Background: Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication. Objective: This paper examines frail older adults’ use of tablet computers and Skype, with their case managers.Method: Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data. Results: The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use. Conclusion: Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further. © 2015 Taylor & Francis

Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.

Objectives: This paper investigated factors associated with internet usage in the Swedish older adults ranging in age from 60 to 96. Personality traits and individual characteristics have been previously noted to influence internet usage, where older adults have not been the focus population. In this study the relationships between personality, individual characteristics and internet usage were investigated. Methods: A descriptive analysis of the personality tests of a total of 1402 subjects included in the Swedish National Study on Aging and Care (SNAC) was conducted. Three variables were controlled for: sex, age and education. Descriptive statistics, Mann-Whitney and Kruskal-Wallis tests, chi square tests and a logistic regression were used in order to detect the relationships with internet usage. Results: Men differ significantly from women in the personality traits analysis. Those with higher education were more open and neuroticism was lower in the oldest older adults. Internet usage declined significantly with age and those with middle to higher education were using the internet the most. No other associations with internet use were found Conclusion: Personality traits and individual characteristics do not seem to influence the Swedish older adult and their internet usage. What one needs to account for is the age and education of the person. The more educated and the youngest cohorts were using the internet more frequently.

The increased reliance on Internet use in social functions has presumably left out a part of the population: the oldest-older adults. These are people who have not kept themselves up to date with the technological developments for various reasons. There are, however, exceptions from whom we have something to learn. This study investigates the older people in Sweden who started to use the Internet over a period of 6 years. Cognition, extraversion, openness, functional disability, household economy, sex, age and education were investigated in relation to starting to use the Internet. A chi-square test, Spearman correlation and a logistic regression analysis were conducted. It was found that higher cognition, being male and being between the ages of 60 and 80 years were determining factors in starting to use the Internet for the Swedish older adult. Our results indicate that the oldest-older adults are slow to adapt to using the Internet and more attention should be paid on how to support this group.

Background: Few studies have compared the impact of different familial losses on life satisfaction (LS). Furthermore, there is a lack of research on the effect of having lost both a child and a spouse among older adults. Sample: A random sample of 1402 individuals, 817 women and 585 men, aged 60–96 years from the Blekinge part of the Swedish National Study of Aging and Care (SNAC-B) participated in this cross-sectional study. Aims: The first aim was to compare the effects of child or spouse or both child and spouse bereavement on LS and, the second aim, to investigate if there were gender differences within the bereaved groups. Results: The results showed that having lost a child, spouse or both child and spouse had a negative association with LS, although this effect was small. Having experienced multiple losses did not predict more variance than a single child or spouse loss. Gender differences were found within all the bereaved groups with bereaved men having lower LS than bereaved women. Longer time since the loss was associated with higher LS. Conclusions: Bereaved older adults have somewhat lower LS than non-bereaved and bereaved men seem more affected than bereaved women. Future research needs to address older menÂŽs experiences after the loss of a loved one. © 2016 Taylor & Francis

Losing a child or a spouse is described as the worst of experiences. However, it is not known whether older adults bereaved of a child, spouse, or both child and spouse experience these losses as among the most important negative events in their lifetime. The aim of this study was to investigate whether the 1,437 older adults bereaved of a child, spouse, or both included in the southern part of the Swedish National Study of Aging and Care mentioned these losses when asked about their three most important negative life events. Gender differences in their choices of important negative life events were also explored. About 70% of those bereaved of a child or a spouse mentioned these losses as among their three most important negative life experiences. In the child-and-spouse-bereaved group, 48% mentioned both the loss of their child and spouse, while 40% mentioned either the loss of a child or a spouse. Gender differences were only found in the child-and-spouse-bereaved group, with a few more women mentioning the loss of the child but not the spouse, and the men showing the opposite pattern. © The Author(s) 2016.

