the 34 municipalities at baseline and 4½-year follow-up. Changes in physical activity were measured through self-reported frequencies of vigorous physical activity. All logistic regression analyses were stratified by sex and age group (75 and 80 years old). There was no effect of receiving preventive home visits on change in physical activity among the men and among the 75-year-old women. Among the physically active 80-year-old women those who accepted and received more than four preventive home visits were more likely to go on being physically active compared to women who did not receive preventive home visits. Among the sedentary 80-year-old women those living in the intervention municipalities tended to increase their physical activity compared to the control women. These results were not seen in the old men. Preventive home visits as part of daily routine in primary care and education of home visitors and general practitioners may promote physical activity in older women.

Aims: In controlled intervention studies, a selective non-response or refusal to participate at baseline may bias measurable effects of the intervention. The aim of this study was to compare mortality and nursing home admission among older persons who accepted (participants) and older person who declined (non-participants) to join a controlled feasibility trial, and to describe and evaluate defined subgroups of non-participants. Methods: Prospective controlled three-year intervention study (1999—2001) in 34 Danish municipalities with five-year follow-up. Randomization and intervention (education of municipality employees) was done at municipality level. In total 5,788 home-dwelling 75- and 80-year-olds living in these municipalities were invited to participate in the study. Written consent was obtained from 4,060 persons (participation rate 71%). Results: During five-year follow-up non-participants had a higher mortality rate (survival analysis risk ratio RR=1.5, 95% CI=1.3—1.7, p<0.0001) and a higher rate of nursing home admissions (RR=1.7, 95% CI=1.3— 2.1, p<0.0001) compared with participants. Subgroups of non-participants describing themselves as ``too ill'' and persons ``not reached'' had a significantly higher mortality rate and risk of admission to nursing home than participants, whereas the subgroups of non-participants describing themselves as ``too healthy'' and having ``another reason for refusal'' did not differ from the participants. There was no difference in mortality rates between non-participants living in intervention municipalities compared with non-participants living in control municipalities. Conclusions: Mortality and nursing home admissions were higher among non-participants. Selection participation bias was of no clinical importance since subgroups of non-participants eligible for the intervention did not differ from the participants.