Anna-Karin Welmer

Background: The patterns and determinants of late-life functional decline are not fully understood. We examined disability trajectories in relation to proximity to death among decedents aged 70 years and older and investigated their associations with sex, age at death, education, cognitive impairment, and chronic conditions. Methods: Harmonized data from six Swedish longitudinal aging studies (1997-2016) within the National E-infrastructure for Aging Research (NEAR) were used. Participants who died at age 70 years or older and had data on activities of daily living (ADL) from at least two assessments were included (N = 2294, 62% women, mean age at death 89.8 years [SD 6.5]). ADL limitations (0-5 scale) were analyzed across four time intervals before death (0-2, >2-4, >4-6, and 6-12 years). Group-based trajectory modelling identified disability trajectories, multinomial logistic regression examined demographic associations, and generalized estimating equations assessed associations of cognitive impairment and chronic conditions with trajectory membership. Results: Three trajectories were identified: constantly low (53%), low-sharply increasing (36%), and high-increasing (11%). Women, those with lower education, and individuals dying at older ages were more likely to follow increasing or persistently high disability trajectories. A high-increasing trajectory was associated with a higher likelihood of cognitive impairment. Conclusions: For most, ADL limitations remained low until the final two years of life, though distinct trajectories with steady or sharp increases also emerged. Identifying demographic and health-related factors associated with functional decline may inform targeted interventions and help anticipate care needs.

Background: Gait speed (GS) has been suggested as a predictor of incident dementia in old age. However, the mechanisms underlying this body–mind connection remain unclear, and it is still unknown whether trajectories of GS decline differ according to levels of blood biomarkers related to Alzheimer's disease ( AD ). This study aims to investigate the association between levels of seven blood biomarkers related to AD and long‐term GS changes in dementia‐free older adults living in the community. Methods: The present study included 1665 community‐dwelling adults ≥ 60 years, followed for 15 years, drawn from the Swedish National study on Aging and Care in Kungsholmen (SNAC‐K). GS (m·s ⁻¹ ) was assessed at baseline and at five subsequent follow‐up time points. Blood biomarkers, including serum amyloid‐ β 42 to amyloid‐ β 40 ratio (A β 42/40), phosphorylated Tau181 ( p ‐Tau181) and Tau217 ( p ‐Tau217), total Tau ( t ‐Tau), neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP), were collected from peripheral venous blood samples at baseline. Linear mixed‐effects models were implemented to investigate the association between blood biomarkers and GS changes over time. Results: After adjusting for potential confounders, participants in the highest quartile of p ‐Tau181 (Model I; 4th quartile β : −0.008, 95% CI: −0.013; −0.003), p ‐Tau217 (Model I; 4th quartile β : −0.010, 95% CI: −0.015; −0.005), NfL (Model I; 4th quartile β : −0.013, 95% CI: −0.019; −0.006) and GFAP (Model I; 4th quartile β : −0.007, 95% CI: −0.013; −0.002) exhibited a steeper decline in GS over time, as compared with those in the lowest quartile. Notably, participants in these highest quartiles developed mobility limitations (GS < 0.8 m·s ⁻¹ ), on average, 2.3 to 6.0 years earlier. Of note, only the association between NfL and GS changes over time persisted after further adjusting for time‐varying global cognition. Conclusions: Higher blood biomarker levels of AD are associated with accelerated trajectories of GS decline and earlier onset of mobility limitations. Consequently, a faster decline in GS may reflect underlying neurodegeneration and indicate changes in brain health.

Purpose: Older adults hospitalised for acute illness are highly vulnerable to functional decline, often exacerbated by inactivity. Although exercise interventions may reduce this risk, uncertainty remains regarding how such programmes should be designed and tailored for frail patients. Embedded within the PREV_FUNC randomized controlled trial, this study explored older patients’ experiences of two in-hospital exercise programmes. Methods: This qualitative study was conducted at a geriatric hospital in Stockholm, Sweden. Using an inductive approach within a constructivist paradigm, semi-structured interviews were conducted with 24 patients aged ≥ 75 years who had participated in either a comprehensive or a simple exercise programme. Data were analysed inductively using reflexive thematic analysis. Results: One overarching theme emerged: Structured exercise disrupted inactivity and sparked hope for a turning point. This theme comprised four subthemes: Exercise awakens hope for improvement; Getting out of bed can be challenging; Overall confidence in structured exercise; and Support from the physiotherapist is crucial. Conclusion: From the patients’ perspective, the exercise programmes helped break periods of inactivity and fostered hope for recovery. These findings suggest that in-hospital exercise may support physical activity in geriatric wards, although individual adaptation and support remain essential.