In the last decades, extensive research efforts have been directed at exploring life satisfaction in old age, and the Life Satisfaction Index A (LSIA) scale, developed by Neugarten et al. in the 1960s, is one of the most commonly used instruments. However, studies have focused on predicting and comparing changes in people's life satisfaction without testing if the LSIA instrument is equally valid for different subgroups of people. The present study investigated the underlying dimensions of the LSIA in a Swedish population (n = 1402) of people 60-96 years of age. The study also examined factorial invariance across age, gender, functional ability and depression during a six-year period. The results showed that while a five-factor solution of the LSIA did not exhibit an acceptable fit to the data, a three-factor solution did show a close fit. The two three-factor models that demonstrated the best fit showed invariance across gender and across time, but noninvariance across groups with different levels of reduced functional ability, depressive symptoms and age. These findings suggest that the psychometric properties of life satisfaction instruments like the LSIA need to be taken into consideration before drawing conclusions about life satisfaction when comparing older people of different ages and with different depression and function levels.

Several studies have shown connections between personality and various kinds of behavioural and psychological symptoms in dementia. It has for example been found that personality traits such as introversion, rigidity, and a tendency to suppress emotions, as remembered retrospectively by a close family member, correlated positively with disturbed communicative behaviors in people with severe dementia. This finding indicates that personality characteristics should be considered in nursing care because they may help a caregiver to understand communicative attempts from a person not able to speak for themselves, i.e. express their feelings. Information from a next of kin about a sick person’s personality may help to bridge communicative gaps in care situations. However, the reliability of such information is not known. The aim of the present study was to evaluate the inter-rater agreement between healthy elderly people`s self-assessment and the assessment made by a next of kin concerning personality and Sense of Coherence (SOC). The participants (n=154) answered questions from the Eysenck personality scale and the Antonovsky SOC scale. The study shows high or moderate agreement in ratings when analysed by means of an intra-class correlation coefficient (range between r =.57 and r = .72) indicating that in general a close relative is able to report on the personality of a next of kin. The inter-rater agreement was high on SOC and Extraversion and somewhat lower on Neuroticism. For Neuroticism, length of time of relationship increased the odds for a good inter-rater agreement. Thus seemingly a next of kin is a reliable informant for the elderly in general and is probably also able to add information useful in the nursing care of people with a severe dementia disease.

Nurses sometimes fail to understand the behaviour of individuals with severe dementia. Information from a next of kin may help to bridge this communicative gap. One factor that influences a person’s reaction to a disease is their personality and ability to cope with stress. The aim of this study was to evaluate the inter-rater agreement between healthy elderly people’s self-assessment and the assessment made by a next of kin concerning personality and sense of coherence. The participants (n¼154) answered questions from the Eysenck Personality Inventory (EPI) and the Antonovsky Sense of Coherence (SOC) scale. The study shows high or moderate agreement in ratings when analysed by means of an intra-class correlation coefficient (range between r¼.57 and r¼.72) and the results indicate that in general a close relative is able to report on the personality of a next of kin. The inter-rater agreement was high on SOC and extraversion and somewhat lower on neuroticism. For neuroticism, length of time in the relationship increased the odds for a good inter-rater agreement. Thus, seemingly a next of kin is a reliable informant for the elderly in general and is probably also able to add information useful in the nursing care of people with dementia.

BACKGROUND AND AIMS: A large, national, long-term, longitudinal, multi-purpose study has been launched in Sweden--the Swedish National study on Aging and Care (SNAC). The study involves four research centers collecting data in four different areas of Sweden. METHODS: The study consists of two parts: the population part and the care and services part. In the population part, a large, representative panel of elders in different age cohorts is followed over time to record and describe the aging process from different aspects. In the care and services part, a systematic, longitudinal, individually-based collection of data is performed concerning provision of care and services together with functional ability, specific health care problems, and living conditions of the recipients living in the area. RESULTS: The data collection in the population part of the SNAC is not yet completed. In the present article, some preliminary results are reported from the care and services part. These pertain to comparisons between the participating areas with respect to the prevalence of disability among those receiving care and social services in their ordinary homes and those receiving care in special accommodation. A comparison is also presented with regard to the amount of home help provided to subjects with a given disability. CONCLUSIONS: This project has several advantages. It is expected to generate a rich data base relevant for future research on aging and care and to have a direct impact on the future Swedish system of care and services for the elderly.

This study investigated the relationship between light and strenuous exercise and depression, as well as gender differences in this relationship, in a representative sample of 860 elderly Swedish suburb-dwelling men and women in age cohorts from 60 to 96 years, drawn from among participants in the Swedish National Aging and Care study. The relationship between depression and self-reported changes in exercise status over time was also examined. Exercise activities were measured with four survey questions, and depression, with the Montgomery Asberg Depression Rating Scale. The inactive elderly had higher depression scores than more active individuals, both in terms of light and strenuous exercise. The continuously active group had lower depression scores than both continuously inactive individuals and individuals reporting a shift from activity to inactivity during the preceding year. Light exercise had a somewhat stronger effect on depression for women.

Aims: The age of retirement has financial implications as we tend to live longer, with the result that an increasing number of older inhabitants have to share limited financial resources. However, this is not only a financial issue. It is also of interest to investigate factors related to health and quality of life associated with the age of retirement. The aim of this study was to investigate changes in mood, activity level, and cognition at the age of 66 associated with leaving working life before 60. Methods: Baseline and follow-up data on 840 participants of the Swedish National Study on Aging and Care - Blekinge was used. Mood was measured by the Montgomery-sberg Depression Scale and activity level by 27 survey items. Cognition was measured by the Mini Mental State Examination. Results: Retirement before 60 years of age was not associated with lower cognitive functions and a higher score on depression at baseline, but retirees were less active. Six years later, at the age of 66, a decline in their cognition was found. Retirees were still not more depressed but less active. In a logistic regression analysis, being retired increased the odds ratio for cognitive decline by 1.36-times (OR 2.36) when gender, activity level, education level, and depression were adjusted for. Conclusions: Participants who retired before the age of 60 declined in cognitive ability over the 6-year study period.

Social networks may affect old people's health behaviours, such as their subjective health evaluations, health care utilization and symptom reporting. In the study, the relationships between social network characteristics and health behaviors were investigated for each gender separately. lt was assumed that the relationships differ between the genders and that female health behavior would be more strongly related to the social network. Social network characteristics, reported symptoms, subjective health and health care utilization were assessed for 107 men and 77 women that were 71 years of age. The results showed that, for women, a general satisfaction with the social network was associated with good subjective health. In addition, satisfaction with social participation and social anchorage were associated with a high frequency of health care utilization. For men, none of these health-related behaviors were bivariately associated with the social network. Furthermore, for women, the frequency of reported symptoms were more often associated with social network characteristics. Multivariate analyses showed that for women, dissatisfaction with social participation and support from the neighborhood predicted stomach symptoms. For men, dissatisfaction with instrumental support and contact with children predicted tension symptoms. This study suggests that health behaviour relates both to social network and gender.

People aged 60 or more are the most frequent users of healthcare services. In this age range, however, both frequent and infrequent users can be found. Frequent users have high rates of illnesses. Previous research has found that the frequency may be influenced also by psychological and social factors. The aim of this study was to investigate to what degree such factors add to the explanation of differences in number of visits to a physician. A crosssectional study was conducted with a random sample consisting of 1017 individuals, aged 60 to 78 years, from the Blekinge part of the Swedish National Study on Aging and Care database. The data were collected during 2001 to 2003. Hierarchical logistic regression analyses were used with frequent (three visits or more during a year) and infrequent use as a dichotomous dependent variable. The final statistical analyses included 643 individuals (63% of the sample). Independent variables were sense of coherence (SOC), internal locus of control, education level and social anchorage. Control variables were age, gender, functional ability and comorbidity. The results showed that comorbidity was most strongly related to frequent use [adjusted odds ratio (OR) = 8.17, 95% confidence interval (CI) 5.54–12.04]. In addition, SOC and internal locus of control had small, but significant effects on the odds of being a frequent user (adjusted OR = 1.03, 95% CI 1.00–1.06 and adjusted OR = 1.14, 95% CI 1.02–1.27, espectively). The lower the SOC and the internal locus of control were, the higher were the odds of frequent use. Education level and social anchorage were unrelated to frequency of use. The results indicate that frequent healthcare services users are more ill than infrequent users. Psychological factors influence the use only marginally, and social factors as well as age and gender are not by themselves reason for frequent healthcare services use.