Background: While pain has been widely studied in relation to physical activity (PA), less is known about how habitual patterns of activity relate to pain in older adults. This study examined associations between pain characteristics and activity patterns in older adults, and whether these associations differ by age and sex. Methods: Cross-sectional data from 665 older adults in the Swedish National Study on Aging and Care–Kungsholmen (SNAC-K, 2016–2019) were analysed. PA and sedentary behaviour were measured using the activPAL3™ accelerometer, and pain characteristics were collected via questionnaires. Latent Class Analysis identified three activity classes (named Active- , Balanced and Sedentary Movers ) based on steps/day, sedentary time- and bout duration, light PA, moderate-to-vigorous PA, and number of light-/moderate-to-vigorous PA events. Multinomial logistic regression assessed associations between activity classes and pain, testing modification by age and sex. Results: In the total sample, higher pain intensity was associated with membership in the Sedentary Movers class (RRR: 2.16, 95% CI: 1.06, 4.40, p = 0.034), characterised by low PA and predominant sedentary behaviour, compared with the Active Movers (reference), characterised by high activity levels with substantial light- and moderate-to-vigorous PA. The interaction analysis displayed that associations were concentrated in women and the oldest-old (≥ 80 years). No significant associations were observed for pain and the Balanced Movers vs. Active Movers classes. Conclusion: Activity patterns characterised by high sedentary behaviour were associated with specific pain characteristics in older adults, particularly among women and the oldest-old. Longitudinal studies are needed to clarify the direction of these associations.

Background: As populations age rapidly, understanding the factors influencing healthy aging is essential. This study explores older adults’ perceptions of healthy aging to broaden perspectives and contextualize the concept within the World Health Organization (WHO) Healthy Ageing Framework. Methods: Thirty-four participants aged ≥ 60 years from the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were interviewed through seven semi-structured qualitative focus groups between December 2023–January 2024. Discussions focused on participants’ perspectives on healthy aging, including factors that facilitate or hinder their ability to age as they desire. Data were analyzed using reflexive thematic analysis. Results: Two overarching themes were identified: “Inner power through vitality and motivation” and “A sense of being needed and having one’s needs met.” Participants emphasized the importance of maintaining autonomy, adapting to life transitions, fostering social connections, and navigating societal structures that impact healthy aging. Conclusions: The findings largely align with the WHO Healthy Ageing Framework, reinforcing the significance of social support, continuous care, and autonomy. By highlighting the importance of an individual’s social and physical environment on their health, this study contributes to an often-overlooked perspective acknowledged by the WHO Healthy Ageing Framework. Participants’ concerns about the current and long-term capacity of the welfare system underscore the urgent need for targeted policy interventions to support the rapidly growing older population. Additionally, the findings emphasize the need to promote equal opportunities among older adults, as those in good health can leverage their inner motivation to build and lead meaningful lives.

Background The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was the first to show that multidomain lifestyle interventions can enhance brain health and reduce cognitive decline. However, the clinical effectiveness and delivery of the FINGER model within primary care settings remain unexplored. This paper presents the protocol for the STRONGER 60+trial, which aims to evaluate both the clinical effectiveness and real-world delivery of an adapted FINGER-based intervention in primary care. Methods and analysis This 6-month randomised controlled clinical effectiveness trial will be conducted in primary care and will include adults aged 60 and older with vascular or lifestyle-related risk factors for dementia. A total of 80 participants will be randomised to either a structured, supervised multidomain lifestyle intervention or a self-guided version of the same programme. The intervention includes nutritional guidance, physical exercise, cognitive training, social engagement and management of vascular and metabolic risk factors. Data will be collected at baseline, 6 months (primary endpoint) and 12 months post-randomisation. The primary outcome is the change in a composite healthy lifestyle score at 6 months. In addition, the study will explore delivery processes and stakeholder (participant and healthcare professional) perspectives using both qualitative and quantitative methods. Ethics and dissemination The study has been approved by the Swedish Ethical Review Authority (approval numbers: 2020–05785, 2021–06413-02, 2022–05454-02) and will follow the principles of the Declaration of Helsinki. Ethical procedures for informed consent, confidentiality and data management will be strictly observed. Results will be disseminated through scientific publications, conferences and targeted outreach to healthcare professionals and the general public. Trial registration number NCT07117916.