Objectives: The aim of the present study was to investigate the relationships of different types of quality of life to strenuous and light physical activity in old age. Methods: The Swedish SNAC-Blekinge baseline database, consisting of data on 585 men and 817 women 60-96 years of age, was utilized. The independent variables were light and strenuous physical activity. Four dependent variables concerned with various quality of life components were employed (well-being, engagement, emotional support and social anchorage). Age, gender, functional ability and co-morbidity were included as possible confounders. Non-parametric bivariate and multivariate statistical tests were performed. Results: Correlations suggested there to generally be a positive relationship between physical activity and quality of life. Multivariate logistic regression analyses controlling for possible confounders showed light physical activity to increase the odds of experiencing well-being, engagement and social anchorage, whereas strenuous physical activity increased the odds of experiencing engagement and emotional support. Thus, light physical activity and strenuous physical activity differed in their relation to quality of life generally. Conclusions: The results indicate that physical activity has a salutogenic effect by enhancing the quality of life, and it can be assumed to be connected to quality of life by generating pleasure and relaxation.

Background: Personality has been shown to be related to numerous health-related factors. In the SNAC-B study, relationships between health variables and the personality traits of neuroticism (N), conscientiousness (C), agreeableness (A), openness (O), and extraversion (E) have been investigated. Aim: In this chapter, stability and change of personality during the ages of 60 to 90 years are explored. In addition, relationships between personality traits and health-related variables are presented. Methods: The results are based on data from the SNAC-B studies of 1402 men and women aged 60 to 90. The participants have been followed up during 12 years, while data on health, well-being, and autonomy have been continuously collected. In addition, variables assumed to influence health have been collected, such as lifestyles, demographic factors, social environment, and personality. Results: The results show personality to be stable over time according to rank order, but all personality traits except neuroticism were shown to have small but significant mean level changes. In addition, connections between a number of health-related variables and personality traits, such as mortality, self-care, work ability, and perception of pain, were indicated. Conclusions: The results indicate that the role of personality should be taken into account in research on health and aging. Personality traits have a lifelong influence on health behaviors and have been shown to affect both subjective and objective aspects of health and the way we cope with health-related experiences.

Background and aims The influence of pain as well as Quality of Life (QoL) varies in accordance with biological, social, psychological and existential factors. This study investigates the influence of such factors on the relationship between pain and QoL among older adults from a gender perspective. Methods The Swedish National Study on Aging and Care (SNAC-Blekinge) baseline sample comprised 1402 individuals aged 60–96 years, of whom 769 (55%) reported pain. The participants were invited by a letter to take part in the study, which was carried out by research staff in two sessions of three hour each. Participants gave informed consent and completed a questionnaire between the two sessions. The reason for non-participation was registered among subjects who declined the invitation. Pain and insomnia were self-reported. Data on age, gender and if living alone or not were collected from the questionnaire. Co-morbidity was obtained from electronic patients records for a period of up to two years prior to participating in the SNAC study. SoC was measured by a translated short form from the original twenty-nine question instrument. QoL, was estimated using the HRQL Medical Outcome Study-Short Form (SF 12). In a model, pain, age, sex, insomnia, co-morbidity, living alone, sense of coherence (SOC), household economy, education and QoL were calculated through multivariate logistic regression. Results Among women, pain was found to have the highest OR (odds ratio) for low QoL [OR 2.27 (CI 1.36–3.78)], followed by low economic status [OR 1.75 (CI 1.08–2.84)], co-morbidity [OR 1.24 (CI 1.05–1.46)], low SOC [OR 1.08 (CI 1.06–1.10)] and lower age [OR 1.05 (CI 1.02–1.08)]. In men, insomnia was found to be the main contributor to low QoL [OR 1.86 (CI 1.04–3.33)], followed by low SOC [OR 1.08 (CI 1.05–1.11)] and lower age [OR 1.04 (CI 1.01–1.07)]. Conclusions Pain has a strong relationship with low QoL among elderly women. Insomnia is associated with low QoL among men who suffer less from pain. Thus the main result is a striking gender difference: Elderly women suffer from pain, elderly men suffer from insomnia. Implications It is important to take account of sex, age, sleep problems, co-morbidity, SOC and economic status in order to understand the relationship between pain and QoL among older adults.