Background and Objectives: Cognitive and functional impairments can both influence and result from deteriorating social health (SH), yet their interplay during aging remains poorly understood. This study investigated the concordance and discordance of trajectories in SH, cognitive, and daily functioning. Research Design and Methods: We analyzed 15-year follow-up data (2001–2015) from 2,848 initially dementia-free older adults in the Swedish National study on Aging and Care in Kungsholmen. Cognition and daily functioning were assessed with the Mini-Mental State Examination and activities of daily living (ADLs)/instrumental ADLs. SH encompassed indices of social participation, connections, and support. Trajectories across these five dimensions were identified using latent growth curve analyses, latent class growth analyses, and growth mixture models. Results: Two cognitive trajectories—relatively preserved (91%) and fast decline (9%)—and two daily functioning trajectories—stable (95%) and declining (5%)—were identified. SH trajectories included stable groups, gradually declining social participation (70%), and low initial social connections (29%). Social support showed stable (95%), declining (2%), and increasing (3%) trajectories. Women were more likely to belong to the initially low-stable social connections group, whereas higher education was linked to favorable trajectories across most dimensions but not social support. Concordance was observed among those with the lowest cognitive, daily functioning, and SH profiles. Notably, increasing social support was linked to low cognition but high daily functioning (odds ratios [OR] = 4.2, 95% CI: 2.3, 7.6). Discussion and Implications: Findings underscore the central role of SH in aging, particularly how dynamic changes in social participation, connections, and support relate to cognitive and functional outcomes.

Aims: Moderate-to-vigorous physical activity (MVPA) protects against cardiovascular disease (CVD), but less is known about how different physical activity (PA) patterns influence CVD risk. This study examined these associations considering age-related differences. Methods and results: Data from 423 CVD-free participants from the Swedish SNAC-K study were analyzed. Accelerometer data was collected from 2016 to 2019, and CVD events (fatal and non-fatal) over an 8-year period were obtained from national registers. Cox regression models were employed to assess associations between PA patterns—including steps per day, sit-to-stand transitions, daily time in light PA (LPA) and MVPA, and walking events (i.e. daily number of LPA or MVPA walking bouts)—and CVD risk. Cubic splines evaluated non-linear relationships, and interactions between PA and age-group (=66 vs. ≥80 years) were explored. Over a mean follow-up period of 5.6 years, 125 participants (30%) experienced at least one CVD event. In the total sample, each additional 10 MVPA walking events reduced CVD risk (HR 0.90, 95% CI: 0.82–0.98, P = 0.019). Among the oldest-old, each additional 100 LPA walking events (HR 0.61, 95% CI: 0.39–0.95, P = 0.027) and each additional 10 MVPA walking events (HR 0.87, 95% CI: 0.76–0.98, P = 0.024) reduced CVD risk. No clear associations were observed in younger-old adults. Conclusion: In this cohort of generally well-functioning older adults, frequent daily engagement in MVPA was associated with a reduced risk of incident CVD. Among the oldest-old, recurrent participation in both LPA and MVPA was linked to lower CVD risk, highlighting the importance of frequent daily PA.

Objective: During the COVID-19 pandemic, universities quickly transitioned from campus-based to online education. However, there is limited insight into how faculty members experienced this transition, particularly in doctoral courses where active student engagement is crucial. This study aimed to explore faculty members’ experiences in promoting active student engagement in online doctoral courses during the COVID-19 pandemic.Methods: A qualitative, inductive approach with a descriptive design was used. Eleven faculty members (3 men and 8 women, median age 51) who served as course leaders in doctoral courses during the pandemic were interviewed. The interviews were recorded, transcribed and analyzed according to reflexive thematic analysis.Results: The analysis generated four themes, Facilitating student learning through flexibility and time for reflection, Using social interaction as a catalyst for learning, Enabling student interaction through a safe and structured online environment, and Engaging in digital tools to create variation and engagement.Conclusion: Our results suggest that the shift to online education during the pandemic accelerated the development of online doctoral courses, driven by adjustments prioritizing social interaction, self-directed learning, and digital tools. However, challenges such as increased cognitive demands and the added effort required by faculty to foster engagement were also identified.